A descriptive analysis of injury triage, surge of medical demand, and resource use in an university hospital after 8.12 Tianjin Port Explosion, China

Blast injury: Impact to the cornea

Visual disorders are common even after mild traumatic brain injury (mTBI) or blast exposure. The cost of blast-induced vision loss in civilians, military personnel, and veterans is significant. The visual consequences of blasts associated with TBI are elusive. Active military personnel and veterans report various ocular pathologies including corneal disorders post-combat blasts. The wars and conflicts in Afghanistan, Iraq, Syria, Ukraine, etc. have increased the number of corneal and ocular disorders significantly among military personnel and veterans. Binocular vision, visual fields, and other visual functions could be impaired following blast-mediated TBI. Blast-associated injuries can cause visual disturbances, binocular system problems, and visual loss. About 25% of veterans exposed to blasts report corneal injury. Blast exposure induces corneal edema, corneal opacity, increased corneal thickness, damage of corneal epithelium, corneal abrasions, and stromal and endothelial abnormality including altered endothelial density, immune cell infiltration, corneal neovascularization, Descemet membrane rupture, and increased pain mediators in animal models and the blast-exposed military personnel including veterans. Immune response exacerbates blast-induced ocular injury. TBI is associated with dry eyes and pain in veterans. Subjects exposed to blasts that cause TBI should undergo immediate clinical visual and ocular examinations. Delayed visual care may lead to progressive vision loss, lengthening/impairing rehabilitation and ultimately may lead to permanent vision problems and blindness. Open-field blast exposure could induce corneal injuries and immune responses in the cornea. Further studies are warranted to understand corneal pathophysiology after blast exposure. A review of current advancements in blast-induced corneal injury will help elucidate novel targets for potential therapeutic options. This review discusses the impact of blast exposure-associated corneal disorders.

A practical method for predicting and analyzing the consequences of ammonium nitrate explosion accidents adjacent to densely populated areas

Several catastrophic ammonium nitrate (AN) explosion accidents have been reported during the last decades. Previous studies have been mainly focused on investigating adverse effects caused by the AN explosion, while only a few systematically analyzed the consequences and impacts of AN explosions. This study collects data from three typical AN explosions (accidental explosion of the US fertilizer plant in 2013; an accidental explosion of China's Tianjin port in 2015, and a recent explosion (2020) of the Beirut port in Lebanon). The consequences of accidental explosions were analyzed by mathematical equations that further provide scientific explanations for AN explosions. Based on the explosives' properties on-site, these accidental explosions were caused by condensed phase explosives. Comparison with the conditions at the explosion site indicated that blast overpressure was the primary factor in the loss of life and damage to the building, while ground shock was a secondary factor. The severity of loss of life and building damage from explosions decreased with increasing distance. These distances could be calculated by the scaling law, which was replaced by the equivalent TNT mass of the explosive and the damage scale's overpressure boundary value. In addition, mapping the damaged area on a map helped in the visual presentation of the consequence assessment. The long-term environmental and ecological impact due to the explosions was also an important issue that could not be ignored. Overall, this study establishes a simple and easy-to-use method to rapidly predict and assess the consequences of an explosion, and provides technical guidance for future emergency response to similar large-scale accidents.

Characteristics and treatments of ocular blast injury in Tianjin explosion in China

BACKGROUND

To document characteristics and treatments of ocular blast injury from a fire and explosion.

METHOD

Authors retrospectively evaluated 116 patients with 166 eye injuries from six hospitals. Terminology of ocular injury referred to Birmingham Eye Trauma Terminology, and best-corrected visual acuity (BCVA) was categorized with the ocular trauma score (OTS) grading system. Incidence, preoperational and follow-up BCVA, treatment of severe ocular blast injuries were surveyed.

RESULTS

Oculoplastic injuries accounted for the majority of eye injuries, while globe injuries were presented in 52 eyes with median baseline OTS 70 ranging from 26 to 100. No endophthalmitis occurred. The mean timing of the first-stage operations was 9.4 ± 6.4 h after blast, while second-stage operations were performed on average 14.7 ± 0.9 days post blast. Final BCVA of 68.8% of eyes achieved 20/200 or better as followed, 7 open globe injuries had a BCVA of no light perception. Additionally, eyes presenting rupture, retinal detachment, vitreous hemorrhage, choroidal injury and initial BCVA less than 20/200 had worse final visual outcomes, while globe penetration was not associated with poor visual acuity.

