Burns expert: White Island victims facing months of fighting for their lives

Australian and New Zealand Burns Society president and burns consultant Jeremy Rawlins in the operating room. Photo / Jeremy Rawlins

WHITE ISLAND ERUPTION - AT A GLANCE
- 14 patients in four hospitals around New Zealand – Middlemore, Hutt Valley, Waikato, Wellington and Christchurch. 10 are critical.
- Of those, eight patients being treated at Middlemore Hospital, two at Waikato Hospital, two at Hutt Valley Hospital and two at Christchurch Hospital.
- 13 have been transferred to Australia. There are no further international air movements planned at this time.
- There are 16 deaths confirmed by police including a man who is understood to have died in hospital in Australia.
- Two people remain unaccounted for on or in the vicinity of Whakaari/White Island.

Victims injured in Whakaari/White Island eruption could be fighting for their lives for months, a medical burns expert says.

Normally, burns patients can expect to stay in hospital about one day for every percentage of burn covering their body - for example someone with 30 per cent burn coverage will likely spent about 30 days in hospital.

But in this case, the recovery time is likely to be twice as long due to the complexity of the burns.

That's according to Jeremy Rawlins, president of the Australian and New Zealand Burns Association and a burns consultant at Fiona Stanley Hospital in Western Australia.

Jeremy Rawlins.

"What we know about the patients being treated in New Zealand and Australia is that they have very complex mechanisms and patterns of burn injury.

"There's been thermal heat, chemical burns. There's been a degree of blast injury so these people have experienced an explosive type of injury when the volcano erupted."

He said speaking to some of his colleagues in Auckland they have been really overwhelmed and slightly surprised by the amount of blast injury they were dealing with.

"Some of these injuries are more akin to blast explosion injuries that we tend to see in military settings.

"These patients are in for a real long haul because they are not just in for a simple thermal burn from a bush fire, these are far more complex than any of us have ever seen."

For the next couple of months, patients will be undergoing multiple surgeries for skin grafting.

"For patients who have 30 to 80 percent burns with limited healthy skin left on their body grafting will need to be staged."

Surgeons will take a 15 per cent graft and then wait two or three weeks for the wound to heal and then go back and take more skin from that same spot.

Rawlins said the difficulty with treating patients in a slow staged process like this was that they become more prone to infection.

"These infections can be catastrophic and can be the final straw resulting in death which can be really devastating because you think you've got the patient through and then they succumb to a bad infection and still die.

"I think these patients will be under intensive care for the next few months," Rawlins said.

To help avoid infection, artificial skin - some made from cow skin collagen and shark fin - and skin donated from deceased people are used to temporarily cover and dress the burns. This can cost up to $1500 for every piece which is roughly 10 by 25 cm.

People pay tribute of victims of the White Island eruption. Photo / Alan Gibson

After surgeries are complete, patients will be moved into the hospitals' standard burns ward for "very intense" physiotherapy.

Once patients are discharged from hospital they will likely require regular follow-up visits for the next two years. This can be as often as twice a week which means most patients will need to stay in the city where the nearest burns unit is.

On the up side, Rawlins said with advancements in modern medicine, their prognosis is much better than it would have been two decades ago.

White Island shortly after the eruption. Photo / White Island Flights

"The old rule used to be if your age and your burn size exceeded 100 then you wouldn't survive. As any example if you were 40 years old and had a 65 per cent burn which comes to 105 then that would be totally unsurvivable.

"Nowadays, that equation is out the window. Someone with a reasonable level of fitness regardless of their age could survive so we would expect in wealthy countries like New Zealand and Australia, these patients will survive."