"Scorched air": A narrative review of inhalational injuries in fire onboard ships

Fires aboard ships remain a serious hazard, posing significant risks to crew members due to the confined and often poorly ventilated environments. Modern ships, especially military vessels with airtight compartments, are particularly vulnerable to rapid accumulation of smoke, even from minor fires. In such settings, smoke inhalation-not burns-is the leading cause of fire-related mortality. This article explores the pathophysiology, clinical manifestations, and management of inhalational injuries resulting from onboard ship fires. It aims to highlight the unique challenges faced in maritime settings and propose strategies for timely diagnosis and effective treatment. Inhalational injuries on ships often involve a combination of thermal injury to the upper airway, chemical irritation from toxic gases (such as carbon monoxide, hydrogen cyanide), and particulate matter deposition. Clinical features may include hoarseness, stridor, facial burns, singed nasal hairs, carbonaceous sputum, and respiratory distress. Symptom onset may be delayed, necessitating a high index of suspicion. Prompt airway management-including early endotracheal intubation-is crucial. Supportive measures such as lung-protective ventilation, fluid resuscitation, and nebulized heparin have demonstrated improved outcomes in severe cases. Given the unique risks associated with enclosed maritime environments, training ship crews in early identification of airway compromise and standardizing evacuation protocols are essential. Improved awareness of onboard medical officers, combined with evidence-based treatment strategies, can significantly reduce morbidity and mortality associated with these injuries.