Citation

Arturson G. Burns 1981; 7(4): 233-251.

Copyright

(Copyright © 1981, Elsevier Publishing)

DOI

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PMID

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Abstract

On 11 July 1978, a road tanker carrying liquefied, flammable gas ran into the Los Alfaques camping ground south of Tarragona on the east coast of Spain and exploded [what is called a boiling-liquid, expanding-vapour explosion (BLEVE) resulted]. The road tanker was loaded with about 45 m3 of propene (propylene). For some unknown reason it ran into the ditch against the wall of the camping ground; where-upon the tank split; large quantities of propene were ejected into the surrounding area; were gasified. The cloud of gas; mixed with air; was ignited, causing a violent explosion.

For the first one-half hour, there was total chaos on the site of the disaster. The injured were removed in a completely unorganized fashion and without any triage. The number of ambulances was insufficient and long delays, about 3 hours, elapsed before the last victim was driven away. The burning tanker blocked the road, thus effectively dividing the injured into two groups one being taken northwards and the other southwards, there were hospitals with similar standards at comparable distances in both directions.

On the road to the north, the injured received adequate medical care, once they had reached either the cottage hospital at Amposta or the hospital at Tortosa. At this stage, the final destination of 58 severely burned patients was the Francisco Franco Hospital in Barcelona, which has a burn unit with 31 beds.

Eighty-two severely burned patients were taken south to the La Fe Hospital in Valencia, which has a burn unit with 14 beds. In most cases no medical steps of any importance were taken during the journey. Several of the injured developed severe shock on the journey and had no measurable blood pressure on arrival.

One hundred and two people died at the site of the explosion. Their identification--a very complicated task--was made more difficult by the efforts of unskilled helpers.A comparative study of the group of 58 patients taken to Barcelona and the group of 82 patients taken to Valencia reveals the following facts. There is no significant difference between the two groups with regard to the patients' ages and the extent and depth of their burns. The only certain difference is that the patients taken to Barcelona received adequate medical treatment during the journey, unlike most of the patients taken to Valencia who received no medical treatment at all during the journey. The medical treatment given at the two burn units in Barcelona and Valencia is first-class and is, in all essentials, the same at both units. During the 4 days immediately following the disaster, the survival rate declined to 93 per cent for the patients taken to Barcelona and to 45 per cent for those taken to Valencia. The reason for the significantly greater mortality in the Valencia patients must be the unsatisfactory medical treatment given en route to the hospital. Twenty-seven of the 31 patients who died during the first few days at the La Fe Hospital in Valencia had deep burns covering at least 90 per cent of the body surface. The remaining 4 deaths were also those of very severely burned patients.

A very large number of the victims were domiciled in France, Germany, Belgium and Holland. In the week immediately following the disaster, these patients were evacuated to their own countries. The evacuation took place as soon as possible and was carried out in an exemplary fashion.A follow-up study of all the patients reveals that there was an insignificant difference in the survival rate between the Barcelona and the Valencia groups two months after the disaster. This must be interpreted as indicating that the patients were so seriously injured in the disaster that the more adequate treatment given at an early stage to the Barcelona group only extended the survival time by a week or so for a large number of patients. Taking into account the 102 who died at the site, the mortality 2 months after the disaster was about 85 per cent.

On some points our view differs from that of our Spanish colleagues. This refers to the psychological care of very severely burned patients whose lives, it was considered, could not be saved. We believe that, as far as possible (but considerately and truthfully), the questions asked by these patients and their relatives should be answered. The care of the relatives of the severely burned patients imposed too heavy a burden on the hospitals. No satisfactory arrangements had been made to provide waiting rooms and information desks at the hospitals. Communications with the mass media were not properly prepared and organized either. This led to misunderstandings and to a number of newspaper articles containing inaccurate and negative criticism of the way in which the clinics had managed the nursing and evacuation of some severely burned patients.

It must be pointed out that this was a very serious disaster which occurred in the countryside, where one cannot expect there to be in existence a disaster plan dimensioned for several hundred victims. If a similar disaster should occur in Sweden, on the west coast north of Gothenburg, for example, all the intensive-care units (6) at the hospitals within a radius of about 150 km from the site would be needed for severely burned patients. Furthermore, at least 4 surgical wards would be needed for the somewhat less severely burned patients. In addition, we would have to reckon that all the beds in Sweden's special intensive-care units for burn cases (20) would be occupied for several months to come.