Case Report
Traumatic Injuries Incidental to Hydraulic Well Fracturing: A Case Series James F. Williams, MPAS,* Jonathan B. Lundy, MD,* Kevin K. Chung, MD,*† Rodney K. Chan, MD,* Booker T. King, MD,* Evan M. Renz, MD,*† Leopoldo C. Cancio, MD,*‡
In the late 1940s, Earl Halliburton developed an oil and gas well stimulating process known as hydraulic well fracturing. The process became widely implemented for stimulating poorly producing wells. The majority of those early wells were vertically drilled and reached conventional oil and gas collections for extraction. Over the past decade, dwindling conventional oil and gas resources necessitated the search for other sources. A novel strategy of combining horizontal or directional drilling techniques along with hydraulic well fracturing has allowed the industry to capitalize on significant areas of oil and gas found trapped within porous rock known as shale. This process effectively liberates trapped oil and gas and has made hydraulic well fracturing the chief method of unconventional mineral extraction within vast contiguous geological areas known as “shale plays” (Figure 1).1 The ever growing demand for low carbon emission fuel such as natural gas and
From the *United States Army Institute of Surgical Research, Fort Sam Houston, Texas; †Uniformed Services University of the Health Sciences, Bethesda, Maryland; and ‡University of Texas Health Science Center at San Antonio, San Antonio, Texas. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. This paper was presented as a poster presentation on April 24, 2013, at the meeting of American Burn Association in Palm Springs, California. J.F.W., J.B.L., R.K.C., B.T.K., and E.M.R. contributed to the original conception and planning of the manuscript. J.F.W., J.B.L., R.K.C., and K.K.C. wrote Journal of Burn Care & Research 146 Williams et al March/April 2016 the manuscript. R.K.C., B.T.K., E.M.R., and L.C.C. critically reviewed, edited, and revised the manuscript. L.C.C. directed the project and approved the final manuscript. Address correspondence to Kevin K. Chung, MD, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam, Houston, Texas 78234. Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000219
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the resultant increased fuel prices in late 2010 and through 2011 further spurred the increased use of hydraulic well fracturing for fossil fuel extraction from shale.2 The industry trend of hydraulic well fracturing requires massive amounts of manpower, resources, and machinery, which also means significant economic windfall in many of the surrounding communities where hydraulic well fracturing takes place.3,4 Spanning across Southern Texas and over to the Louisiana coast is the Haynesville and Eagle Ford Shale, holding about 13% of all U.S. natural gas resources; an additional 10% is shared in the Barnett and Barnett-Woodford shales located in north central Texas, Oklahoma, and Arkansas. The economic value of the Eagle Ford Shale, a relatively new area of development, has been estimated at 117,000 new jobs and $90 billion by 2021. By the end of 2011, gas and oil extraction from the Eagle Ford Shale had already been recognized as providing an infusion of $25 billion in revenues. In 1991, the U.S. National Safety Council deemed the oil and gas extraction industry as having a 49% higher nonfatal injury rate than all other U.S. industries combined.5 Given the increase of hydraulic well fracturing and the past record of nonfatal injury within the oil and gas extraction industry, we anticipate that hydraulic well fracturing will contribute to increasing the number of injuries. The purpose of this report is to describe injuries related to hydraulic well fracturing (or “fracking”) in patients admitted to our burn center over a 14-month period.
METHODS We reviewed the records of consecutive patients presenting to our burn center who were injured incidental to hydraulic well fracturing. This case series was exempt from Institutional Review Board submission at our institution. Before
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were present but unknown; therefore, the patient was admitted for observation of any worsening signs or symptoms. This patient was transferred to our burn center by an outside hospital. Initial decontamination and emergency response events were not known. The patient was released the following day after being treated with topical antimicrobial ointments, and his cutaneous wounds healed without the need for surgery.
November 2011, no such injuries had presented at the burn center. Cases were included based on patient history and documentation that the cause of injury was related to the process of hydraulic well fracturing. Data collected included sex, age, mechanism of injury, days of hospital admission, injury severity score, burn size, and presence of inhalation injury.
RESULTS
Case 2
Over a 14-month period, eight patients sustained injuries in conjunction with hydraulic fracturing or while handling the natural gas product (Table 1). All patients included in this report survived their injuries. Mean age was 33.5 years; 88% were men. The most common mechanism of injury was explosive (50%; n = 4). Explosions resulted in burn, abdominal, soft tissue, and musculoskeletal injuries. Cutaneous injury was present in 75% (n = 6) of patients, with fire being the most common mechanism (n = 3), followed by chemical (n = 2) and scalding (n = 1). All patients sustained some form of extremity injury. Half of these patients required intensive care, and 75% (n = 6) required surgery. Mean hospital length of stay was 26.4 days (range, 1–88 days). In total, patients required 45 operative procedures (5.6 mean procedures per patient; range, 0–19). Mean intensive care unit (ICU) length of stay was 17.6 days (range, 20–67 days).
