Facial airway burns

Introduction

Explosions on ships often lead to facial burns and airway injuries, posing severe challenges to crew safety and health. These injuries can be life-threatening, particularly when thermal damage and swelling compromise the airway. Without prompt intervention, swelling of the larynx can obstruct breathing entirely, necessitating advanced procedures like tracheal intubation or, in extreme cases, a cricothyrotomy. The role of maritime medics is crucial in managing such emergencies, ensuring crew members receive timely care to stabilize their condition and improve survival outcomes.

Understanding Facial and Airway Burns

Facial burns caused by explosions often extend beyond visible injuries, impacting the respiratory tract. The following factors highlight the severity of these injuries:

• Thermal Injury to the Airway: Intense heat from explosions damages the mucosa of the upper airway, causing inflammation and ulceration.
• Rapid Laryngeal Edema: Swelling occurs within minutes to hours, significantly narrowing the airway and making breathing difficult.
• Inhalation of Toxic Gases: Explosions release smoke and harmful gases that exacerbate airway injuries, potentially leading to respiratory failure or long-term lung damage.

These injuries require immediate attention to prevent fatal outcomes. Delays in treatment increase the risk of total airway obstruction, necessitating invasive procedures.

Challenges of Managing Airway Burns at Sea

Addressing airway burns on ships far from shore is uniquely challenging due to limited resources and environmental constraints. Key challenges include:

1. Rapidly Evolving Airway Obstruction

Swelling and inflammation progress quickly following thermal burns. Without immediate intervention, the airway can become completely obstructed, leaving little time for medics to act.

2. Limited Medical Equipment

Many ships lack the advanced tools required for procedures like cricothyrotomy, leaving medics reliant on intubation as the primary intervention. The absence of ventilators and monitoring devices further complicates care.

3. Delayed Evacuation

Transporting critically injured patients to a medical facility may take hours or even days. During this time, the patient’s condition can deteriorate without proper onboard care.

4. Environmental Constraints

The ship’s movement, confined spaces, and rough seas make performing medical procedures even more challenging. Medics must work efficiently under these adverse conditions to stabilize the patient.

Importance of Maritime Medic Training

The skills and training of maritime medics directly impact the outcomes of airway burn emergencies. Comprehensive training programs equip medics with the knowledge and confidence to handle these critical situations. Key aspects of training include:

1. Tracheal Intubation Skills

Intubation is essential to maintaining an open airway. Medics must master:

• Techniques for intubation under challenging conditions, such as limited visibility and equipment constraints.
• The use of video laryngoscopes, which enhance visibility and increase success rates.

2. Cricothyrotomy as a Last Resort

If intubation fails, a cricothyrotomy may be necessary. This invasive procedure requires precise skills and sterile conditions. Although most ships lack specialized tools for this procedure, medics should be trained to perform it effectively in emergencies.

3. Recognition of Symptoms

Early detection of airway burns is critical. Medics must identify signs such as:

• Hoarseness or changes in voice.
• Singed nasal hairs and soot in the airway.
• Carbonaceous sputum and respiratory distress.
• Stridor or wheezing sounds.

4. Telemedicine Support

Collaboration with shore-based medical experts through telemedicine can provide critical guidance. Medics can receive advice on airway management techniques, medication dosages, and evacuation planning.

Frequency and Costs of Medical Evacuations

According to the International Maritime Health Journal, thermal injuries account for 15% of severe traumas aboard commercial vessels, with 30% involving the face and upper airway (Smith et al., 2018). In 25% of these cases, medical evacuation to the nearest port is required, resulting in significant operational and financial impacts.

The costs of medical deviations include:

• Fuel Costs: Unplanned deviations consume additional fuel, with expenses ranging from $20,000 to $50,000 depending on the distance traveled.
• Delays: Loss of charter time and financial penalties due to disrupted schedules.
• Indirect Costs: Reputational damage and loss of client trust following incidents can have long-term financial consequences.

Steps for Emergency Management

Effective emergency management requires a structured approach to stabilize the patient and ensure their survival. The following steps are critical:

1. Immediate Airway Assessment

Medics must evaluate the airway promptly, looking for signs of impending obstruction such as:

• Hoarseness or voice changes: These indicate swelling of the vocal cords.
• Stridor or wheezing sounds: These are warning signs of narrowing airways.
• Soot in the airway or carbonaceous sputum: This suggests inhalation of smoke or toxins.
• Burns around the nose, mouth, or face: Visible damage often indicates internal injuries to the airway.