CONCLUSION

Various ocular injuries were commonly in the casualties of blast, in which open-globe injuries have worst visual prognosis. OTS is a valid approach for evaluation of prognosis and optimizing the therapeutic strategies subsequently in the massive casualty. Intense rescue and careful examination, proper surgery should be performed correctly to rescue patients.

Analysis of Ocular Injury Characteristics in Survivors of the 8.12 Tianjin Port Explosion, China

Introduction

On the evening of August 12, 2015, a large chemical explosion occurred at Tianjin Port. We analyzed ocular injury characteristics in the survivors of this accident.

Methods

Twenty injured eyes of 17 hospitalized patients were included. Initial best-corrected visual acuity (BCVA), injury type, injury cause, relative afferent pupillary defect (RAPD), zone of injury (ZOI), and ocular trauma score (OTS) were evaluated. Final BCVA and enucleation were the final outcome index. The relationship between risk factors and final outcomes was analyzed.

Results

The patients comprised 14 males and 3 females (mean age, 35.24 ± 12.68 years). Eighteen eyes had open-globe and 2 had closed-globe injuries. Fifteen ocular injury types were reported. Initial visual acuity (VA) was 20/50 to 20/200, 20/200 to finger counting (FC), hand motion to light perception (HM-LP), and no light perception (NLP) in 2, 7, 7, and 4 eyes, respectively. RAPD was found in 5 eyes. Most eyes sustained severe injuries with OTSs of 1 (25%) and 2 (40%). Of the injured eyes, 50% had Zone III injuries. In 95% of the injured eyes, glass was the cause of injury. Three of 4 eyes with an initial VA of NLP had a final VA of NLP and an outcome of enucleation. In 5 eyes with RAPD, 3 had a final VA of NLP and a final outcome of enucleation. Eyes with lower OTSs generally had poorer outcomes. All eyes with a final VA of NLP and an enucleation outcome had Zone III injuries. All 3 eyes with an enucleation outcome had retinal injuries, whereas eyes with no retinal injury had a better final BCVA.

Conclusions

Explosions can inflict severe ocular trauma, even indoors; 90% of injured eyes had open-globe injuries caused by glass fragments. Initial NLP, RAPD, low OTS, posterior extended wound, and retinal injury indicate a poor final outcome.

Thoracic damage control surgery

Thoracic damage control surgery (TDCS) is a decision making tool and derivate of the damage control concept (DCC), where physiological stabilization has a priority over anatomical reconstruction under the pressure of time. Intrathoracic haemorrhage control and pleural decompression are the two main immediate tasks of TDCS, while definitive procedures follow when the patient is stabilised in 24-48 hours. The focus of the thoracic surgeon is on the prevention of the haemorrhage induced coagulopathy, metabolic acidosis and hypothermy formed triad of death. Surgical haemorrhage control and pleural space decompression are to be performed. The individual patients benefit from TDCS procedures whose condition is too severe for a complex immediate reconstruction (polytrauma). Life threatening chest injuries in multiple/mass casualty scenarios in civilian and military environment alike are triaged and treated accordingly. Onset of acute mismatch between the resources (available hands, OP theaters, resources, hardware) and the needs (number and severity of chest trauma cases), a mindset shift should take place, where time and space the two main limiting factors. Airway obstruction, tension haemo/pneumothorax falls into the preventable death category. Chest drainage and emergency thoracotomy are the two main procedures offered by TDCS. An intervention structured organ/injury specific list of procedures is detailed. This is a mix of emergency surgery and cardiothoracic surgery, where less is more. TDSC is not the Holy Grail found to solve all complex thoracic trauma cases, but is a good tool to increase the chance for survival in challenging, and frequently quite hopeless situations.

Medical Response to the Tianjin Explosions: Lessons Learned

BACKGROUND

On August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned.

METHODS

This study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals.

RESULTS

A total of 46 ambulances and 143 prehospital care professionals were dispatched to the scene, and 198 wounded were transferred to hospitals by ambulance. More than 4000 wounded casualties surged into hospitals, and 798 wounded were admitted. Both emergency medical services and hospitals were quick and successful in the early stage of the explosions. The strategy of 4 centralizations (4Cs) for medical services management in a mass casualty event was successfully applied.

CONCLUSIONS

The risk of accidental events has increased in recent years. We should take advantage of the lessons learned from the explosions and apply these in future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 411-414).