A 50-year-old tractor-trailer truck driver sustained burns of 2.75% TBSA after a rollover accident and vehicle fire. The driver was transporting silica sand specifically used in hydraulic well fracturing to the site. The injuries were located on his face and both upper extremities. The patient had no other injuries identified and was discharged within 24 hours after being treated with topical antimicrobial ointments. His wounds healed without the need for surgery.
Case 3 A 27-year-old man sustained severe burn injury as a result of an explosion at a hydraulic well fracturing service site. The report received by the air ambulance crew stated that the patient was cleaning out tanks used to transport and store fracking chemicals when the explosion occurred. The burns involved 31% TBSA, including the face, neck, torso, and both upper and lower extremities. Fiber-optic bronchoscopy revealed inhalation injury. Decontamination was done during his initial wound care on arrival to our burn center. There was no hazardous material response documented in the chart. He required multiple grafting procedures and had a prolonged
Case 1 A 20-year-old man sustained burns of 5% of the total body surface area burned (TBSA) because of contact with scalding water while manipulating a fracking pump. The injuries involved the face, shoulder, and chest and were superficial partial thickness on initial presentation. Additives in the scalding fracking water
Table 1. Patient injuries incidental to hydraulic well fracturing, by case Case
Age
Sex
1 2 3 4 5 6 7 8 Mean
20 50 27 42 39 31 29 30 33.5
Male Male Male Female Male Male Male Male –
Mechanism of Injury Scald Fire Fire, explosion Chemical Chemical Fire, explosion Explosion Explosion –
ISS, injury severity score; ICU, intensive care unit; LOS, length of stay.
TBSA%
ISS
No. of Procedures
ICU Days
5.0 2.75 31.0 2.75 7.0 59.25 0 0 13.5
1 1 14 1 1 16 26 10 8.75
0 0 5 1 1 8 11 19 5.6
0 0 26 0 0 67 28 20 17.6
Total LOS 1 1 43 7 4 88 28 39 26.375
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hospital course complicated by inhalation-injuryassociated pneumonia and candidemia, but he survived.
multiple procedures to irrigate, debride, and reconstruct the complex upper extremity soft-tissue wounds; his hospital course was 28 days.
Case 4
Case 8
A 42-year-old woman was exposed to an unknown chemical at a hydraulic well fracturing site that caused a 3% TBSA full-thickness burn to her right lower extremity. The patient sought medical treatment on her own, and was transferred to our facility by an outside hospital. She stated she initially flushed the area with large amounts of water but did not seek medical treatment until the wound worsened. Treatment included multiple excision and grafting procedures.
A 30-year-old male oil-field worker was involved in the same above-ground detonation noted in case 7. He presented in extremis, having sustained a traumatic right transradial amputation and traumatic evisceration because of a complex abdominal wall wound. He underwent 19 procedures, including initial damage control surgery, debridements, and reconstructive procedures to achieve wound closure. This patient’s ICU admission was 20 days.
Case 5 While working at a hydraulic well fracturing site, a 39-year-old man was exposed to formic acid causing 7% TBSA burns. The patient was treated at the scene by coworkers who flushed the exposed skin with large amounts of water. The patient was then transported from the scene to our Emergency Department where further irrigation took place. On arrival to our center, the patient underwent additional wound cleansing and debridement with water and chlorhexidine gluconate 4%. No hazardous material response event was documented in the chart or recounted by the patient. Wounds to his left lower extremity were full-thickness and were treated with excision and grafting; the remainder of his wounds healed without the need for surgery.
Case 6 A 31-year-old male natural gas refinery worker sustained burns of 59% TBSA as a result of an explosion at a facility where products of fracking are processed. The injuries involved the face, torso, and both upper and lower extremities. No hazardous material response was documented in the chart. The patient required seven surgical procedures to achieve wound closure and was discharged after an 84-day admission with 67 days in the ICU. He was readmitted twice, for axillary burn scar contracture release and for cellulitis.
