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Burn injuries following explosion of car heaters
BURNS
ELSEVIER.
Burns
24 (1998)
579-580
rn injuries following ex.plosion of car heaters D. Alonso *, J. Valero-Gasalla, M. Arnaiz, F. Martelo Bum
Unit,
Plastic
Surgery
Service,
Juan
Accepted
Canalejo
7 April
Hospital,
La Conma,
Spain
1998
Abstract
We report four casesof burn injuries inflicted by hot coolant after the explosion of the heating unit in Tour motor-vehicles of the same make and version, in similar circumstances while the patients were driving their cars. Burns of this type can cause considerable morbidity with an accompanying high risk of a traffic accident. 0 1998 Elsevier Science Ltld for ISBI. All rights reserved.
1. Introduction Burn injuries sustained from motor vehicles form an important group as has been reported [l, 111. Mechanisms of injury have a great variety: cdr fires following road traffic accidents [2], car radiator-related burns [3-51, carburetor-related burns [3,6], car seats in burns to infants 17, S] and inappropriate use of matches [9]. FOLW patients were admitted to the Burn Unit at .Iuan Canalejo Hospital in La Corufia over a 14 month period. The distribution of the burns characteristically affected lower limbs, genital area and buttocks. In all cases the injury was produced as a result of a breakdown of the car heating unit which allowed the escape of hot coolant and steam from it through the front panel to the driver seat. The make and model of the car was the same in all cases and the circumstances and nature of the accidents were very similar. Patients said that when they were driving normally they suddenly heard a noise like an explosion from the car engine and at the same time they felt a great pain from a burn injury produced by hot water and a steam jet flowing from somewhere just through the heating grill which is on the right side of the accelerator pedal. Two of the drivers lost control of their cars, one of them crossed the central line of a motorway to stop at
* Corresponding Surgery. General
author. Present address: Service Yague Hospital. Burgos, Spain.
3305-4179i98;$19.00 10 1998 Elsevier PII: SO305-4179(98)00072-2
Science
Ltd
for ISBI,
of
Plastic
All rights
reserved.
the other side, the other car ran off the road. The other two patients managed to stop their cars without further traffic problems.
2:. Case report Case 1: A 56 year-old male, hard working. He had sustained 18% body surface area (BSA) superficial and deep dermal scalds to both lower limbs and genital area when he was driving his van. The other people on board suffered no injuries. The patient was operated on 10 days following admission and he was discharged from hospital 17 d.ays after injury. Burn areas required tangential excision and skin grafting. Case 2: A 31 year-old male, goods vehicle driver. No other people were travelling in the van. He sustained 8% body surface area [BSA) superficial burn. The right buttock, posterior part of the right thigh and the dorsum of the right foot were the worst affected. He left the hospital on the 6th day after admission and all burned areas were allowed to heal spontaneously. Case 3: A 42 year-old male, hard working. He suffered from hypercholesterolemia as a major health problem prior to admission. He sustained 15% body surface area (BSA) scald burn. Only 1% was a deep dermal burn which had to be excised and needed skin grafting and the rest of the burn area was managed conservatively. The stay in hospital was 6 days.
580
D. Ahso
ei ~1. i Bum
Case 4: A 50 year-old male, hard working. He suffered from arterial hypertension and diabetes mellitus type II. He was driving his car, with no other person in the car, when a similar accident occurred. He had sustained a superficial and deep dermal burn covering 15% of the body surface and localized on right lower limbs and on the right buttocks. On day 6 postburn, debridement and split grafting were performed. His hospital stay was 18 days and pressure therapy in the form of a custom-made lycra garment was applied to the right thigh.
The cause and circumstances of the burn injuries reported in this paper are unusual. A review of bibliography (MEDIINE on Silver Plate 1966-1996) (Request: Automobiles and Burns), found only one paper in which similar cases were reported [lo]. Our cases :;howed that all patients were driving the same model of car and were injured in the same circumstances. At present we have not received any official explanation from the car factory manager but our investigations indicate that the accident is probably produced by a breakdown of a specific part of the heating unit made of plastic. A heating system> as a rule, has to keep water to a high temperature, under high pressure and flowing constantly. With the passage of time, the circuit becomes worn out allowing the escape of water at a high temperature and under pressure to penetrate through the heating grill near the pedal into the cabin where the driver is seated. The hot water produces the burn injuries as well as the steam that also dramatically reduces visibility. Both the pain and ‘blinding’ conditions brought about a very dangerous situation with a high risk of morbidity and even mortality.
