Record Low 3% Mortality Rate
Taiwan’s Burn Care Shines on Global Stage
Taiwan’s response to an amusement park tragedy that left hundreds of revelers severely burned prompted over 300 medical professionals to travel to Taipei to learn about the experience at a global conference. The last survivor to be discharged as well as her attending physician shared with CommonWealth what they went through nearly two years ago.
Taiwan’s Burn Care Shines on Global StageBy Patty Yen
From CommonWealth Magazine (vol. 619 )
Han Ning is one of the survivors of the tragedy that took place at a Color Play Asia party held at the Formosa Fun Coast amusement park on June 27, 2015. Injured in the accident, she was taken to the Intensive Care Unit at Mackay Memorial Hospital in Tamsui. As her situation took a turn for the worse after three days in the ICU, from out of her comatose state she overheard the doctor telling her mother, “You should start making funeral preparations in the next couple of days.”
Born in 1993, Han Ning suffered burns over 80 percent of her body. Now, sitting across from the reporter wearing light makeup, a contented smile on her face, she relates her phoenix-like rebirth in the wake of the ordeal.
From April 1-4, 350 of the Asia Pacific region’s most accomplished and renowned medical professionals will assemble in Taiwan for the 11th Asia Pacific Burn Congress (APBC). One symposium on Day Two of the conference, entitled “Formosa Fun Coast Dust Explosion Disaster,” will specifically address the tragedy and the efforts that saved Han Ning and her fellow victims from death’s door.
The 499 officially documented Formosa Coast colored powder explosion victims ranged in age from 18 to 25 at the time of the incident, averaging burns over 40 percent of their bodies, and resulting in 15 fatalities to date. “Had the Formosa Fun Coast disaster not set a record for the lowest fatality rate at just three percent, shocking the world, Taiwan would likely never have been selected to host the APBC,” relates Kwang-Yi Tung, head of Plastic and Reconstruction Surgery at Mackay Memorial Hospital in Taipei.
The Formosa Coast tragedy helped catapult Taiwan’s burn trauma medicine to international prominence. The tireless efforts of Dr. Niann-Tzyy Dai, president of the Taiwan Society for Burn Injuries and Wound Healing, were instrumental in the establishment of the Asia Pacific Burn Association this past January.
Dr. Dai, the association’s first president, is director of the plastic surgery and burn center at Tri Service General Hospital in Taipei. Like the International Society for Burn Injuries and the American Burn Association, the Asia Pacific Burn Association is an international academic society dedicated to the study of burn trauma and treatment.
Given fears of mass burn victims in a possible terror attack, and Taiwan’s superior survival rate among burn victims in the same age group at the Formosa Coast powder explosion, the U.S. government is sending a delegation of over 10 representatives from U.S. health agencies and the medical community to attend the Asia Pacific Burn Congress, hosted by the APBA. Disaster management and burn treatment with respect to terror attacks is among the topics of discussion at the congress.
In response to requests from medical communities around the world, Dr. Dai has developed a 48-hour advanced emergency burn care (AEBC) course. He will unveil the program for the first time at the congress.
Sharing Response Lessons
Dr. Dai will open the conference with an address entitled “Burn Disaster Management, Stabilization, Transfer and Transport.” Recalling the Formosa Fun Coast dust explosion, nearly 500 burn victims descended en masse on area hospitals. “When so many patients with such extensive burns flooded in, most people presumed the mortality rate would skyrocket. So how did Taiwan respond right from the start to lower the mortality rate?” asks Dai.
Two hospitals received a quarter of the burn victims, the largest proportion of those caught in the conflagration at Formosa Fun Coast. Tri Service General Hospital sectioned off regular patient rooms to form a special burn unit, and in order to accommodate more patients, the Mackay Memorial Hospital’s Tamsui branch repurposed a bone marrow center that had not yet become operational into a temporary burn care center.
For mass-scale burn victims, the critical life-or-death period is known as the “acute phase.” Han Ning was one of 22 patients placed on life support using intubation at Mackay Memorial Hospital. “I woke up at two in the morning wondering, where am I? I wanted to speak, but something stuck in my throat prevented me from saying anything,” she recalls. Suffering from severe inhalation injury, she was unable to breathe without the aid of a respiratory tube.
On the third day the doctor declared her in critical condition. Her body in a state of shock from her burns, she required large fluid transfusions and expensive protein nutrition injections, and attentive nurses had to be vigilant to keep her wounds from getting infected to stabilize her vitals and keep her alive.
“The hospital agreed to give full support to provision of medical supplies, medicines, and cadaver skin, and some hospitals even brought out ECMO machines for the victims,” recalls Kwang-Yi Tung. Tung believes that government promises made within the first two days were absolutely key, and that donations from the public all around Taiwan helped doctors put all their energy into saving lives.
Han Ning’s mother stayed outside the ICU at all time. “Even in a coma, patients need a lot of mental support,” says Lu Pi-yi, Formosa Fun Coast explosion incident case manager. Mrs. Han asked nurses to constantly play recordings at her daughter’s bedside in hopes of rekindling her will to live.
Taiwanese diva A-Mei (Chang Hui-mei): “Han Ning, you can pull through! You can do it. Go, go, go! I love you.”
Foxconn founder Terry Gou: “…I hope you can be strong, strong, and even stronger.”
“In my daze, these sounds went from distant to near, indistinct to clear. They got closer and closer, until they reverberated in my ear,” recalls Han Ning, who finally regained consciousness.
