Responding to Major Burn Disasters in Resource-Limited Settings: Lessons Learned From an Oil Tanker Explosion in Nakuru, Kenya

Abstract

Background: On January 31, 2009, a fuel tanker exploded in rural Kenya, killing and injuring hundreds of people. This article describes the care of Ͼ80 burn victims at a rural hospital in Kenya, Nakuru Provincial General Hospital, and provides lessons for care of a large number of burned patients in a resource-limited setting. Methods: Data were obtained from retrospective review from hospital registers and patient files. Results: Treatment was provided for 89 victims. Eighty-six (97%) were men; median age was 25 years (interquartile range [IQR],[19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Half of the patients (45) died, the majority (31, 69%) within the first week. The median total body surface area burned for those who died was 80% (IQR, 60 -90%) compared with 28% (IQR, 15-43%) for those who survived (p Ͻ 0.001). Twenty patients were transfused a total of 73 units of blood including one patient who received 9 units. Eighty surgical interventions were performed on 31 patients and included 39 split-thickness skin grafts, 21 debridements, 7 escharotomies, 6 dressing changes, 4 contracture releases, and 3 finger amputations. Of the 44 survivors, 39 (89%) were discharged within 4 months of the event. Conclusions: Mortality after mass burn disasters is high in Africa. In areas where referral to tertiary centers is not possible, district hospitals should have mass disaster plans that involve collaboration with other organizations to augment medical and psychologic services. Even for patients who do not survive, compassionate care with analgesics can be given.

A comparison of burn related injuries following the natural disaster Super Storm Hurricane Sandy to the National Burn Repository of the American Burn Association

“…45 patients died within 1 week and had a total body surface area burned of 80 % as compared with 28 % for survivors. They concluded that in areas where referral to tertiary centers is not possible, district hospitals should have mass disaster plans that involve burn related victims [ 5 ]. In this study, we were able to detail the burn related injuries following the natural disaster SSHS.…”

Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels

“…In addition, areas with extraordinary burn burden and frequent burn disasters, like sub-Saharan Africa and South Asia, require special attention. (10, 12, 19, 20) Given the high incidence and prevalence of burn injury and complications in LMICs, allocating resources essential for burn care is important for effective humanitarian assistance.…”

The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature

“…The epidemiology of burns in mass casualty events and terrorist attacks provides an additional source of knowledge on the manifestation and distribution of blast-related burn injuries in settings ranging from Europe (Turégano-Fuentes et al, 2008) and the Middle East (Paydar et al, 2012) to Africa (Van Kooij et al, 2011) and South Asia (Tekade et al, 2017;Yu et al, 2016). For example, Paydar and colleagues, 2012, wrote an overview of the events of a mosque bombing in Shiraz, Iran, outlining the average age of patients (26 years), sex breakdown (67 percent male and 23 percent female), and most-prevalent causes of hospital admission).…”