24 (1998)
579-S80
The four patients had to be admitted to our Burn Unit. Three out of the four required tangential excision and splint skin grafting while the other one heaIed spontaneously with topical application of silver sulphadiazine cream. The extent, depth and burns localization in lower limbs, genitalia and buttocks place these patients in the moderate and major burns category following the ‘Classification of Burn Severity’ defined by the American Burn Association (ABA). It is likely that this kind of injury with such a specific origin has been observed at other hospitals. If this is so, this is an avoidable situation and health authorities should be informed because in these cases prevention can be easily achieved.
References Papaevangelou J, Batchelor JS, Roberts AHN. Motor vehiclerelated burns: a review of 107 cases. Burns 1995:21:36&g. King BG. Mothor vehicle-related burns. JAMA 1974;229: 1474, Renz BM, Sherman R. Automobile carburetorand radiator-related burns. J Burn Care Rehabil 1992;13:41~21. Al-Baker AA, Attallla MF> El-Ekiabi SA, Al Ghoul A. Car radiator burns: a report on 72 cases. Burns 1989;15:265-7. O’Neal N, Pardue G, Hunt J. Burns caused by automobile radiators: a continuing problem. J Burn Care Rehabil 1992;13:422-5. Klabacha M, Nelson H, Parshley P: Miller S, Demuth R, Pav J. Carburetor priming: a cause of gasoline burn. J Trauma 1985;25:10968. Schmitt BD. Gray JD, Britton HL. Car seat burns in infants: avoiding confusion with inflicted burns. Pediatrics 1978;64:6079. Carter BA. Car seat burns. Pediatrics 1983;72:918. [9] King BG, Abston S, Burke Evans E. A survey ot motor vehicle burn accidents in children: Report of 45 cases. J Trauma 1975;15:490-3. [lQ] Pearce RL. Burns from car heaters. Med J Aust 1975;1:270-1. [l 1] Motor vehicle-related burn injuries, Massachusetts. MMWR 198.5;34:597-600.
ELSEVIER.
Burns
24 (1998)
579-580
rn injuries following ex.plosion of car heaters D. Alonso *, J. Valero-Gasalla, M. Arnaiz, F. Martelo Bum
Unit,
Plastic
Surgery
Service,
Juan
Accepted
Canalejo
7 April
Hospital,
La Conma,
Spain
1998
Abstract
We report four casesof burn injuries inflicted by hot coolant after the explosion of the heating unit in Tour motor-vehicles of the same make and version, in similar circumstances while the patients were driving their cars. Burns of this type can cause considerable morbidity with an accompanying high risk of a traffic accident. 0 1998 Elsevier Science Ltld for ISBI. All rights reserved.
1. Introduction Burn injuries sustained from motor vehicles form an important group as has been reported [l, 111. Mechanisms of injury have a great variety: cdr fires following road traffic accidents [2], car radiator-related burns [3-51, carburetor-related burns [3,6], car seats in burns to infants 17, S] and inappropriate use of matches [9]. FOLW patients were admitted to the Burn Unit at .Iuan Canalejo Hospital in La Corufia over a 14 month period. The distribution of the burns characteristically affected lower limbs, genital area and buttocks. In all cases the injury was produced as a result of a breakdown of the car heating unit which allowed the escape of hot coolant and steam from it through the front panel to the driver seat. The make and model of the car was the same in all cases and the circumstances and nature of the accidents were very similar. Patients said that when they were driving normally they suddenly heard a noise like an explosion from the car engine and at the same time they felt a great pain from a burn injury produced by hot water and a steam jet flowing from somewhere just through the heating grill which is on the right side of the accelerator pedal. Two of the drivers lost control of their cars, one of them crossed the central line of a motorway to stop at
* Corresponding Surgery. General
author. Present address: Service Yague Hospital. Burgos, Spain.
3305-4179i98;$19.00 10 1998 Elsevier PII: SO305-4179(98)00072-2
Science
Ltd
for ISBI,
of
Plastic
All rights
reserved.
the other side, the other car ran off the road. The other two patients managed to stop their cars without further traffic problems.
