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Analysis of burns caused by pre-filled gas canisters used for lamps or portable camping stoves
Burns 32 (2006) 1028–1031 www.elsevier.com/locate/burns
Analysis of burns caused by pre-filled gas canisters used for lamps or portable camping stoves C. Desouches a, B. Salazard a, F. Romain b, C. Karra a, A. Lavie a, C. Della Volpe a, J.C. Manelli a, G. Magalon a,* b
a Regional Burn Center, Assistance Publique – Hoˆpitaux de Marseille, Marseille, France Medical Information Unit, Assistance Publique – Hoˆpitaux de Marseille, Marseille, France
Accepted 21 March 2006
Abstract The use of pre-filled valveless gas canisters for lamps or camping stoves has caused a number of serious burn incidents. We performed a retrospective analysis of all of the patients who were victims of such incidents admitted to the Marseille Burn Centre between January 1990 and March 2004. There were a total of 21 patients burned in such conditions. Adult males made up the majority of the victims of this sort. Lesions were often extensive (60% of the patients were burned over more than 10% of their body surface) and systematically deep. In order of frequency, burn locations were: the lower limbs, the upper limbs, the hands and the face. The incidents principally occurred during replacement of the canister near an open flame. The marketing of a canister with a valve in order to avoid gas leaks did not cause the old canisters to be taken off the market. On the contrary, European Safety Standard EN417, updated in October 2003, validated the use of these valveless canisters. The severity of the lesions caused and the existence of safe equivalent products requires the passage of a law that forbids valveless canisters. # 2006 Elsevier Ltd and ISBI. All rights reserved. Keywords: Burns; Accident prevention; Accidents; Home; Consumer product safety; Safety management; Camping
1. Introduction
2. Materials and methods
Hospitals which treat burn patients have reported a great number of burns in people who handle liquefied gas canisters [1,2]. These canisters are used to supply gas to numerous portable devices (stoves, lamps,. . .). They are simply perforated when they are put in their supports. This system can cause considerable gas leaks if the procedure is not done properly. Serious accidents occur when this very volatile product is ignited by a source of ignition.
This is a retrospective analysis of the characteristics of patients who were victims of burns linked to the use of canister pre-filled with liquefied gas (Fig. 1). These patients were admitted to the Centre Re´gional des Grands Bruˆle´s, Assistance Publique – Hoˆpitaux de Marseille, Marseille, France (Marseille University Hospital Burn Centre) between January 1, 1990 and March 31, 2004. Burn patients whose burns did not require hospitalisation were not included in the study. The principal aim of this study was to describe the state of patients burned by canisters filled with liquefied gas. The secondary aim was to compare this population with other patients who were victims of thermal burns and admitted during the same period. Only patients over 15 years of age were included in the study. The following variables were collected for each
* Corresponding author at: Centre Re´gional des Grands Bruˆle´s, Assistance Publique – Hoˆpitaux de Marseille, 147 bdv Baille, F-13385 Marseille Cedex 05, France. Tel.: +33 491 383 556; fax: +33 491 382 857. E-mail address: [email protected] (G. Magalon). 0305-4179/$30.00 # 2006 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2006.03.019
C. Desouches et al. / Burns 32 (2006) 1028–1031
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Fig. 2. Breakdown of victims by total burn surface and total deep burn surface.
Fig. 1. Pre-filled liquefied gas canister without valve used as a refill for numerous portable devices.
patient: age, gender, total burn surface, total deep burn surface, duration of hospitalisation, deaths, location of burns and history. The exact circumstances of each accident were noted. In order to describe the population, we provided the percentage and total number of patients and for the quantitative variables, the mean (M), the standard deviation (S.D.) as well as the range (Min–Max). In order to compare the characteristics of the population of gas canister victims with other burn victims, we used the following non-parametric statistical tests: Fisher’s exact test for qualitative variables; Mann–Whitney test for quantitative variables. The statistical analysis was performed with the SPSS 10.0 software programme. The threshold for significance ( p) was set at 0.05 for all of the tests.