Case 7 A 29-year-old male oil-field worker was injured as a result of an above-ground detonation of a device used for perforating well fracturing pipe. His injuries included multiple fragment wounds to both hands and the abdominal wall. The patient required
DISCUSSION Natural gas production is predicted to position the United States as a leading natural gas exporter by 2021. The fossil fuel industry agrees that the efficient extraction of natural gas and current production levels could not be achieved without the use of hydraulic well fracturing. As its use quickly becomes the standard practice for fossil fuel extraction from shale, coupled with the demand and expected course for natural gas exportation, it is predicted that exponential growth of the oil and gas industry is on the immediate horizon.6 The oil and gas industry is well known for its inherently hazardous environment. From 2003 to 2006, a 15% increase in fatalities was noted among oil-field industry workers in the US. The majority of fatalities (110) involved vehicles; other mechanisms causing fatalities were being struck by objects (88), explosions (36), falls (30), fires (27), and being caught in machinery (26). The Centers for Disease Control and Prevention reported a direct correlation between increased numbers of fatalities and the production level of gas and oil extraction that was in effect at that time. These figures represent increased fatalities just before the surge in hydraulic well fracturing.7,8 This report describes a constellation of possible injuries with hydraulic well fracturing and correlates them with the associated hazards in the field. A case-by-case review of some of these hazards is appropriate. Case 1 represents contact with scalding water. High temperatures around hydraulic well fracturing sites are primarily geothermal and can be as high as 320°F. Scald injuries can be compounded by the presence of extremely high pressures that are used in pumping hydraulic fracturing fluids, which can be as high as 10,000 pounds per square inch (psi).
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Utilization of pressurized fluid in the high-temperature environment of the deep-well hole is critical in the success of the hydraulic fracturing process.8 In case 2, the driver was transporting silica sand to a hydraulic well fracturing site. Silica sand is one of several commonly used materials that are critical in the hydraulic well fracturing process. These materials are called proppants because they “prop” open the fractures and are left in place to keep the fracture open. This case demonstrates the risk of transportation-related accidents during the fracturing process. In case 3, a worker was injured as a result of an explosion at a hydraulic well fracturing service site specializing in the handling of chemicals used in the fracking industry. Various chemical additives are used in hydraulic fracturing to affect the deep-ground geology and break up the target shale even more. Some of these chemicals adjust pH, density, viscosity, and stability in high temperatures, and some additives protect metal surfaces that the fracture fluids come in contact with (known as “corrosion inhibitors”). Corrosion inhibitors such as isopropanol, methanol, and acetaldehyde are highly flammable. Other chemicals used in hydraulic well fracturing are distilled from petroleum and are also flammable or combustible.8 Many of these chemicals are transported in specialized containers or tanks, which can be reused after safe cleaning. The liquid or vapors from these types of volatile chemicals can accumulate, causing explosions and fires.9 Cases 4 and 5 demonstrate the dangers of caustic chemicals used in the hydraulic well fracturing process. In our review of the patients sustaining chemical injury, in only one instance was the substance contacted known; and in no situation was concentration known or safety data information available. It is also important to reiterate that information on initial decontamination and/or hazardous materials response events were not relayed to our burn center. Many chemical additives that are used in hydraulic well fracturing are mixed from highly concentrated forms. Chemicals such as hydrochloric, formic, acetic, and boric acids; sodium hydroxide; acetaldehyde; potassium carbonate; and antibacterial “biocides” in their prediluted states pose increased risks for injuries if inhaled or physically contacted. More than 900 gallons of hydrochloric acid is used in a typical 4-million-gallon fracturing job. Most additives must be transported to the work site in a concentrated state. It is at the intervals during transportation, mixing, and blending that serious accidents can happen. Information on which chemicals are used at particular hydraulic well fracturing sites can be found
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on the Internet at an industry-supported Web site called “FracFocus.” The site was developed in order to improve disclosure of which chemicals are being used at hydraulic well fracturing sites.7,11 In case 6, a 31-year-old male natural gas refinery worker sustained burns as a result of a refinery system explosion. Along with increased natural gas production comes the increased demand for refining and processing systems. The daily natural gas production within the Eagle Ford Shale in Texas increased from 216 million cubic feet in 2010 to 964 million cubic feet by the end of 2012.5 Nationally, recent estimates predict that natural gas production will likely increase 30% to 28 trillion cubic feet annually by the year 2035. The combination of horizontal drilling and hydraulic fracturing is credited for this significant increase in production.3,6 Additionally, it is estimated that 70% of all future natural gas development will be based on this process.12 Cases 7 and 8 represent the explosive nature of a common process in hydraulic well fracturing known as well perforating. Perforating a well pipe segment is critical in the hydraulic well fracturing process. Well perforation typically involves sending an apparatus known as a well gun or perforating gun down to a specific section of the well. The well gun carries multiple high-velocity projectiles that are detonated within the interior of the well pipe to fenestrate it. The highvelocity piercing is accomplished by using advanced explosive charges, which compress a projectile of molten metal known as a jet and can produce up to 10 million psi of pressure. The projectiles perforate the well pipe and lodge within surrounding target shale. After a certain number of perforations are completed, the explosively formed openings will serve as pathways for the pressurized hydraulic fracturing fluids. The fluids along with sand and additives are forced through the perforations filling and creating more fractures and fissures in the surrounding geology. After the hydraulic fluid process is complete, the perforations serve as passageways for the released gas and/or oil extraction via the well pipe.9,13,14 Perforating guns are extremely dangerous and have been known to explode while being handled. Above-ground detonations of these highly explosive devices can understandably cause devastating and lethal injuries.15
CONCLUSIONS By the year 2035 natural gas production is expected to increase by 77%, which represents 21 trillion cubic feet of gas annually.12 With this information in mind, the authors predict that injuries sustained as a result of hydraulic well fracturing will also rise. To the best
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of our knowledge, this publication is the first to describe thermal injuries as an occupational hazard associated with hydraulic well fracturing.