“How come there’re recordings of A-Mei and Terry Gou’s voices?” asked an incredulous Han Ning shortly upon awakening. As it turns out, A-Mei is the main force behind Boxing, an urban Latino rap group formed by her brother. And it was he that asked a favor of A-Mei. Han Ning is also a great admirer of business magnate Gou, whom she met on one occasion, and her cousin reached out to him in a letter. Throughout it all, the Yonglin Health Foundation, operated under the auspices of Gou’s Hon Hai Corporation, has stood by Han Ning.
For Han Ning, the real pain began after she woke up. Head lowered, she recalls, “Cleaning the wounds and changing the dressing by removing the gauze, was the worst as it ripped the skin with it.”
However, Tung stresses that cleaning and dressing wounds is critically important. “Only when wounds are cleaned thoroughly to eliminate infections and dead tissue can skin grafts be performed and wounds finally healed,” he offers. With that in mind, he established two dedicated wound cleaning and dressing units.
With a unit of 10 to 13 medical professionals, they changed dressings for the patients twice per day. It normally takes a nurse five minutes to change dressings each time, however, it took a half hour to change each severe burn victim’s dressing. Facing a manpower shortage, Mackay Memorial Hospital head nurse Lin Mei-ling recalls, “The previous shift stayed another three hours on their own to help out with the next shift, stacking manpower to make up for the shortfall.”
Every burn victim underwent at least 10 operations, and Tung performed operations nearly every day. Facing a serious shortage of surgeons, hospitals called on several dozen surgeons that had left the hospital care field for private practice. With them back in the fold as volunteers, everyone made it through the difficult time.
“Would you mind not taking any more of my scalp skin? I’m afraid I’ll never grow hair again,” complained Han Ning to attending physician Dr. Chia-Meng Yu, director of Mackay Memorial Hospital’s burn center. Han endured a total of 10 scalp surgeries.
Areas affected by third-degree burns do not have functioning hair follicles and sweat glands, which must be replaced with grafts of endogenous skin. Donor skin is typically taken from the thighs, scalp, and back; however, severe burns to all four limbs limited usable donor skin. Yu explains that Han Ning also suffered burns over her back, leaving only scalp skin for grafting. With an abundance of hair follicles and strong regenerative capacity, it can be harvested repeatedly.
Extensive use of the Meek skin graft technique was made. According to Tung, this technique can expand a four-by-four centimeter area of scalp skin up to nine times, making it heavily relied upon for skin replacement in this case.
Enduring excruciating torment, Han Ning drew comfort from reading Bible verses such as Psalm 23:4: “Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me.” She was later baptized in her hospital room, drawing the strength to make it through from her mother’s love, recordings, and prayer, observes Lu.
Keeping going, even when bleeding
Holding the ideal of every patient being able to walk out of the hospital, Mackay Memorial Hospital begins the rehabilitation process from the patient’s first day of admission, relates Lu. In the United States, physical therapists, social workers, occupational therapists, physicians, and nursing teams are viewed as a standard burn treatment team, an approach that will be introduced to regional countries at the Asia Pacific Burn Congress.
Unable to bear the searing pain of the tug of wounded tissue, some patients can only make it through with the aid of morphine. Rehabilitation begins with being able to stand up and sit down, and after a month and a half, Han Ning was starting to stand and practice walking. She started from one step, then two, but blood often seeped from her wounds when she walked. Two weeks later she was able to walk to a fellow victim’s room next door and say, “You can do it!” But the next day when her wounds were being re-dressed the skin on her thighs ruptured once again.
Han Ning watched as one fellow victim after another was released from the hospital, yet she was still unable to straighten her left arm due to scar contracture. “That’s no good. Straighten your arm,” ordered Yu. As Han Ning recoiled in pain, the doctor forced her arm open, in an instant breaking up the thick scar tissue, which throbbed and shook in intense pain until surgery the next day.
Having made it through the final obstacle, now able to straighten her arm, Han Ning finally went home in November, the last of Mackay’s patients discharged. And according to Lu, she also owns the distinction of staging the fastest recovery following her discharge.
“He is the one I hated the most at the time, and the one I’m most grateful to now. If he hadn’t pushed me I would be in far more pain today,” says Han Ning, describing her heartfelt thanks for Dr. Yu’s genuine caring.
Spared from death, life’s struggles had only just begun. “They will always bear mental and physical scars,” relates Yu. Beyond the physical marks on the body, third-degree burns interfere with perspiration, causing abnormal heat regulation and constant itching.
Dressed in long sleeves and pants, and wearing a rich variety of expressions on her face, Han Ning still has light scars on her hands and arms.
Working on the final part of his post-discharge patient evaluation of Formosa Fun Coast explosion victims, Yu has discovered that a small portion of patients have sequestered themselves at home since their release from the hospital, prevented by their physical and emotional scars from going to work or school. He appeals to them, “You must summon the courage to get out there!” The final arbiter of whether or not they have recovered is not their discharge from the hospital, but whether they are able to return to society, their families, or start a new family.
From near-death critical condition to her hospital discharge, Han Ning rose like a phoenix from the ashes. Immediately following her release, she went back to work as a military police officer at the Presidential Office Building in Taipei. Being in the military was always her dream job, and her escape from death and recovery has been a huge inspiration to her fellow soldiers. She has been made a military recruitment ambassador for her hometown of Pingtung, and her story will be recounted with admiration at the Asia Pacific Burn Congress.
Under the warmth of spring, Han Ning joins her fellow burn victims, now friends, as they move into a future filled with love and warmth, welcoming hope and blessings together.
Translated from the Chinese by David Toman