Burn locations were broken down as follows: 71% of the patients had burns on the lower limbs; 67% of the patients had burns on the upper limbs and the hands; 48% of the patients had burns on the head and neck; 43% of the patients had burns on the trunk. Among the 21 patients, 4 had cognitive troubles during the incident owing to the consumption of a psychoactive substance (alcohol, drugs). The circumstances of the incidents were explicitly described in 12 cases. They uniquely occurred when changing the canisters near an incandescent source. Three of these burn patients were homeless. The number of burned patients admitted during the same period was 1220. A comparison of the population burned by pre-filled canisters did not show a significant difference concerning age, total burn surface, or total deep burn surface.
4. Discussion 3. Results Our population was made up of 21 patients or 1.72% of the patients admitted to our unit for burns during the same period. The age of the patients ranged from 20 to 60 years (M: 38 years; SD: 11.3). The population was essentially male with a male/female sex ratio of 9.5. The mean duration of hospitalisation was 15 days (S.D.: 11.1). None of the patients died during hospitalisation. The percentage of total body surface burned ranged from 2 to 50% (M: 14%, S.D.: 10.6). The mean deep burn surface was 9% (S.D.: 8.3). Among these patients, 10 (48%) had a percentage of total burn surface that was between 10 and 20% (Fig. 2). The breakdown by deep burn surface principally revealed burns of less than 5%.
Liquefied gas canisters installed by perforation are common throughout the world. They are a source of energy for numerous portable devices such as gas stoves, gas lamps, or even blowtorches. Their use has become widespread owing to the increase in outdoor activities linked to the development of leisure and free time. The number of patients in our series understates the total number of burns caused by these canisters in our region. Indeed, superficial burns treated on an out-patient basis in our centre and elsewhere were not included in this series. In our series, these canisters were responsible for numerous burns on young men in visible (face) and functional (hands) regions. However, the lower limbs were the principal location of these burns. Indeed, the gas is in liquid form when it comes out of the canister and tends to spread on the ground before igniting. Handling of the
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C. Desouches et al. / Burns 32 (2006) 1028–1031
product at the moment of the accident explains the high number of burns on the hands. The burned surface was generally extensive with 60% of the patients burned over 10% of their body surface. This burn by flame was systematically deep. Some patients presented with severe burns. Their severity was statistically identical to the other thermal burns treated in our unit. This type of burn has already been described in the literature. In 1985, Saxby and Shakespeare published a series of 31 patients burned in such conditions including one death [2]. In 1999, Richard et al. expressed concern about the persistence and frequency of this type of burn [1]. The principal victims are people who practice outdoor activities. However, the homeless population is also affected. There are numerous reasons for such events in this population: a low educational level that prevents them from reading the instructions for use, frequent use of such devices, and chronic toxic intake that alters their psychomotor capacities. These canisters are dangerous products. However, such incidents are usually due to the fact that the victims do not follow the operating instructions that are printed on the canisters). In all of the cases, there was always a source of ignition during canister replacement which triggered a liquefied gas explosion. This, of course, is explicitly forbidden in the instructions for use. It is important to note that during normal perforation of the canister, there is always a small gas leak. In some circumstances (withdrawal of a canister that still contains gas, poor functioning of the valve, incorrect positioning of the canister in its housing), this gas leak can be major and create a high burn risk. Since the appearance of changeable canisters in the late 1950s, there have been major technical improvements to make this product safer. Since the 1990s, there have been similar canisters with valves on the market which make it possible to avoid leaks when changing canisters and thereby avoid all accidents linked to poor handling (Fig. 3). It is important to stress the efficacy of this system since we have noted no accidents with these safe canisters. The beginning of our study corresponds to the date these safe canisters appeared on the market. Despite this technical development, the number of burns is comparable to that of previous studies. This is due to the fact that canisters with the old system continue to be sold. Manufacturers are conscious of the dangers of their products given the long list of precautions that they print on their canisters and the fact that safe products have been put on the market. However, they have not taken the voluntary step to replace these poorly designed and dangerous products with safe ones. On the contrary, a recent European safety standard (EN 417, October 2003) authorises the manufacture of these valveless canisters. Burn centres often issue warnings about commercial products that could eventually cause serious burns [3–5]. Such actions have sometimes caused the withdrawal of these products such as electric plugs that can burn a child’s mouth
Fig. 3. Pre-filled liquefied gas canister made safer with a valve.
