Paediatric alkaline and thermal burn injury due to airbag deployment: A public health risk

Abstract

A 4-year-old boy (forward-facing, restrained front-seat passenger) was involved in a road traffic accident resulting in the deployment of the ipsilateral airbag. During activation, airbags expel sodium azide, which oxidizes immediately on exposure to the air producing sodium hydroxide. This potent alkali, in combination with the high-temperature gases released, can cause burns. In this case, both chemical and thermal burns were sustained to the left side of face. An element of mechanical friction burn was also apparent. On admission, the child had oedematous lips and facial swelling, in addition to 2% superficial partial thickness burns confined to the face. The eyes were erythematous, oedematous, and the conjunctival surface had a pH of 8. This injury necessitated intubation for a total 48 h, with 24 h on PICU. The eyes required copious irrigation with normal saline to reduce the pH. The burns healed in 7 days with conservative management (Bacitracin ointment). Fortunately, there were no long-term sequelae. For over 10 years, airbag design has been modified to reduce the risk of injury to occupants whilst maintaining their life-saving function. It would be of benefit to consider further changes to these devices as they continue to pose a threat to children and adults, inflicting unnecessary injuries over and above those that might be expected in a high-speed collision scenario. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. It would seem appropriate that vehicles should have a mandatory performance standard which requires the suppression of automatic airbag deployment if a child is located in the front passenger seat.