ACKNOWLEDGMENTS This study was supported by the Clinical Trials Task Area, U.S. Army Institute of Surgical Research, Ft Sam Houston, Texas. The authors would like to thank Otilia Sánchez, who provided medical writing services on behalf of the U.S. Army Institute of Surgical Research. REFERENCES 1. Halliburton Company. Hydraulic fracturing: a look back; available from http://www.halliburton.com/public/projects/pubsdata/hydraulic_fracturing/fracturing_101.html; accessed January 28, 2013. 2. Considine TJ. The economic impacts of the Pennsylvania Marcellus Shale natural gas play: an update. 24 May 2011. Pennsylvania State University College of Earth and Mineral Sciences Department of Energy and Mineral Engineering; available from http://marcelluscoalition.org/wp-content/ uploads/2010/05/PA-Marcellus-Updated-EconomicImpacts-5.24.10.3.pdf; accessed January 28, 2013. 3. King H. Hydraulic fracturing of oil and gas wells drilled in shale hydraulic fracturing and horizontal drilling have turned unproductive shales into the largest natural gas fields in the world; available from http://geology.com/articles/hydraulic-fracturing/; accessed January 28, 2013. 4. Groat CG, Grimshaw TW. Fact-based regulation for environmental protection in shale gas development. Austin: University of Texas; 2011; available from http://energy. utexas.edu/images/ei_shale_gas_regulation120215; accessed January 28, 2013. 5. Al-Rubaee FR, Al-Maniri A. Work related injuries in an oil field in Oman. Oman Med J 2011;26:315–8. 6. Cooley H, Donnelly K. Hydraulic fracturing and water resources separating the frack from the fiction. Oakland, CA: Pacific Institute; 2012; available at http://www.pacinst. org/reports/fracking/; accessed January 28, 2013.
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7. Centers for Disease Control. Fatalities among oil & gas extraction workers—United States, 2003–2006. Morbidity Mortality Wkly Rep. 2008;57:429–31. 8. McCurdy R. High rate hydraulic fracturing additives in non-marcellus unconventional shales. In: Hydraulic Fracturing Technical Presentation Session 1: Fracture Fluid Formulations and Purposes. Presented at U.S. EPA Proceedings of the Technical Workshops for the Hydraulic Fracturing Study: Chemical & Analytical Methods, Arlington, Virginia, p. 1–30. 9. Occupational Safety and Health Administration U.S. Department of Labor. Flammable and Combustible Liquids. 2012; available from http://www.osha.gov/dte/ library/flammable_liquids/flammable_liquids.pdf; accessed February 23, 2013. 10. Fracfocus. Chemical disclosure registry. What chemicals are used; available from http://fracfocus.org/chemicaluse/what-chemicals-are-used; accessed 20 January 20, 2013. 11. Gas Production Statistics. Texas Eagle Ford shale gas well production 2008 through November 2012. Eagle ford information; January 22, 2013. In: Railroad Commission of Texas; available from http://www.rrc.state.tx.us/eagleford/index.php; accessed February 3, 2013. 12. U.S. Energy Information Administration, Press release: EIA energy outlook projects growing reliance on natural gas from shale, reduced energy import shares, and increased electricity generation from renewables and natural gas. 2010; available from http://www.eia.gov/neic/press/press352.html; accessed February 21, 2013. 13. Hanson B. Drilling and completion-casing perforation overview. U.S. EPA proceedings of the technical workshops for the hydraulic fracturing study: well construction and operation; available from http://water.epa.gov/type/groundwater/uic/class2/hydraulicfracturing/upload/hydraulicfracturingstudywellconstructionandoperation.pdf; accessed February 23, 2013. 14. Mukherjee H. Fractured well performance: key to fracture treatment success; available from http://www.spe.org/jpt/ print/archives/1999/03/JPT1999_03_DA_series.pdf; accessed February 23, 2013. 15. U.S. Department of Labor. Occupational safety and health act. Employee killed by jet perforators’ discharge. Accident investigation summary; 1990; available from http://www.osha.gov/pls/imis/establishment.inspection_ detail?id=105924286; accessed February 23, 2013.
