Photo by Sheila Sund.

Photo by Sheila Sund.

I am very conscious of fire risk following natural disasters, particularly earthquakes. In the 1994 Northridge earthquake, the turn of a key in a stalled truck ignited a broken gas line that exploded with spectacular flames 100 feet high – just a mile from my parents’ home. After a disaster, one of my first steps is to scour my house, fire extinguisher in hand, looking for any sign of fire. Then I’ll do the same thing in my neighborhood – a fire from someone else’s home could easily spread without firemen to put it out. All my wonderful emergency supplies are no good if my house burns down (although I would bring what I could when I evacuated)! I don’t have natural gas, but if I did, I would turn the gas off even before searching the house.

Frequency of Fires Following Earthquakes

An interesting 2008 scenario study for the California Geological Survey called “Fire Following Earthquake” estimated that a 7.8 San Andreas Fault earthquake hitting Los Angeles would ignite about 1600 fires requiring an official fire response (not counting fires extinguished by citizens like me!). Half would be electrical in origin, a quarter would start from gas leaks, and the others would have a variety of causes, including spilled chemicals. Interestingly, 75% of the fires start in homes or apartments. Wood framed houses are great places during an earthquake – they rarely collapse. They’re not so great if a fire breaks out afterwards. One fire can easily burn through entire neighborhoods of closely placed wood homes.

 Fires in Other Natural Disasters

Post-disaster fires are not limited to earthquakes. The Queens fire in Hurricane Sandy burned 111 houses (or 125, 100, 80 or 50 houses, depending on your favorite newspaper – why is it so hard to count houses after fires?). If you like disaster or fire videos, here is a YouTube link with a title making it sound worse than it was – “Huge Fire Raging through New York – Hurricane Sandy“. Anything that ruptures pipes, breaks wires, or overturns things causes fires – a description fitting just about every natural disaster I know! And then we get “untrained survivor” fires – people handling generator fuel incorrectly, cooking on a grill in the house, knocking over candles or lanterns, and even debris bonfires getting out of control (although the risk of death is even greater from carbon monoxide poisoning generated by incorrectly used generators, heaters, or ovens).

Burnt neighborhood in Breezy Point, Queens, when fire trucks were unable to respond because of Hurricane Sandy.

Burnt neighborhood in Breezy Point, Queens, when fire trucks were unable to respond because of Hurricane Sandy.

Do Fires Equal Deaths and Burns?

What do all these fires mean in terms of human injuries and death? These answers are a little tougher to find. There are hundreds of fire reported deaths after disasters (500 estimated in the 1995 Kobe earthquake), but they mostly represent burnt bodies found in buildings. Some may have been crushed or died first of asphyxiation, instead of being killed by the fire. As far as survivors, the number of people seeking burn treatment after an earthquake is quite low these days, even in third world countries. In both the Haiti and Kobe earthquakes, only about 2 per cent of hospital treated victims had burns. Most were minor scalds (hot liquid spills) and required minimal treatment. One report from a New Jersey burn center reported an increase from 1-2 severe burn admissions to 3-4 admissions a day after Hurricane Sandy, almost entirely from survivor carelessness (The Burn Center at Saint Barnabas Offers Safety Tips).

Post disaster treatment numbers are not definite. In the first few days after a disaster, tracking emergency healthcare is not a high priority – you just treat as many patients as possible, and then try to figure out later what you did. Despite this, it’s unlikely that later hospital counts miss large numbers of significant burn victims. In a natural disaster, it really seems that most fire victims either die in their homes or escape with minimal or no injury. Talk about all or nothing!

Man-made Disasters Cause Severe Burns

In man-made disasters, it’s an entirely different story – explosions, bombs, crashes, and the recurring problem of nightclub fires. These often result in many burn victims, particularly if occurring inside a building or closed space, which concentrates force and heat, and makes escape difficult. Emergency responders are usually quickly available to rescue people (unlike in many natural disasters), leaving more survivors facing severe burn injuries. This potential burn surge event will really test the healthcare community’s ability to respond.

Standard Medical Care of Burns

Under normal conditions, all significant burn injuries are treated at specialized burn centers. Oregon’s only burn center is located in Portland. The next nearest burn centers are Seattle and Sacramento. In the United States, there are only about 1850 burn beds and 125 burn centers (some treating children exclusively). Burn care is a unique specialty area, including surgical procedures like skin grafting, difficult wound care, intensive breathing support, medical complications particular for burns, prolonged rehabilitation, and intense emotional support needs. It makes sense to centralize this intensity of care at specialty centers.

Typical burn center admission criteria are:

Horrible scarring and joint immobility following inadequate burn treatment.

Horrible scarring and joint immobility following inadequate burn treatment.

1. Partial thickness burns (second degree) over 10% or more of the body.

2. Any full thickness burns (third degree) or burns into muscle or deep tissues (fourth degree). Third degree burns require skin grafts, and fourth degree burns can require amputation.

3. Burns involving the face, hands, feet, groin or major joints.

4. Electrical (including lightning) and chemical burns.

5. Inhalation injuries (smoke, toxins, carbon monoxide).

6. Burns in patients with other medical problems complicating treatment.

7. Combinations of burns and trauma, when burns are the bigger problem.

7. Children with burns needing a pediatric hospital.

8. Burns in people with special social, emotional or long-term rehab needs.

 Burn Surge – Mass Casualty Incidents with Multiple Burn Injuries

As you can see, most significant burns will usually end up at a burn center. Although good for patient care, it leaves most local doctors and nurses with no experience in treating major burns. They’ve never done it. So what happens when there are suddenly many burn victims? Both in the field and at the local hospital, someone must assess burns, start proper treatment, and watch for the medical complications uniquely threatening to burn victims. Local hospitals try to “turf” (get rid of) burn victims as quickly as possible, but with large numbers of victims, coordinating transfer and transport to burn centers could take several days. With limited local skill levels, disaster planning must include advance and just-in-time training in burn management for local healthcare. The Oregon Burn Center has a Burn Mass Casualty Plan available in all hospitals, including good treatment protocols. (Whoopee – someone is ahead of the game!)

Life Flight Helicopter for emergency medical transport

Life Flight Helicopter for emergency medical transport

Even when emergency transportation to Portland is available, our burn center expands to a maximum of 24 patient beds – not enough for a big burn disaster, particularly if we use similar admission criteria to normal times. Current plans include moving some victims completely out of the area to other burn centers. If I had to choose between leaving vs. having long-term treatment from a local hospital with no burn experience, I would willingly go to Seattle or Sacramento. I’m glad that multiple severe burn injuries are not common with natural disasters when transportation might be iffy at best. At least in a man-made disaster, infrastructure should be intact (unless it is a nuclear bomb, in which case we’ll all have far worse things to worry about!).

So there you have it – a capsule summary of fires and burns in disasters. As always, one post often prompts another. I am already writing the next one – what you need to know to treat burns in the field! Whether you are an emergency responder, an official volunteer, or someone just willing to assist when official help is not available, knowledge of basic burn treatment is always good. Until then..

Stay safe,

Sheila Sund, M.D.

  1. […] Fires and Burns in Disasters – What Should We Know? (Part 1) […]

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