專題討論1:八仙樂園粉塵爆燃燒傷治療
Victims’ medical treatment of Formosa Fun Coast Dust Explosion

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Effective mass casualty management following cornstarch explosive burn: Clinical experience of National Taiwan University Burn Center
Eng-Kean Yeong
臺大醫院燒燙傷中心

  June 27 2015 a cornstarch dust explosion causing 500 mass casualties in Taiwan has attracted worldwide public attention. Thirty three victims (mean age : 21) with burn area 43% of the body surface area suddenly arrived to our emergency ward, stressing our burn care system, as the number of admissions is almost equal to the mean annual major burn admissions in the past 15 years. There were 14 patients with burn area greater than 50% TBSA including one 88%. In response to the mass casualty, we expanded our burn team members and care facilities from 4 intensive care bed to 18. Fluid resuscitation was performed in 30 patients and 18 patients were intubated for ventilator support. For effective communications, besides face to face meetings, LINE android software was used for group discussion and treatment plan making. Appropriate fluid resuscitation with lactate ringer and fresh frozen plasma, early ventilator withdrawal and vigorous enteral nutrition support, closed monitoring of sepsis and aggressive treatment, and early tangential excision and skin grafting were the main treatment strategy. Abnormal chest X ray findings was noted in 18 patients, 1 patient received tracheostomy, 3 have disseminated intravascular coagulation, 3 have multiple organ failure syndrome, 12 have septic shock and 2 patients have dialysis. Cell suspension was used in 3 patients and cell epithelial culture in one. The mortality outcome was zero, compared to the expected mortality of 34.4% in our previous experience in burn greater than 50% TBSA. We concluded that young age and effective teamwork across several fields of specialists are the main factors leading to high survival rate.