2:. Case report Case 1: A 56 year-old male, hard working. He had sustained 18% body surface area (BSA) superficial and deep dermal scalds to both lower limbs and genital area when he was driving his van. The other people on board suffered no injuries. The patient was operated on 10 days following admission and he was discharged from hospital 17 d.ays after injury. Burn areas required tangential excision and skin grafting. Case 2: A 31 year-old male, goods vehicle driver. No other people were travelling in the van. He sustained 8% body surface area [BSA) superficial burn. The right buttock, posterior part of the right thigh and the dorsum of the right foot were the worst affected. He left the hospital on the 6th day after admission and all burned areas were allowed to heal spontaneously. Case 3: A 42 year-old male, hard working. He suffered from hypercholesterolemia as a major health problem prior to admission. He sustained 15% body surface area (BSA) scald burn. Only 1% was a deep dermal burn which had to be excised and needed skin grafting and the rest of the burn area was managed conservatively. The stay in hospital was 6 days.
580
D. Ahso
ei ~1. i Bum
Case 4: A 50 year-old male, hard working. He suffered from arterial hypertension and diabetes mellitus type II. He was driving his car, with no other person in the car, when a similar accident occurred. He had sustained a superficial and deep dermal burn covering 15% of the body surface and localized on right lower limbs and on the right buttocks. On day 6 postburn, debridement and split grafting were performed. His hospital stay was 18 days and pressure therapy in the form of a custom-made lycra garment was applied to the right thigh.
The cause and circumstances of the burn injuries reported in this paper are unusual. A review of bibliography (MEDIINE on Silver Plate 1966-1996) (Request: Automobiles and Burns), found only one paper in which similar cases were reported [lo]. Our cases :;howed that all patients were driving the same model of car and were injured in the same circumstances. At present we have not received any official explanation from the car factory manager but our investigations indicate that the accident is probably produced by a breakdown of a specific part of the heating unit made of plastic. A heating system> as a rule, has to keep water to a high temperature, under high pressure and flowing constantly. With the passage of time, the circuit becomes worn out allowing the escape of water at a high temperature and under pressure to penetrate through the heating grill near the pedal into the cabin where the driver is seated. The hot water produces the burn injuries as well as the steam that also dramatically reduces visibility. Both the pain and ‘blinding’ conditions brought about a very dangerous situation with a high risk of morbidity and even mortality.
24 (1998)
579-S80
The four patients had to be admitted to our Burn Unit. Three out of the four required tangential excision and splint skin grafting while the other one heaIed spontaneously with topical application of silver sulphadiazine cream. The extent, depth and burns localization in lower limbs, genitalia and buttocks place these patients in the moderate and major burns category following the ‘Classification of Burn Severity’ defined by the American Burn Association (ABA). It is likely that this kind of injury with such a specific origin has been observed at other hospitals. If this is so, this is an avoidable situation and health authorities should be informed because in these cases prevention can be easily achieved.
References Papaevangelou J, Batchelor JS, Roberts AHN. Motor vehiclerelated burns: a review of 107 cases. Burns 1995:21:36&g. King BG. Mothor vehicle-related burns. JAMA 1974;229: 1474, Renz BM, Sherman R. Automobile carburetorand radiator-related burns. J Burn Care Rehabil 1992;13:41~21. Al-Baker AA, Attallla MF> El-Ekiabi SA, Al Ghoul A. Car radiator burns: a report on 72 cases. Burns 1989;15:265-7. O’Neal N, Pardue G, Hunt J. Burns caused by automobile radiators: a continuing problem. J Burn Care Rehabil 1992;13:422-5. Klabacha M, Nelson H, Parshley P: Miller S, Demuth R, Pav J. Carburetor priming: a cause of gasoline burn. J Trauma 1985;25:10968. Schmitt BD. Gray JD, Britton HL. Car seat burns in infants: avoiding confusion with inflicted burns. Pediatrics 1978;64:6079. Carter BA. Car seat burns. Pediatrics 1983;72:918. [9] King BG, Abston S, Burke Evans E. A survey ot motor vehicle burn accidents in children: Report of 45 cases. J Trauma 1975;15:490-3. [lQ] Pearce RL. Burns from car heaters. Med J Aust 1975;1:270-1. [l 1] Motor vehicle-related burn injuries, Massachusetts. MMWR 198.5;34:597-600.