Inhalation of smoke or vapour cloud from LiBs

Kristina Stiles, Plastic Surgery Clinical Nurse Specialist (Bank), King’s College Hospital NHS Foundation Trust has drawn my attention to some very interesting presentations and posters at the joint British Burn Association and International Society for Burn Injuries Congress in August 2024. These were describing the treatment of casualties from escooter and ebike fires.

Christie Brennan, Burns and Plastic Surgery, North Bristol NHS Trust Southend Hospital reviewed 40 cases from the UK International Burn Injury database from 2016 – 2023 which showed that the length of stay in hospital increased from 1 to 14 days with a concomitant 14-fold increase in cost. This increased demand on resources was a common theme.

Dr. Sharon Kennedy of St James’ Hospital, Dublin reviewed a case involving a male patient caught in an ebike fire. The patient had profound acidosis and elevated carboxyhaemoglobin level on admission and was treated by incubating with high oxygen. However, gas exchange was poor and the patient developed acute respiratory distress syndrome (ARD) which required protracted ventilation for 32 days. Computed tomography of the thorax during admission showed symptoms consistent with chemical pneumonitis. Kristina states that when the presence of hydrofluoric acid was realised and nebulised calcium gluconate gel administered, the patient started to show improvement, and was discharged after 43 days of treatment.

Dr Peter Berry of St Andrew’s Centre reported a study on 7 burns patients, all male, with burns on 12 – 63% of the total body surface area. The mean length of stay in Intensive Care was 22 days. As well as burns, several suffered severe respiratory problems.

Kristina concludes “As you can see from the abstracts, our critical care colleagues are good at managing symptoms and supporting organ systems, but any delay to definitive treatment will cause long term and chronic morbidity to our patients, and for some may result in death”.

I also suggest that first responders not equipped with BA take extreme care when dealing with the fumes or vapour cloud from even small lithium-ion batteries (escooters and above).