[6]. Two articles [1-2] have incited manufacturers to develop canisters with valves but have not prompted them to permanently scrap the old system. The growing number of articles reporting this type of accident will perhaps make them aware of the danger of their products. However, legislation is the most effective method to ban a dangerous product. The creation of specific laws has made it possible to significantly reduce the number of burns by hot water [7] and the number of apartment fires [8]. The continued commercialisation of these gas canisters is causing serious and permanent consequences that represent a danger for the population. The existence of safe equivalent products prompts us to ask that valveless canisters be forbidden. All burn centres confronted with this type of burn should pass this information on to the public authorities so that each government will take the appropriate measures.
5. Conclusion Liquefied valveless gas canisters are commonly used in every country in the world. They are responsible for numerous burns with major functional and aesthetic consequences. Given the existence of identical products with safety valves, it is indispensable that governmental measures be taken to ban the sale of such canisters.
References [1] Richards AM, Shakespeare PG, Rossi A. Portable camping stoves continue to cause burns. BMJ 1999;318:604. [2] Saxby PJ, Shakespeare PG. Burn injuries from portable butane camping stoves. Burns Incl Therm Inj 1985;11:427–8. [3] Cassell OC, Hubble M, Milling MA, Dickson WA. Baby walkers—still a major cause of infant burns. Burns 1997;23:451–3. [4] Meyer M. ‘Baby-walker’ frames: a preventable factor in infant burns. Burns Incl Therm Inj 1988;14:145–6.
C. Desouches et al. / Burns 32 (2006) 1028–1031 [5] Chuang SS, Yang JY, Tsai FC. Electric water heaters: a new hazard for pediatric burns. Burns 2003;29:589–91. [6] Crikelair GF, Dhaliwal AS. The cause and prevention of electrical burns of the mouth in children. A protective cuff. Plast Reconstruct Surg 1976;58:206–9.
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[7] Erdmann TC, Feldman KW, Rivara FP, Heimbach DM, Wall HA. Tap water burn prevention: the effect of legislation. Pediatrics 1991;88: 572–7. [8] Liao CC, Rossignol AM. Landmarks in burn prevention. Burns 2000;26:422–34.
Analysis of burns caused by pre-filled gas canisters used for lamps or portable camping stoves C. Desouches a, B. Salazard a, F. Romain b, C. Karra a, A. Lavie a, C. Della Volpe a, J.C. Manelli a, G. Magalon a,* b
a Regional Burn Center, Assistance Publique – Hoˆpitaux de Marseille, Marseille, France Medical Information Unit, Assistance Publique – Hoˆpitaux de Marseille, Marseille, France
Accepted 21 March 2006
Abstract The use of pre-filled valveless gas canisters for lamps or camping stoves has caused a number of serious burn incidents. We performed a retrospective analysis of all of the patients who were victims of such incidents admitted to the Marseille Burn Centre between January 1990 and March 2004. There were a total of 21 patients burned in such conditions. Adult males made up the majority of the victims of this sort. Lesions were often extensive (60% of the patients were burned over more than 10% of their body surface) and systematically deep. In order of frequency, burn locations were: the lower limbs, the upper limbs, the hands and the face. The incidents principally occurred during replacement of the canister near an open flame. The marketing of a canister with a valve in order to avoid gas leaks did not cause the old canisters to be taken off the market. On the contrary, European Safety Standard EN417, updated in October 2003, validated the use of these valveless canisters. The severity of the lesions caused and the existence of safe equivalent products requires the passage of a law that forbids valveless canisters. # 2006 Elsevier Ltd and ISBI. All rights reserved. Keywords: Burns; Accident prevention; Accidents; Home; Consumer product safety; Safety management; Camping
1. Introduction
2. Materials and methods
Hospitals which treat burn patients have reported a great number of burns in people who handle liquefied gas canisters [1,2]. These canisters are used to supply gas to numerous portable devices (stoves, lamps,. . .). They are simply perforated when they are put in their supports. This system can cause considerable gas leaks if the procedure is not done properly. Serious accidents occur when this very volatile product is ignited by a source of ignition.
