This is the text content of a poster presented about a train disaster in Russia in 1989 TRAIN EXPLOSION DISASTER ADLER - NOVOSIBIRSK LINE URAL MOUNTAINS - USSR JUNE 3rd,1989 PADDY DEWAN - DUBLIN/MELBOURNE PAEDIATRIC SURGERY SENIOR REGISTRAR HUGH SEATON - BRISTOL/SYDNEY ANAESTHETIC REGISTRAR At 23.14 hrs on June 3rd, 1989 two trains were passing each other in a valley in the Central Russian district of Bashkiria (See Map). One train was departing from a family camp, the other was travelling to the same summer holiday location. The valley in which they crossed had became filled with a mixture of volatile gas from a rupture in the enormous Trans-Siberian pipeline. Sparks from the trains caused an explosion equivalent to a 10-kiloton bomb (Fig.2-5). Scores of people were killed and 762 were hospitalized with flash burn injuries. Many of the victims were children. The injured were transported to burn centres in Ufa, Chelyabinsk and secondarily, Moscow. Burn relief teams were mobilized from around Russia, and from England, Ireland and the USA. The team from England and Ireland consisted of 8 surgeons, 3 anaesthetists, 4 nurses, and a dialysis team of 3. In Chelyabinsk (Fig.6), the burn unit had been expanded to encompass three floors of the main hospital building (Fig.7), and the infectious diseases ward of the children's pavilion was converted into a paediatric intensive care unit (Fig.8). Our team (Fig.9) was divide into units and attached to different wards with interpreters constantly available. The team from America was sent to Ufa, to the west of the Ural mountains. We arrived on the 9th of June into a formerly closed area of Russia; to the heat, humidity and mosquitos of a mid-USSR summer. The instant and fluid balance deaths were over; we had arrived in time to see the septic deaths. Of the people who survived the explosion, 180 were transferred to the burn centre in Chelyabinsk and eighty died in the first week, having suffered flash burns in excess of 40% body surface area. The majority of patients had upper and lower limb, and facial burns and were less severely burnt in areas where they were covered with clothing (Fig.10). The number and severity of burns to hands and feet were particularly note-worthy (Fig.11). Some victims had superficial burns over a wide area and a small number were lucky enough to have superficial injuries to confined areas (Fig.12). Amongst the survivors, respiratory burns, shock lung (Fig.13), renal failure, gastrointestinal haemorrhage and infection (Fig.14) were major problems, contributed to by the isolation of the disaster site and consequent delays in instigating active resuscitation. Many of the patients had large area superficial burns, which were left open. Many patients were nursed on netting beds with fan heaters in the rooms (Fig.15). Others were wrapped in gauze dressings which were subsequently changed under ketamine anaesthetic (Fig.16); these patients were to be grafted at 3 weeks post burn. Fluids were administered through central venous lines (Fig.17), antibiotics were given only for sepsis and antacids were used routinely. Early excision for full thickness burns was not performed as the manpower had not been available in the first few days after the accident, and economics dictated that glass syringes (Fig.18), instruments, and gloves were washed in antiseptic and reused. The Soviet Fund For Children played a major role in the looking after the general well-being of the younger victims, which included providing them with toys (Fig.19). Now that large numbers of people congregate in small areas, the potential for multiple injuries from one incident is ever increasing. Earthquakes, plane crashes, bombs, civil unrest, stadium and railway station fires and uncontrolled crowds have all recently featured as the cause of large numbers of people being injured. A system is needed to enable a rapid response of appropriate medical teams to these events and the methods used by Russia, and their degree of success, provide useful insight. The teams that went into Russia were recruited by Russian Government calling selectively on Ireland, England and America for trained staff appropriate to the need. Similarly, staff from all over the USSR were seconded. Also, The World Association for Emergency and Disaster Medicine provided an anaesthetic team from Bristol. Unfortunately, our arrival at the treatment centre was both late and early; too late for the resuscitation phase and too early for the grafting, indicating that appropriate recruitment networks need to be established before such events. However, on this occasion, the patient management and relief exercise co-ordination were well performed under the circumstances. Fortunately, some of the children were able to smile at the prospect of returning home (Fig.20 & 21), but the enormity of the tragedy will live-on in their minds, and in the minds of the relief team members.