On 9th December 2019, White Island in New Zealand erupted when 47 people were on or near the island. At the time of eruption, they were broadly separated into three groups; one group nearing the crater (most suffered immediate loss of life), another group headed back to the jetty, and a group of five who had arrived on a tourist helicopter. Of the initial survivors, 31 (age range 13-72) sustained extensive burns requiring admission to Plastic Surgical departments around the country. The average Total Body Surface Area (TBSA) burn was 45% (range 7-90%). Distribution and severity of injury varied according to proximity to the crater and therefore exposure to blast injury, thermal injury and acidic ash from pyroclastic flow.
Within a few days of the eruption, increasing distance from the eruption was correlating with survival. Clothing and personal protective equipment influenced burn distribution. Patterns of injury were unique to this incident and consistent among many survivors. These included severe burns to both palmar and dorsal hands with sparing of feet, scalp, perineum and perioral areas. These burn distributions naturally impacted upon the surgical management including donor site availability. Those with perioral sparing from use of masks had less significant inhalation injury.
We report on patients cared for at the National Burn Centre for New Zealand. Specifically we consider how burn distribution and survival was influenced by location on the island during the eruption, extent of clothing and use of masks, behavioural responses and first aid, exposure time and extraction methods.