This is a retrospective analysis of the characteristics of patients who were victims of burns linked to the use of canister pre-filled with liquefied gas (Fig. 1). These patients were admitted to the Centre Re´gional des Grands Bruˆle´s, Assistance Publique – Hoˆpitaux de Marseille, Marseille, France (Marseille University Hospital Burn Centre) between January 1, 1990 and March 31, 2004. Burn patients whose burns did not require hospitalisation were not included in the study. The principal aim of this study was to describe the state of patients burned by canisters filled with liquefied gas. The secondary aim was to compare this population with other patients who were victims of thermal burns and admitted during the same period. Only patients over 15 years of age were included in the study. The following variables were collected for each
* Corresponding author at: Centre Re´gional des Grands Bruˆle´s, Assistance Publique – Hoˆpitaux de Marseille, 147 bdv Baille, F-13385 Marseille Cedex 05, France. Tel.: +33 491 383 556; fax: +33 491 382 857. E-mail address: [email protected] (G. Magalon). 0305-4179/$30.00 # 2006 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2006.03.019
C. Desouches et al. / Burns 32 (2006) 1028–1031
1029
Fig. 2. Breakdown of victims by total burn surface and total deep burn surface.
Fig. 1. Pre-filled liquefied gas canister without valve used as a refill for numerous portable devices.
patient: age, gender, total burn surface, total deep burn surface, duration of hospitalisation, deaths, location of burns and history. The exact circumstances of each accident were noted. In order to describe the population, we provided the percentage and total number of patients and for the quantitative variables, the mean (M), the standard deviation (S.D.) as well as the range (Min–Max). In order to compare the characteristics of the population of gas canister victims with other burn victims, we used the following non-parametric statistical tests: Fisher’s exact test for qualitative variables; Mann–Whitney test for quantitative variables. The statistical analysis was performed with the SPSS 10.0 software programme. The threshold for significance ( p) was set at 0.05 for all of the tests.
Burn locations were broken down as follows: 71% of the patients had burns on the lower limbs; 67% of the patients had burns on the upper limbs and the hands; 48% of the patients had burns on the head and neck; 43% of the patients had burns on the trunk. Among the 21 patients, 4 had cognitive troubles during the incident owing to the consumption of a psychoactive substance (alcohol, drugs). The circumstances of the incidents were explicitly described in 12 cases. They uniquely occurred when changing the canisters near an incandescent source. Three of these burn patients were homeless. The number of burned patients admitted during the same period was 1220. A comparison of the population burned by pre-filled canisters did not show a significant difference concerning age, total burn surface, or total deep burn surface.
4. Discussion 3. Results Our population was made up of 21 patients or 1.72% of the patients admitted to our unit for burns during the same period. The age of the patients ranged from 20 to 60 years (M: 38 years; SD: 11.3). The population was essentially male with a male/female sex ratio of 9.5. The mean duration of hospitalisation was 15 days (S.D.: 11.1). None of the patients died during hospitalisation. The percentage of total body surface burned ranged from 2 to 50% (M: 14%, S.D.: 10.6). The mean deep burn surface was 9% (S.D.: 8.3). Among these patients, 10 (48%) had a percentage of total burn surface that was between 10 and 20% (Fig. 2). The breakdown by deep burn surface principally revealed burns of less than 5%.
