title: Experience in managing an urban massive burn incident: The Hangzhou bus attack on 5 July 2014.
abstract: BACKGROUND
  On 5 July 2014, a suicide terrorist set a crowded bus on fire in Hangzhou, injuring 33 passengers. Among these, 19 adult victims with the most severe burns were triaged to our center. This is a single-center, descriptive study recording the prehospital response and in-hospital treatment of these patients.
  
  
  METHODS
  Information on the attack, on-scene rescue, and patient triage was collected from public media, governmental, and hospital reports. Information on patient injury and our in-hospital procedures was collected from the emergency registry and patient records.
  
  
  RESULTS
  Of the 80 passengers in the burning bus, 33 were injured. The total burn surface area (TBSA) of the 19 most severely injured patients triaged to our hospital ranged from 25% to 95% (mean 48.3 ± 2.08%). Two patients had a TBSA of >90% (92% and 95%) and eight had a TBSA of >60%. Nineteen cases of inhalation injury were diagnosed, eight of which were severe. The emergency center performed 14 bedside escharotomies, 14 central venous catheter (CVC) implantations, and one cardiopulmonary resuscitation (CPR). Approximately 131000 ml of resuscitation fluid was infused within the first 24h and 111000 ml within the second; further, 160230 ml of plasma and 4100 ml of red blood cells were infused during the antishock stage. All victims were transported to the burn ward to receive burn-centered multidisciplinary care. The respiratory team conducted 121 bronchoscopies. A total of 89 operations were performed, and the residual wound area decreased dramatically. After 124 days of extensive therapy, complete wound healing was observed and all patients entered the rehabilitation stage.
  
  
  CONCLUSIONS
  Adequate preparation, including planning and disaster drills, is crucial for handling mass casualty events. Efficient and precise first rescue and triage can reduce prehospital mortality, and burn-centered multidisciplinary care and hospital-government cooperation helps reduce in-hospital mortality. Nevertheless, lessons can be drawn from this incident to be better prepared for future disasters.
authors.affiliation: Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhejiang 310009, PR China.
authors.forename: Hu
authors.initials: H
authors.lastname: Hang
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou 310009, PR China.
authors.forename: Wang
authors.initials: W
authors.lastname: Jianan
authors.affiliation: Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhejiang 310009, PR China. Electronic address: hanchunmao1@126.com.
authors.forename: Han
authors.initials: H
authors.lastname: Chunmao
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000628:therapy*; D002681:China; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005390:Fires; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D015208:Smoke Inhalation Injury / Q000628:therapy; D023481:Terrorism; D014218:Triage / Q000379:methods*; D014505:Urban Population
keywords: Bus fire attack; Disaster planning; Massive burn casualty