Traumatic Injuries Incidental to Hydraulic Well Fracturing: A Case Series James F. Williams, MPAS,* Jonathan B. Lundy, MD,* Kevin K. Chung, MD,*† Rodney K. Chan, MD,* Booker T. King, MD,* Evan M. Renz, MD,*† Leopoldo C. Cancio, MD,*‡
In the late 1940s, Earl Halliburton developed an oil and gas well stimulating process known as hydraulic well fracturing. The process became widely implemented for stimulating poorly producing wells. The majority of those early wells were vertically drilled and reached conventional oil and gas collections for extraction. Over the past decade, dwindling conventional oil and gas resources necessitated the search for other sources. A novel strategy of combining horizontal or directional drilling techniques along with hydraulic well fracturing has allowed the industry to capitalize on significant areas of oil and gas found trapped within porous rock known as shale. This process effectively liberates trapped oil and gas and has made hydraulic well fracturing the chief method of unconventional mineral extraction within vast contiguous geological areas known as “shale plays” (Figure 1).1 The ever growing demand for low carbon emission fuel such as natural gas and
From the *United States Army Institute of Surgical Research, Fort Sam Houston, Texas; †Uniformed Services University of the Health Sciences, Bethesda, Maryland; and ‡University of Texas Health Science Center at San Antonio, San Antonio, Texas. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. This paper was presented as a poster presentation on April 24, 2013, at the meeting of American Burn Association in Palm Springs, California. J.F.W., J.B.L., R.K.C., B.T.K., and E.M.R. contributed to the original conception and planning of the manuscript. J.F.W., J.B.L., R.K.C., and K.K.C. wrote Journal of Burn Care & Research 146 Williams et al March/April 2016 the manuscript. R.K.C., B.T.K., E.M.R., and L.C.C. critically reviewed, edited, and revised the manuscript. L.C.C. directed the project and approved the final manuscript. Address correspondence to Kevin K. Chung, MD, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam, Houston, Texas 78234. Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000219
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the resultant increased fuel prices in late 2010 and through 2011 further spurred the increased use of hydraulic well fracturing for fossil fuel extraction from shale.2 The industry trend of hydraulic well fracturing requires massive amounts of manpower, resources, and machinery, which also means significant economic windfall in many of the surrounding communities where hydraulic well fracturing takes place.3,4 Spanning across Southern Texas and over to the Louisiana coast is the Haynesville and Eagle Ford Shale, holding about 13% of all U.S. natural gas resources; an additional 10% is shared in the Barnett and Barnett-Woodford shales located in north central Texas, Oklahoma, and Arkansas. The economic value of the Eagle Ford Shale, a relatively new area of development, has been estimated at 117,000 new jobs and $90 billion by 2021. By the end of 2011, gas and oil extraction from the Eagle Ford Shale had already been recognized as providing an infusion of $25 billion in revenues. In 1991, the U.S. National Safety Council deemed the oil and gas extraction industry as having a 49% higher nonfatal injury rate than all other U.S. industries combined.5 Given the increase of hydraulic well fracturing and the past record of nonfatal injury within the oil and gas extraction industry, we anticipate that hydraulic well fracturing will contribute to increasing the number of injuries. The purpose of this report is to describe injuries related to hydraulic well fracturing (or “fracking”) in patients admitted to our burn center over a 14-month period.
METHODS We reviewed the records of consecutive patients presenting to our burn center who were injured incidental to hydraulic well fracturing. This case series was exempt from Institutional Review Board submission at our institution. Before
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were present but unknown; therefore, the patient was admitted for observation of any worsening signs or symptoms. This patient was transferred to our burn center by an outside hospital. Initial decontamination and emergency response events were not known. The patient was released the following day after being treated with topical antimicrobial ointments, and his cutaneous wounds healed without the need for surgery.
November 2011, no such injuries had presented at the burn center. Cases were included based on patient history and documentation that the cause of injury was related to the process of hydraulic well fracturing. Data collected included sex, age, mechanism of injury, days of hospital admission, injury severity score, burn size, and presence of inhalation injury.
RESULTS
Case 2
Over a 14-month period, eight patients sustained injuries in conjunction with hydraulic fracturing or while handling the natural gas product (Table 1). All patients included in this report survived their injuries. Mean age was 33.5 years; 88% were men. The most common mechanism of injury was explosive (50%; n = 4). Explosions resulted in burn, abdominal, soft tissue, and musculoskeletal injuries. Cutaneous injury was present in 75% (n = 6) of patients, with fire being the most common mechanism (n = 3), followed by chemical (n = 2) and scalding (n = 1). All patients sustained some form of extremity injury. Half of these patients required intensive care, and 75% (n = 6) required surgery. Mean hospital length of stay was 26.4 days (range, 1–88 days). In total, patients required 45 operative procedures (5.6 mean procedures per patient; range, 0–19). Mean intensive care unit (ICU) length of stay was 17.6 days (range, 20–67 days).
