• Lorenzo Gamberini, Guglielmo Imbriaco, Alfonso Flauto, Alessandro Monesi, Carlo Alberto Mazzoli, Cristian Lupi, Daniela Maria Roberta Costa, Fabio Mora, Oscar Dell'Arciprete, Fiorella Cordenons, Cosimo Picoco, and Giovanni Gordini.
• Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
• J Emerg Med. 2021 Apr 1; 60 (4): 471-477.

BackgroundThe catastrophic fail of a container holding a pressure-liquified gas can generate a boiling liquid expanding vapor explosion (BLEVE) with a subsequent blast wave, flying fragments, and fire or toxic gas release.Case ReportThis report describes the management of a mass casualty disaster related to a BLEVE in an urban area due to a highway accident involving a tanker carrying liquified petroleum gas and a truck transporting chemical solvents. The event resulted in 158 casualties that were triaged, stabilized, and transported into the "hub" and "spoke" hospitals of the regional trauma network within 3 h and 22 min from the event by the Emergency Medical Services. The logistic complications related to the partial collapse of the highway bridge on an underlying urban road and the relative solutions adopted, as well as the application and advantages of the use of the Simple Triage and Rapid Treatment (START) algorithm in the field and the criteria adopted for the distribution of patients within the trauma network, are discussed, along with the potential pitfalls observed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: BLEVE events are rare but can be complex in both logistical management and clinical presentation of the lesions related to the event. The START algorithm is a valuable tool for rapid triage in mass casualty incidents.Copyright © 2020 Elsevier Inc. All rights reserved.

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