Early recognition of these signs is essential. Medics must act quickly to prevent rapid deterioration, which could lead to complete airway closure.

2. Oxygen Therapy

Providing supplemental oxygen is one of the first interventions in cases of airway burns. Medics should:

• Administer oxygen using masks or nasal cannulas to maintain adequate oxygenation.
• Monitor oxygen saturation levels continuously using a pulse oximeter, ensuring they remain above 92%.
• Be prepared to adjust oxygen flow rates based on the patient’s condition to avoid hypoxia and further complications.

In extreme cases where oxygen is unavailable, medics must focus on ensuring airway patency through positioning and other supportive measures until oxygen can be administered.

3. Preparation for Intubation

Intubation is often required to secure the airway and prevent obstruction due to swelling. Steps include:

• Readying all necessary equipment: Ensure laryngoscopes, endotracheal tubes, suction devices, and airway adjuncts are sterile and functional.
• Performing pre-intubation assessments: Evaluate the patient’s anatomy to anticipate difficulties, especially in cases of significant swelling.
• Practicing techniques under pressure: Medics should regularly rehearse intubation in simulated scenarios to maintain proficiency.
• Considering alternative tools: If available, video laryngoscopes can improve visibility and success rates in challenging airway situations.

Prompt and skillful intubation is critical, as airway edema can make the procedure increasingly difficult or impossible over time.

4. Telemedicine Support

In complex or deteriorating cases, telemedicine provides an essential lifeline for medics aboard ships. Remote support includes:

• Consultation with shore-based specialists: Medics can receive step-by-step guidance on airway management techniques or medication administration.
• Real-time feedback: Sharing images or videos of the patient’s airway allows remote doctors to provide accurate assessments and recommendations.
• Guidance on evacuation decisions: Remote experts can advise when immediate evacuation is necessary or when the patient can be stabilized onboard.

Telemedicine bridges the gap between onboard care and expert medical advice, ensuring the medic is not working alone in critical situations.

5. Evacuation Planning

If airway stabilization cannot be achieved onboard, immediate evacuation to the nearest medical facility becomes essential. Medics should:

• Coordinate with the ship’s captain and telemedicine providers to identify the nearest port with advanced medical facilities.
• Ensure the patient’s condition is monitored during transport, using pulse oximetry and other available tools.
• Maintain communication with the receiving medical team to provide a detailed handover, including all treatments administered onboard.

Evacuation planning should include contingency measures to address potential complications during transport, such as worsening airway obstruction or oxygen supply shortages.

Conclusion

Facial and airway burns caused by explosions on ships require immediate and skilled intervention. The expertise of maritime medics in airway management, symptom recognition, and telemedicine collaboration is vital for ensuring survival. By investing in advanced training and equipping ships with the necessary tools, the maritime industry can significantly enhance crew safety and reduce the operational and financial impact of such emergencies.

References

• Smith, J., & Brown, K., “Thermal Injuries in Maritime Settings: A Review”, International Maritime Health Journal, 2018.
• Wilken, J., “Burn Injuries at Sea: Challenges and Costs of Deviation”, 2015.
• Tansley, G., “Economic Impact of Medical Emergencies on Commercial Vessels”, 2020.

Frequently Asked Questions

1. What are the main risks of delaying the treatment of airway burns at sea?

   • Delaying treatment can lead to severe hypoxia, causing damage to vital organs like the brain and heart.
   • There is an increased risk of infection in the injured airway, which can worsen the condition.
   • More invasive procedures, such as tracheostomy, may be required, which are challenging to perform on a ship.

2. What is the importance of psychological support for the crew after emergency incidents?

   • Psychological support helps the crew manage stress and fear after serious incidents.
   • It reduces the risk of developing disorders such as post-traumatic stress disorder (PTSD).
   • It boosts the crew’s confidence in handling future crises.

3. How can technology assist in better managing burn incidents at sea?

   • Use of portable devices to monitor vital signs in real time.
   • Electronic applications that provide guidelines for emergency medical interventions.
   • Telemedicine systems that connect rescuers with specialized doctors onshore.