A 50-year-old tractor-trailer truck driver sustained burns of 2.75% TBSA after a rollover accident and vehicle fire. The driver was transporting silica sand specifically used in hydraulic well fracturing to the site. The injuries were located on his face and both upper extremities. The patient had no other injuries identified and was discharged within 24 hours after being treated with topical antimicrobial ointments. His wounds healed without the need for surgery.
Case 3 A 27-year-old man sustained severe burn injury as a result of an explosion at a hydraulic well fracturing service site. The report received by the air ambulance crew stated that the patient was cleaning out tanks used to transport and store fracking chemicals when the explosion occurred. The burns involved 31% TBSA, including the face, neck, torso, and both upper and lower extremities. Fiber-optic bronchoscopy revealed inhalation injury. Decontamination was done during his initial wound care on arrival to our burn center. There was no hazardous material response documented in the chart. He required multiple grafting procedures and had a prolonged
Case 1 A 20-year-old man sustained burns of 5% of the total body surface area burned (TBSA) because of contact with scalding water while manipulating a fracking pump. The injuries involved the face, shoulder, and chest and were superficial partial thickness on initial presentation. Additives in the scalding fracking water
Table 1. Patient injuries incidental to hydraulic well fracturing, by case Case
Age
Sex
1 2 3 4 5 6 7 8 Mean
20 50 27 42 39 31 29 30 33.5
Male Male Male Female Male Male Male Male –
Mechanism of Injury Scald Fire Fire, explosion Chemical Chemical Fire, explosion Explosion Explosion –
ISS, injury severity score; ICU, intensive care unit; LOS, length of stay.
TBSA%
ISS
No. of Procedures
ICU Days
5.0 2.75 31.0 2.75 7.0 59.25 0 0 13.5
1 1 14 1 1 16 26 10 8.75
0 0 5 1 1 8 11 19 5.6
0 0 26 0 0 67 28 20 17.6
Total LOS 1 1 43 7 4 88 28 39 26.375
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hospital course complicated by inhalation-injuryassociated pneumonia and candidemia, but he survived.
multiple procedures to irrigate, debride, and reconstruct the complex upper extremity soft-tissue wounds; his hospital course was 28 days.
Case 4
Case 8
A 42-year-old woman was exposed to an unknown chemical at a hydraulic well fracturing site that caused a 3% TBSA full-thickness burn to her right lower extremity. The patient sought medical treatment on her own, and was transferred to our facility by an outside hospital. She stated she initially flushed the area with large amounts of water but did not seek medical treatment until the wound worsened. Treatment included multiple excision and grafting procedures.
A 30-year-old male oil-field worker was involved in the same above-ground detonation noted in case 7. He presented in extremis, having sustained a traumatic right transradial amputation and traumatic evisceration because of a complex abdominal wall wound. He underwent 19 procedures, including initial damage control surgery, debridements, and reconstructive procedures to achieve wound closure. This patient’s ICU admission was 20 days.
Case 5 While working at a hydraulic well fracturing site, a 39-year-old man was exposed to formic acid causing 7% TBSA burns. The patient was treated at the scene by coworkers who flushed the exposed skin with large amounts of water. The patient was then transported from the scene to our Emergency Department where further irrigation took place. On arrival to our center, the patient underwent additional wound cleansing and debridement with water and chlorhexidine gluconate 4%. No hazardous material response event was documented in the chart or recounted by the patient. Wounds to his left lower extremity were full-thickness and were treated with excision and grafting; the remainder of his wounds healed without the need for surgery.
Case 6 A 31-year-old male natural gas refinery worker sustained burns of 59% TBSA as a result of an explosion at a facility where products of fracking are processed. The injuries involved the face, torso, and both upper and lower extremities. No hazardous material response was documented in the chart. The patient required seven surgical procedures to achieve wound closure and was discharged after an 84-day admission with 67 days in the ICU. He was readmitted twice, for axillary burn scar contracture release and for cellulitis.
