title: Human survival in volcanic eruptions: Thermal injuries in pyroclastic surges, their causes, prognosis and emergency management.
abstract: This study of burns patients from two eruptions of Merapi volcano, Java, in 1994 and 2010, is the first detailed analysis to be reported of thermal injuries in a large series of hospitalised victims of pyroclastic surges, one of the most devastating phenomena in explosive eruptions. Emergency planners in volcanic crises in populated areas have to integrate the health sector into disaster management and be aware of the nature of the surge impacts and the types of burns victims to be expected in a worst scenario, potentially in numbers and in severity that would overwhelm normal treatment facilities. In our series, 106 patients from the two eruptions were treated in the same major hospital in Yogyakarta and a third of these survived. Seventy-eight per cent were admitted with over 40% TBSA (total body surface area) burns and around 80% of patients were suspected of having at least some degree of inhalation injury as well. Thirty five patients suffered over 80% TBSA burns and only one of these survived. Crucially, 45% of patients were in the 40-79% TBSA range, with most suspected of suffering from inhalation injury, for whom survival was most dependent on the hospital treatment they received. After reviewing the evidence from recent major eruptions and outlining the thermal hazards of surges, we relate the type and severity of the injuries of these patients to the temperatures and dynamics of the pyroclastic surges, as derived from the environmental impacts and associated eruption processes evaluated in our field surveys and interviews conducted by our multi-disciplinary team. Effective warnings, adequate evacuation measures, and political will are all essential in volcanic crises in populated areas to prevent future catastrophes on this scale.
authors.affiliation: Institute of Public Health, University of Cambridge, UK. Electronic address: pjb21@medshl.cam.ac.uk.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Baxter
authors.affiliation: Department of Earth Sciences, University of Bristol, UK.
authors.forename: Susanna
authors.initials: S
authors.lastname: Jenkins
authors.affiliation: Burn Unit, Dr Sardjito General Hospital, University of Gadjah Mada, Yogyakarta, Indonesia.
authors.forename: Rosadi
authors.initials: R
authors.lastname: Seswandhana
authors.affiliation: Institut de Physique du Globe de Paris, CNRS UMR 7154, Université Sorbonne Paris Cité, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Komorowski
authors.affiliation: Burn Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Dunn
authors.affiliation: Hartford Environmental Research, Hatfield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Purser
authors.affiliation: Department of Geosciences, Penn State University, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Voight
authors.affiliation: Department of Geosciences, Penn State University, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Shelley
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D004189:Disaster Planning / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018707:Volcanic Eruptions / Q000009:adverse effects*; D055815:Young Adult
keywords: Burns; Emergency management; Eruptions; Human survival; Volcanoes