Pyroclastic flow injury. Mount St. Helens, May 18, 1980.

Three patients who were on the periphery of the pyroclastic flow of the Mount St. Helens eruption on May 18, 1980 were treated for severe thermal and inhalation injuries. Although exposed in identical manner, two patients arrived with heavily colonized burn wounds and developed adult respiratory distress syndrome leading directly to their death, whereas the third patient, with a noncolonized burn wound and little evidence of adult respiratory distress syndrome, survived. Evidence of inhaled ash complicating various stages of adult respiratory distress syndrome was confirmed by energy dispersive roentgenographic analysis. In the Pacific Northwest, Alaska, and the Aleutian Islands, potential for further injuries of this type in even larger numbers exists. Should these occur, those who treat the victims should be aware of the potential for severe inhalation problems in addition to the obvious burns.