Case 7 A 29-year-old male oil-field worker was injured as a result of an above-ground detonation of a device used for perforating well fracturing pipe. His injuries included multiple fragment wounds to both hands and the abdominal wall. The patient required
DISCUSSION Natural gas production is predicted to position the United States as a leading natural gas exporter by 2021. The fossil fuel industry agrees that the efficient extraction of natural gas and current production levels could not be achieved without the use of hydraulic well fracturing. As its use quickly becomes the standard practice for fossil fuel extraction from shale, coupled with the demand and expected course for natural gas exportation, it is predicted that exponential growth of the oil and gas industry is on the immediate horizon.6 The oil and gas industry is well known for its inherently hazardous environment. From 2003 to 2006, a 15% increase in fatalities was noted among oil-field industry workers in the US. The majority of fatalities (110) involved vehicles; other mechanisms causing fatalities were being struck by objects (88), explosions (36), falls (30), fires (27), and being caught in machinery (26). The Centers for Disease Control and Prevention reported a direct correlation between increased numbers of fatalities and the production level of gas and oil extraction that was in effect at that time. These figures represent increased fatalities just before the surge in hydraulic well fracturing.7,8 This report describes a constellation of possible injuries with hydraulic well fracturing and correlates them with the associated hazards in the field. A case-by-case review of some of these hazards is appropriate. Case 1 represents contact with scalding water. High temperatures around hydraulic well fracturing sites are primarily geothermal and can be as high as 320°F. Scald injuries can be compounded by the presence of extremely high pressures that are used in pumping hydraulic fracturing fluids, which can be as high as 10,000 pounds per square inch (psi).
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Utilization of pressurized fluid in the high-temperature environment of the deep-well hole is critical in the success of the hydraulic fracturing process.8 In case 2, the driver was transporting silica sand to a hydraulic well fracturing site. Silica sand is one of several commonly used materials that are critical in the hydraulic well fracturing process. These materials are called proppants because they “prop” open the fractures and are left in place to keep the fracture open. This case demonstrates the risk of transportation-related accidents during the fracturing process. In case 3, a worker was injured as a result of an explosion at a hydraulic well fracturing service site specializing in the handling of chemicals used in the fracking industry. Various chemical additives are used in hydraulic fracturing to affect the deep-ground geology and break up the target shale even more. Some of these chemicals adjust pH, density, viscosity, and stability in high temperatures, and some additives protect metal surfaces that the fracture fluids come in contact with (known as “corrosion inhibitors”). Corrosion inhibitors such as isopropanol, methanol, and acetaldehyde are highly flammable. Other chemicals used in hydraulic well fracturing are distilled from petroleum and are also flammable or combustible.8 Many of these chemicals are transported in specialized containers or tanks, which can be reused after safe cleaning. The liquid or vapors from these types of volatile chemicals can accumulate, causing explosions and fires.9 Cases 4 and 5 demonstrate the dangers of caustic chemicals used in the hydraulic well fracturing process. In our review of the patients sustaining chemical injury, in only one instance was the substance contacted known; and in no situation was concentration known or safety data information available. It is also important to reiterate that information on initial decontamination and/or hazardous materials response events were not relayed to our burn center. Many chemical additives that are used in hydraulic well fracturing are mixed from highly concentrated forms. Chemicals such as hydrochloric, formic, acetic, and boric acids; sodium hydroxide; acetaldehyde; potassium carbonate; and antibacterial “biocides” in their prediluted states pose increased risks for injuries if inhaled or physically contacted. More than 900 gallons of hydrochloric acid is used in a typical 4-million-gallon fracturing job. Most additives must be transported to the work site in a concentrated state. It is at the intervals during transportation, mixing, and blending that serious accidents can happen. Information on which chemicals are used at particular hydraulic well fracturing sites can be found
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on the Internet at an industry-supported Web site called “FracFocus.” The site was developed in order to improve disclosure of which chemicals are being used at hydraulic well fracturing sites.7,11 In case 6, a 31-year-old male natural gas refinery worker sustained burns as a result of a refinery system explosion. Along with increased natural gas production comes the increased demand for refining and processing systems. The daily natural gas production within the Eagle Ford Shale in Texas increased from 216 million cubic feet in 2010 to 964 million cubic feet by the end of 2012.5 Nationally, recent estimates predict that natural gas production will likely increase 30% to 28 trillion cubic feet annually by the year 2035. The combination of horizontal drilling and hydraulic fracturing is credited for this significant increase in production.3,6 Additionally, it is estimated that 70% of all future natural gas development will be based on this process.12 Cases 7 and 8 represent the explosive nature of a common process in hydraulic well fracturing known as well perforating. Perforating a well pipe segment is critical in the hydraulic well fracturing process. Well perforation typically involves sending an apparatus known as a well gun or perforating gun down to a specific section of the well. The well gun carries multiple high-velocity projectiles that are detonated within the interior of the well pipe to fenestrate it. The highvelocity piercing is accomplished by using advanced explosive charges, which compress a projectile of molten metal known as a jet and can produce up to 10 million psi of pressure. The projectiles perforate the well pipe and lodge within surrounding target shale. After a certain number of perforations are completed, the explosively formed openings will serve as pathways for the pressurized hydraulic fracturing fluids. The fluids along with sand and additives are forced through the perforations filling and creating more fractures and fissures in the surrounding geology. After the hydraulic fluid process is complete, the perforations serve as passageways for the released gas and/or oil extraction via the well pipe.9,13,14 Perforating guns are extremely dangerous and have been known to explode while being handled. Above-ground detonations of these highly explosive devices can understandably cause devastating and lethal injuries.15
CONCLUSIONS By the year 2035 natural gas production is expected to increase by 77%, which represents 21 trillion cubic feet of gas annually.12 With this information in mind, the authors predict that injuries sustained as a result of hydraulic well fracturing will also rise. To the best
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of our knowledge, this publication is the first to describe thermal injuries as an occupational hazard associated with hydraulic well fracturing.