Liquefied gas canisters installed by perforation are common throughout the world. They are a source of energy for numerous portable devices such as gas stoves, gas lamps, or even blowtorches. Their use has become widespread owing to the increase in outdoor activities linked to the development of leisure and free time. The number of patients in our series understates the total number of burns caused by these canisters in our region. Indeed, superficial burns treated on an out-patient basis in our centre and elsewhere were not included in this series. In our series, these canisters were responsible for numerous burns on young men in visible (face) and functional (hands) regions. However, the lower limbs were the principal location of these burns. Indeed, the gas is in liquid form when it comes out of the canister and tends to spread on the ground before igniting. Handling of the
1030
C. Desouches et al. / Burns 32 (2006) 1028–1031
product at the moment of the accident explains the high number of burns on the hands. The burned surface was generally extensive with 60% of the patients burned over 10% of their body surface. This burn by flame was systematically deep. Some patients presented with severe burns. Their severity was statistically identical to the other thermal burns treated in our unit. This type of burn has already been described in the literature. In 1985, Saxby and Shakespeare published a series of 31 patients burned in such conditions including one death [2]. In 1999, Richard et al. expressed concern about the persistence and frequency of this type of burn [1]. The principal victims are people who practice outdoor activities. However, the homeless population is also affected. There are numerous reasons for such events in this population: a low educational level that prevents them from reading the instructions for use, frequent use of such devices, and chronic toxic intake that alters their psychomotor capacities. These canisters are dangerous products. However, such incidents are usually due to the fact that the victims do not follow the operating instructions that are printed on the canisters). In all of the cases, there was always a source of ignition during canister replacement which triggered a liquefied gas explosion. This, of course, is explicitly forbidden in the instructions for use. It is important to note that during normal perforation of the canister, there is always a small gas leak. In some circumstances (withdrawal of a canister that still contains gas, poor functioning of the valve, incorrect positioning of the canister in its housing), this gas leak can be major and create a high burn risk. Since the appearance of changeable canisters in the late 1950s, there have been major technical improvements to make this product safer. Since the 1990s, there have been similar canisters with valves on the market which make it possible to avoid leaks when changing canisters and thereby avoid all accidents linked to poor handling (Fig. 3). It is important to stress the efficacy of this system since we have noted no accidents with these safe canisters. The beginning of our study corresponds to the date these safe canisters appeared on the market. Despite this technical development, the number of burns is comparable to that of previous studies. This is due to the fact that canisters with the old system continue to be sold. Manufacturers are conscious of the dangers of their products given the long list of precautions that they print on their canisters and the fact that safe products have been put on the market. However, they have not taken the voluntary step to replace these poorly designed and dangerous products with safe ones. On the contrary, a recent European safety standard (EN 417, October 2003) authorises the manufacture of these valveless canisters. Burn centres often issue warnings about commercial products that could eventually cause serious burns [3–5]. Such actions have sometimes caused the withdrawal of these products such as electric plugs that can burn a child’s mouth
Fig. 3. Pre-filled liquefied gas canister made safer with a valve.
[6]. Two articles [1-2] have incited manufacturers to develop canisters with valves but have not prompted them to permanently scrap the old system. The growing number of articles reporting this type of accident will perhaps make them aware of the danger of their products. However, legislation is the most effective method to ban a dangerous product. The creation of specific laws has made it possible to significantly reduce the number of burns by hot water [7] and the number of apartment fires [8]. The continued commercialisation of these gas canisters is causing serious and permanent consequences that represent a danger for the population. The existence of safe equivalent products prompts us to ask that valveless canisters be forbidden. All burn centres confronted with this type of burn should pass this information on to the public authorities so that each government will take the appropriate measures.
5. Conclusion Liquefied valveless gas canisters are commonly used in every country in the world. They are responsible for numerous burns with major functional and aesthetic consequences. Given the existence of identical products with safety valves, it is indispensable that governmental measures be taken to ban the sale of such canisters.
References [1] Richards AM, Shakespeare PG, Rossi A. Portable camping stoves continue to cause burns. BMJ 1999;318:604. [2] Saxby PJ, Shakespeare PG. Burn injuries from portable butane camping stoves. Burns Incl Therm Inj 1985;11:427–8. [3] Cassell OC, Hubble M, Milling MA, Dickson WA. Baby walkers—still a major cause of infant burns. Burns 1997;23:451–3. [4] Meyer M. ‘Baby-walker’ frames: a preventable factor in infant burns. Burns Incl Therm Inj 1988;14:145–6.
C. Desouches et al. / Burns 32 (2006) 1028–1031 [5] Chuang SS, Yang JY, Tsai FC. Electric water heaters: a new hazard for pediatric burns. Burns 2003;29:589–91. [6] Crikelair GF, Dhaliwal AS. The cause and prevention of electrical burns of the mouth in children. A protective cuff. Plast Reconstruct Surg 1976;58:206–9.
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[7] Erdmann TC, Feldman KW, Rivara FP, Heimbach DM, Wall HA. Tap water burn prevention: the effect of legislation. Pediatrics 1991;88: 572–7. [8] Liao CC, Rossignol AM. Landmarks in burn prevention. Burns 2000;26:422–34.