After Longview implosion, doctors explain severity of chemical burns

Dr. Mark Thomas was on call at the Legacy Oregon Burn Center on Tuesday when a message came in from a hospital in Longview.

About 50 miles away, PeaceHealth St. John Medical Center was caring for some of those hurt in the implosion at the Nippon Dynawave Packaging Co. facility, but a few injuries were too severe. Those patients needed to be sent south, to the nearest Level 1 trauma center with a burn unit.

There, Thomas, along with other surgeons, burn specialists and emergency room staff, got to work.

Everyone was obviously stressed, but they also did their jobs," said Thomas, associate director of the burn center, housed at Legacy Emanuel Medical Center in northeast Portland.

In what Gov. Bob Ferguson has described as perhaps the "deadliest industrial tragedy in modern Washington state history," eight people were confirmed dead as of Thursday and three others were likely killed.

As patients arrived at Emanuel, the challenge was immediately clear. They were exposed to a particularly dangerous chemical involving a strong alkaline substance called white liquor.

A caustic chemical used to break down wood into pulp, white liquor is like "really concentrated bleach," Thomas said. Exposure is especially concerning because of how deep it can seep into the body, he said.

"We always think about acid (burns) being the worst," Thomas said. "Alkaline substances are worse."

He continued, "Not only do you get skin involvement, but you get the underlying fat tissue, what we call adipose tissue, down into the muscle and even into bone."

Thomas has treated patients with similar chemical burns, but "nowhere near the extent that we encountered Tuesday," he said.

The first step was to prepare a decontamination center outside Emanuel's emergency department, making sure the facility and staff were not also exposed, he said.

Medical teams then doused the patients' skin with water and rinsed their eyes with saline, working to wash the chemicals off.

What then typically follows is supportive care with IV fluids and multiple surgeries, involving skin grafting and reconstruction of tissue, Thomas said.

He noted a body's normal pH is around 7.4, while white liquor's pH is up to 12 to 13, meaning direct contact with the skin can cause the cells to "essentially disintegrate."

So even if the skin is washed and decontaminated, white liquor can still sink into deeper tissues and "run its course of destruction on the body," he said.

The chemical can also produce hydrogen sulfide, a toxic fume that causes damage to the lungs. The combination of inhalation injuries and battling deep burns can put a lot of stress on the body, and can lead to complications involving other organs, Thomas said.

Dr. Barclay Stewart, a trauma, burn and critical care surgeon at UW Medicine, also pointed to concerns about eye injuries in instances of chemical exposure. Both the alkaline substances and fumes can lead to ulcerations on the cornea and ocular burns, said Stewart, associate chief of trauma and burns at Harborview Medical Center.

Major burn injuries are not conditions that can be "treated and done," Stewart added. "It's a chronic disease."

But with treatment and rehabilitation, many patients do get better over time, he said.

"There's a lot of hope" in recovery, Stewart said. He said there are patients who experience "post-traumatic growth," particularly after connecting with and finding community among others who have suffered similar burn injuries.

Stewart also praised teams at the Legacy Oregon Burn Center, which is verified by the American Burn Association and has trained for these types of responses.

"Legacy Emanuel is very well-versed as being a Level 1 trauma center and having a mass casualty incident plan, so they're as well-prepared as any hospital in the country to do this sort of work, Stewart said.

Two of those injured in the implosion continue to receive care at the Oregon Burn Center, according to Legacy Health. Five have been discharged.

"There's some individuals who will be with us for an extended period of time," Thomas said. "I offer my condolences to the victims of this tragedy because it is pretty severe and overwhelming."

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