ACKNOWLEDGMENTS This study was supported by the Clinical Trials Task Area, U.S. Army Institute of Surgical Research, Ft Sam Houston, Texas. The authors would like to thank Otilia Sánchez, who provided medical writing services on behalf of the U.S. Army Institute of Surgical Research. REFERENCES 1. Halliburton Company. Hydraulic fracturing: a look back; available from http://www.halliburton.com/public/projects/pubsdata/hydraulic_fracturing/fracturing_101.html; accessed January 28, 2013. 2. Considine TJ. The economic impacts of the Pennsylvania Marcellus Shale natural gas play: an update. 24 May 2011. Pennsylvania State University College of Earth and Mineral Sciences Department of Energy and Mineral Engineering; available from http://marcelluscoalition.org/wp-content/ uploads/2010/05/PA-Marcellus-Updated-EconomicImpacts-5.24.10.3.pdf; accessed January 28, 2013. 3. King H. Hydraulic fracturing of oil and gas wells drilled in shale hydraulic fracturing and horizontal drilling have turned unproductive shales into the largest natural gas fields in the world; available from http://geology.com/articles/hydraulic-fracturing/; accessed January 28, 2013. 4. Groat CG, Grimshaw TW. Fact-based regulation for environmental protection in shale gas development. Austin: University of Texas; 2011; available from http://energy. utexas.edu/images/ei_shale_gas_regulation120215; accessed January 28, 2013. 5. Al-Rubaee FR, Al-Maniri A. Work related injuries in an oil field in Oman. Oman Med J 2011;26:315–8. 6. Cooley H, Donnelly K. Hydraulic fracturing and water resources separating the frack from the fiction. Oakland, CA: Pacific Institute; 2012; available at http://www.pacinst. org/reports/fracking/; accessed January 28, 2013.
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7. Centers for Disease Control. Fatalities among oil & gas extraction workers—United States, 2003–2006. Morbidity Mortality Wkly Rep. 2008;57:429–31. 8. McCurdy R. High rate hydraulic fracturing additives in non-marcellus unconventional shales. In: Hydraulic Fracturing Technical Presentation Session 1: Fracture Fluid Formulations and Purposes. Presented at U.S. EPA Proceedings of the Technical Workshops for the Hydraulic Fracturing Study: Chemical & Analytical Methods, Arlington, Virginia, p. 1–30. 9. Occupational Safety and Health Administration U.S. Department of Labor. Flammable and Combustible Liquids. 2012; available from http://www.osha.gov/dte/ library/flammable_liquids/flammable_liquids.pdf; accessed February 23, 2013. 10. Fracfocus. Chemical disclosure registry. What chemicals are used; available from http://fracfocus.org/chemicaluse/what-chemicals-are-used; accessed 20 January 20, 2013. 11. Gas Production Statistics. Texas Eagle Ford shale gas well production 2008 through November 2012. Eagle ford information; January 22, 2013. In: Railroad Commission of Texas; available from http://www.rrc.state.tx.us/eagleford/index.php; accessed February 3, 2013. 12. U.S. Energy Information Administration, Press release: EIA energy outlook projects growing reliance on natural gas from shale, reduced energy import shares, and increased electricity generation from renewables and natural gas. 2010; available from http://www.eia.gov/neic/press/press352.html; accessed February 21, 2013. 13. Hanson B. Drilling and completion-casing perforation overview. U.S. EPA proceedings of the technical workshops for the hydraulic fracturing study: well construction and operation; available from http://water.epa.gov/type/groundwater/uic/class2/hydraulicfracturing/upload/hydraulicfracturingstudywellconstructionandoperation.pdf; accessed February 23, 2013. 14. Mukherjee H. Fractured well performance: key to fracture treatment success; available from http://www.spe.org/jpt/ print/archives/1999/03/JPT1999_03_DA_series.pdf; accessed February 23, 2013. 15. U.S. Department of Labor. Occupational safety and health act. Employee killed by jet perforators’ discharge. Accident investigation summary; 1990; available from http://www.osha.gov/pls/imis/establishment.inspection_ detail?id=105924286; accessed February 23, 2013.
