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 >80 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], 19-32). 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 < 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.