Repost from The Star Tribune, Minneapolis MN

Twin Cities hospitals are front line in treating Bakken burn victims

There are no specialty centers near Bakken fields.

By Maya Rao, February 14, 2015

Flames seared the pants off Kyle’s legs as he raced across a bed of ruddy red rocks, screaming for help.

A pipe on a machine processing oil at high heat had burst, soaking him in methanol and sparking a fire.

“You could just feel it cooking my legs,” he said. “It almost sounded like chicken frying in an oiler.”

Hours later, Kyle woke up at Regions Hospital in St. Paul last month, after a 600-mile plane ride from the oil fields of North Dakota. His legs were burned so deeply that the bottom layer of skin would never grow back. It was the worst pain he’d ever felt.

Burn injuries among North Dakota workers have surged to more than 3,100 over the past five years, as the once nearly barren prairies have become the epicenter of a massive oil-drilling boom. Despite the flammability of Bakken crude and the danger of oil-rig work, North Dakota has no burn centers. The Twin Cities is the closest place to go for patients like Kyle, 27, who agreed to be interviewed on the condition that his last name not be used.

While other kinds of injuries may be more common, oil field burns are among the most painful and costly to treat. An oil field worker’s treatment at a burn unit can cost $1 million.

“The burns from the oil fields can be pretty dramatic,” said Bill Mohr, a surgeon at Regions.

Just 17 percent of North Dakota residents can be transported by air or ground to a burn center within two hours — fewer than every state but Alaska and Montana. The extra time it takes to move patients poses a medical challenge, since care administered in the first day factors into burn patients’ long-term recovery.

Mohr said oil field burns are three or four times bigger than those of the average patient and that Bakken burn victims who come in to Regions are more likely to need ventilators.

One died after arriving with 98 percent of his body burned. Some needed limbs amputated and had burns that bore down into the bone. Many never returned to the oil fields.

Shortage of burn doctors

Hospitals nationwide have been closing burn units and are grappling with a shortage of burn doctors. States with low populations, like the Dakotas, Montana, Wyoming and Idaho, have not been able to justify opening such expensive, specialized facilities.

When a truck carrying crude crashes and explodes, or an oil rig blows out, burn victims are initially taken to a hospital in the Bakken. The staff assesses whether the burns are severe enough to fly them to burn centers in the Twin Cities, Salt Lake City or Denver.

Gary Ramage, medical director at McKenzie County Healthcare Systems in North Dakota, said he sends patients out of state if the burns affect their respiratory system, face or hands — the most difficult areas to treat — and at least 10 percent of their body.

Oilfield workers are brought to Regions almost once a month, including a patient last month who had been working on an oil heater near Mandaree, N.D., that ignited. He died.

Another dozen Bakken burn victims have been treated at the Hennepin County Medical Center in the last three or so years, according to its burn unit director, Ryan Fey.

HCMC paid closer attention to oil field burns after a train carrying Bakken crude derailed in Casselton, N.D., 13 months ago. While no one was injured, members of the medical staff are examining how they would address an oil train accident that caused mass burn injuries.

“That’s become more and more of an issue because we have all these Bakken oil trains that come rolling through just one after another,” Fey said.

Bakken hospitals are looking at how to improve burn care. Two nurses at St. Joseph’s Hospital in Dickinson, N.D., recently traveled to a Galveston, Texas, hospital to learn burn management techniques. And doctors at Regions regularly travel to the Bakken to talk to medical staff about treating burns in the early stages.

Serious oil field burns destroy what’s known as the dermis, or the thicker, second layer of skin that contains blood vessels and sweat glands. Burn doctors excise the damaged skin to prevent infections. Then they apply bioengineered tissue made of cow collagen and shark cartilage to function as the new dermis. They harvest the top layer of skin from a healthy part of the body and graft it over the artificial skin tissue.

Even after recovering from those surgeries, patients must still do months or years of physical therapy to fix the loss of flexibility in their skin. And then there is the emotional recovery: Severe burn patients can face post-traumatic stress disorder on par with soldiers.

Lighting a cigar

Advances in burn treatment mean that some oil workers who would have died a decade or two ago now have a chance.

One is Casey Malmquist. The head of a Whitefish, Mont., construction company, Malmquist came to the Bakken to build housing for oil workers. In July 2013, he stepped onto the deck of one of the newly finished homes for Halliburton employees and leaned over to light a cigar.

There was a whoosh and then an explosion. He flew off the deck. His shirt, he recalled, lit up like a lantern.

The cause appeared to be leaking propane gas that had not been properly odorized to alert him that he was near a flammable substance. He fell into a coma and woke up three weeks later at Regions, 68 percent of his body burned. The Bemidji native, then 56, seemed destined to die.

But after three months at Regions and many surgeries, Malmquist returned to Montana. He still goes to physical therapy daily and hasn’t returned to some of the activities he once loved, like hockey, because his skin is fragile and managing his body temperature is difficult.

He said living in his new body “is like wearing a wet suit that’s five times too small, and there’s ground glass between you and the wet suit.”

In November, Minneapolis attorney Fred Pritzker sued Horizontal Resources on Malmquist’s behalf, claiming the company was negligent in not odorizing the propane.

Nightmares

Kyle moved to Williston, N.D., in 2011 with his pregnant wife, Shawna, after he was laid off as a plumber in Helena, Mont.

He found work as a maintenance roustabout, checking oil tanks, pumping units, well heads and other equipment.

Last month, Kyle and a co-worker went to an oil pad just south of Ross, N.D., and noticed a unit by the oil treater was frozen. Oil treaters separate oil from water and gas before it moves to storage tanks. After they worked to thaw it with water from a hot oil truck, Kyle said he tried to fix a misplaced valve.

A pipe blew out and soaked him with gas. It was so uncomfortable that he took off the flame-retardant pants over his jeans just before a fire ignited.

Several men who saw Kyle ablaze tackled him and blasted him with a fire extinguisher, ordering him to roll on the ground.

As the ambulance took him to a hospital in Stanley to be stabilized, Kyle said he thought, “How am I going to support my family now?”

He woke up in Regions with a breathing tube, his legs stapled and wrapped in casts.

Kyle can walk; he strode down the hall to pick up Forrest Gump from the hospital’s movie selection after his wife joked that she’d make him watch Titanic. But it hurts.

As OSHA investigates, Kyle said he doesn’t blame his company and considers it a freak accident. He hopes to get his old job back one day.

Memories of the fire shake him. “I keep having nightmares about it,” Kyle said. “I’ve been trying to take a nap all day and … I jump and think that I’m back in the fire.”