“A bizarre and fateful coincidence.” Paul van Zuijlen, at the time a doctor in training in the plastic surgery department at the Beverwijk Burn Center, has recently given several interviews in which he looked back on the New Year’s fire in ‘t Hemeltje in Volendam – 25 years ago this year. He talked about rows of victims. About the intensive care unit that was full. About the lessons that burn care had learned from it.
And just when he thought his last interview had been published, . A fire broke out in a bar in the Crans-Montana ski resort. Now, a day and a half after the incident, it is clear that approximately forty people have died and more than a hundred have been injured. More than twenty injured people were burned to more than 60 percent – that is
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Van Zuijlen, now medical director of the burn center in Beverwijk, immediately took action. His hospital, like the Maasstad Hospital in Rotterdam and the Martini Hospital in Groningen, has offered to accommodate victims. There are six Dutch beds in total
“A lot has to be coordinated,” says Van Zuijlen. How many beds are available? Can we offer that too? Does the minister agree? “It was now possible to get in no time to be ready to offer assistance.”
Transport to the Netherlands
As far as we know, there are no Dutch people among the victims. If Switzerland actually calls on the Netherlands, victims will probably be transported by plane. That is “tricky,” says Van Zuijlen.
“When you take off, the air pressure in the cabin drops. This can cause the lungs to fill with fluid.” Yet in these types of situations, flying is almost always chosen. “You want treatment as quickly as possible.”
In the first few days it is especially important that someone survives, says Van Zuijlen. And so a doctor looks “beyond burns” alone. In the worst cases, they are “not the most deadly.” Sometimes the airways themselves are burned, which must be secured with a tube so that someone can continue to breathe. The large amount of fluid that someone ‘leaks’ also poses a risk. “Sometimes you have to give someone 20 liters of fluid in one night.”
During the first few days you can give wounds the opportunity to heal themselves, says Van Zuijlen. But third-degree burns – where both the epidermis and dermis are burned – never recover on their own. With surgery, ‘good’ skin from the body can be used to ‘close’ the damaged parts.
Popular locations for this are the thigh and scalp. That last option sounds crazy, but “then you shave someone’s head and as soon as the hair has grown back, you no longer see the scars.” Crucially, if someone has more burns, they by definition also have less good skin to treat those burns. Donor skin can only help temporarily. “That works well as a ‘bandage’, but your body will always eventually reject it.”
Psychological effect
It can take months before someone leaves the hospital. “You cannot simply ‘close’ a body that is 80 percent burned.” People often get infections. After a coma, the muscles need to strengthen. And then there are the scars. “They will never go away.” That also has a psychological effect.
The fire in Switzerland is, says Van Zuijlen, an “extreme” contrast. Party, and then the blackest thing you can imagine in one go. But just like in Volendam, the doctor does not let the suffering get under his skin too much. “I can’t do anything about the fact that people have terrible injuries. What I can do about it is help them get better.”
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