title: Mass chemical casualties: treatment of 41 patients with burns by anhydrous ammonia.
abstract: BACKGROUND
  This article reports a chemical burn incident that occurred on 31 August 2013 in Shanghai. We describe situations at the scene, emergency management, triage, evacuation, and follow-up of the victims.
  
  
  METHODS
  The scene of the incident and information on the 41 victims of this industrial chemical incident were investigated. The emergency management, triage, evacuation, and hospitalization data of the patients were summarized.
  
  
  RESULTS
  At the time of the incident, 58 employees were working in a closed refrigerator workshop, 41 of whom sustained burns following the leakage of anhydrous ammonia. Ten victims died of severe inhalation injury at the scene, and another five victims died during the process of evacuation to the nearest hospital. After receiving information on the incident, a contingency plan for the burn disaster was launched immediately, and a first-aid group and an emergency and triage group were dispatched by the Changhai Hospital to the scene to aid the medical organization, emergency management, triage, and evacuation. All casualties were first rushed to the nearest hospital by ambulance. The six most serious patients with inhalation injuries were evacuated to the Changhai Hospital and admitted to the burn intensive care unit (BICU) for further treatment, one of whom died of respiratory failure and pulmonary infection.
  
  
  CONCLUSIONS
  This mass casualty incident of anhydrous ammonia leakage caused potential devastating effects to the society, especially to the victims and their families. Early first-aid organization, emergency management, triage, and evacuation were of paramount importance, especially rapid evaluation of the severity of inhalation injury, and subsequent corresponding medical treatment. The prognosis of ammonia burns was poor and the sequelae were severe. Management and treatment lessons were drawn from this mass casualty chemical burn incident.
authors.affiliation: Department of Burn Surgery, the Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Burn Surgery, the Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China.
authors.forename: Xing-Feng
authors.initials: XF
authors.lastname: Zheng
authors.affiliation: Department of Burn Surgery, the Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Ma
authors.affiliation: Department of Burn Surgery, the Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Fan
authors.affiliation: Department of Burn Surgery, the Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China. Electronic address: southeast000@163.com.
authors.forename: Guang-Yi
authors.initials: GY
authors.lastname: Wang
authors.affiliation: Department of Burn Surgery, the Second Military Medical University Affiliated Changhai Hospital, Shanghai 200433, China. Electronic address: xiazhaofan_smmu@163.com.
authors.forename: Zhao-Fan
authors.initials: ZF
authors.lastname: Xia
mesh_terms: D000062:Accidents, Occupational; D000328:Adult; D000641:Ammonia / Q000506:poisoning*; D002053:Burn Units / Q000458:organization & administration*; D002057:Burns, Chemical / Q000209:etiology*; D002059:Burns, Inhalation / Q000209:etiology*; D002681:China; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005392:First Aid; D006761:Hospitals; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D008875:Middle Aged; D012189:Retrospective Studies; D014218:Triage / Q000458:organization & administration*; D055815:Young Adult
chemical_list: D000641:Ammonia
keywords: Ammonia burns; Emergency management; Evacuation; Inhalation injury; Triage