A burn mass casualty event due to boiler room explosion on a cruise ship: Preparedness and outcomes

Akin Tekin, Nicholas Namias, Terence OKeeffe, Louis Pizano, Mauricio Lynn, Robin Prater-Varas, Olga Delia Quintana, Leda Borges, Mary Ishii, Seong Lee, Peter Lopez, Sharon Lessner-Eisenberg, Angel Alvarez, Tom Ellison, Katherine Sapnas, Jennifer Lefton, Charles Gillon Ward

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent burns and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event, having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80%) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events.

Original languageEnglish (US)
Pages (from-to)210-215
Number of pages6
JournalAmerican Surgeon
Volume71
Issue number3
StatePublished - Dec 1 2005
Externally publishedYes

Fingerprint

Mass Casualty Incidents
Ships
Explosions
Burns
Steam
Intra-Abdominal Hypertension
Resuscitation
Inhalation
Burn Units
Wounds and Injuries
Inhalation Burns
Pericardiectomy
Psychology
Hoarseness
Cardiac Tamponade
Vocal Cords
Body Surface Area
Thoracotomy
Operating Rooms
Decompression

ASJC Scopus subject areas

  • Surgery

Cite this

Tekin, A., Namias, N., OKeeffe, T., Pizano, L., Lynn, M., Prater-Varas, R., ... Ward, C. G. (2005). A burn mass casualty event due to boiler room explosion on a cruise ship: Preparedness and outcomes. American Surgeon, 71(3), 210-215.

A burn mass casualty event due to boiler room explosion on a cruise ship : Preparedness and outcomes. / Tekin, Akin; Namias, Nicholas; OKeeffe, Terence; Pizano, Louis; Lynn, Mauricio; Prater-Varas, Robin; Quintana, Olga Delia; Borges, Leda; Ishii, Mary; Lee, Seong; Lopez, Peter; Lessner-Eisenberg, Sharon; Alvarez, Angel; Ellison, Tom; Sapnas, Katherine; Lefton, Jennifer; Ward, Charles Gillon.

In: American Surgeon, Vol. 71, No. 3, 01.12.2005, p. 210-215.

Research output: Contribution to journalArticle

Tekin, A, Namias, N, OKeeffe, T, Pizano, L, Lynn, M, Prater-Varas, R, Quintana, OD, Borges, L, Ishii, M, Lee, S, Lopez, P, Lessner-Eisenberg, S, Alvarez, A, Ellison, T, Sapnas, K, Lefton, J & Ward, CG 2005, 'A burn mass casualty event due to boiler room explosion on a cruise ship: Preparedness and outcomes', American Surgeon, vol. 71, no. 3, pp. 210-215.
Tekin A, Namias N, OKeeffe T, Pizano L, Lynn M, Prater-Varas R et al. A burn mass casualty event due to boiler room explosion on a cruise ship: Preparedness and outcomes. American Surgeon. 2005 Dec 1;71(3):210-215.
Tekin, Akin ; Namias, Nicholas ; OKeeffe, Terence ; Pizano, Louis ; Lynn, Mauricio ; Prater-Varas, Robin ; Quintana, Olga Delia ; Borges, Leda ; Ishii, Mary ; Lee, Seong ; Lopez, Peter ; Lessner-Eisenberg, Sharon ; Alvarez, Angel ; Ellison, Tom ; Sapnas, Katherine ; Lefton, Jennifer ; Ward, Charles Gillon. / A burn mass casualty event due to boiler room explosion on a cruise ship : Preparedness and outcomes. In: American Surgeon. 2005 ; Vol. 71, No. 3. pp. 210-215.
@article{7c1d3354c9dc47f2962b180b326078a8,
title = "A burn mass casualty event due to boiler room explosion on a cruise ship: Preparedness and outcomes",
abstract = "The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent burns and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event, having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80{\%}) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events.",
author = "Akin Tekin and Nicholas Namias and Terence OKeeffe and Louis Pizano and Mauricio Lynn and Robin Prater-Varas and Quintana, {Olga Delia} and Leda Borges and Mary Ishii and Seong Lee and Peter Lopez and Sharon Lessner-Eisenberg and Angel Alvarez and Tom Ellison and Katherine Sapnas and Jennifer Lefton and Ward, {Charles Gillon}",
year = "2005",
month = "12",
day = "1",
language = "English (US)",
volume = "71",
pages = "210--215",
journal = "Handbook of Behavioral Neuroscience",
issn = "0003-1348",
publisher = "JAI Press",
number = "3",

}

TY - JOUR

T1 - A burn mass casualty event due to boiler room explosion on a cruise ship

T2 - Preparedness and outcomes

AU - Tekin, Akin

AU - Namias, Nicholas

AU - OKeeffe, Terence

AU - Pizano, Louis

AU - Lynn, Mauricio

AU - Prater-Varas, Robin

AU - Quintana, Olga Delia

AU - Borges, Leda

AU - Ishii, Mary

AU - Lee, Seong

AU - Lopez, Peter

AU - Lessner-Eisenberg, Sharon

AU - Alvarez, Angel

AU - Ellison, Tom

AU - Sapnas, Katherine

AU - Lefton, Jennifer

AU - Ward, Charles Gillon

PY - 2005/12/1

Y1 - 2005/12/1

N2 - The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent burns and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event, having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80%) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events.

AB - The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent burns and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event, having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80%) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events.

UR - http://www.scopus.com/inward/record.url?scp=19844368030&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19844368030&partnerID=8YFLogxK

M3 - Article

C2 - 15869134

AN - SCOPUS:19844368030

VL - 71

SP - 210

EP - 215

JO - Handbook of Behavioral Neuroscience

JF - Handbook of Behavioral Neuroscience

SN - 0003-1348

IS - 3

ER -