Kathe M. Conlon

Disaster planning: the basics of creating a burn mass casualty disaster plan for a burn center.

In 2005, the American Burn Association published burn disaster guidelines. This work recognized that local and state assets are the most important resources in the initial 24- to 48-hour management of a burn disaster. Historical experiences suggest there is ample opportunity to improve local and state preparedness for a major burn disaster. This review will focus on the basics of developing a burn surge disaster plan for a mass casualty event. In the event of a disaster, burn centers must recognize their place in the context of local and state disaster plan activation. Planning for a burn center takes on three forms; institutional/intrafacility, interfacility/intrastate, and interstate/regional. Priorities for a burn disaster plan include: coordination, communication, triage, plan activation (trigger point), surge, and regional capacity. Capacity and capability of the plan should be modeled and exercised to determine limitations and identify breaking points. When there is more than one burn center in a given state or jurisdiction, close coordination and communication between the burn centers are essential for a successful response. Burn surge mass casualty planning at the facility and specialty planning levels, including a state burn surge disaster plan, must have interface points with governmental plans. Local, state, and federal governmental agencies have key roles and responsibilities in a burn mass casualty disaster. This work will include a framework and critical concepts any burn disaster planning effort should consider when developing future plans.

Developing and implementing a plan for large-scale burn disaster response in New Jersey.

For the first time in modern history burn centers must face the reality of having to potentially care for a staggering number of injured patients. Factors such as staffing, patient acuity and bed availability compel medical professionals to regularly examine various aspects of their respective healthcare delivery systems, especially with regards to how these systems should function for mass casualty response. The majority of burn care in New Jersey is provided by one designated burn treatment facility. A planning group was formed to identify additional hospital support systems capable of providing short-term patient care during a disaster. Focus was on three key areas: identifying actual versus potential nonburn center resources, ascertaining the number and level of burn expertise at these facilities, and assessing the capacities of any available resources and personnel. Retrospective review of discharge data highlighted which of the more than seventy New Jersey hospitals besides The Burn Center were treating and releasing burn injures. In a disaster The Burn Center designates these hospitals as Tier Facilities to serve as additional resources until patients may be transferred to other recognized regional and national burn centers. Triage is conducted in accordance with the American Burn Association Benefit-to-Ratio Triage grid, matching patient acuity with each hospitals tier designation. A secondary triage, conducted 24 hours after the initial incident, identifies which patients require transport for more specialized burn care. Twenty-seven burn centers from Maine through Maryland and the District of Columbia, who have joined together as a Consortium, agree to support one another for optimal patient distribution and management in accordance with accepted national standards of care. State Medical Coordination Centers equipped to coordinate and track transport of large numbers of injured personnel are able to facilitate this collaborative, multiagency response throughout the northeast region. Burn centers share many issues common to emergency preparedness. Paramount among them is an ability to provide quality burn care for the greatest number of patients at a time when staff and resources will be severely limited. It is incumbent upon burn centers to explore opportunities extending beyond individual state and regional resources in order for centers to continually maintain this standard of care, particularly in a disaster.

Guideline for Burn Care Under Austere Conditions: Special Care Topics.

Introduction Management of pain after a catastrophe that generates a large number of casualties that may have burns, traumatic brain injury, fractures, amputations, and significant soft tissue injuries will be problematic. In an environment of logistical uncertainty with limited to no resupply, it will be much worse. Supply may be rapidly outstripped by demand. What will be available to treat our patients? In this scenario, drastic changes in pain management philosophy and algorithms will be necessary. Burn mass casualty events (BMCI) will alter what aspects of pain will be treated, and most troubling, the level at which pain is treated. The purpose of this paper is to outline the philosophy of pain management in austere environments and outline practical applications when resources are limited.

Guidelines for Burn Care Under Austere Conditions: Introduction to Burn Disaster, Airway and Ventilator Management, and Fluid Resuscitation

e427 All disasters are local, and a burn mass casualty incident (BMCI) is no different. During the past 150 years, burn disasters have typically been associated with three factors: a fire/explosion in a mass gathering, natural disaster, or act of war/terrorism. Although the incidence of fire/explosion disasters has decreased during the past 50 years, recent natural disasters and acts of war/terrorism highlight the need for ongoing preparedness.1 The goal of this missive is to provide a background for disaster preparedness and a framework for initial assessment in a burn mass casualty.

Guidelines for Burn Care under Austere Conditions: Surgical and Nonsurgical Wound Management

Introduction The burn wound is central to all aspects of burn care. The size, depth, and condition of the burn wound directly impacts fluid resuscitation, hypermetabolic response, immune system dysfunction, and predicted survival. Optimal care of the burn wound requires specialized facilities and experienced burn nurses and surgeons, all of which are in limited supply under normal circumstances. These resources may become overwhelmed or unavailable as a result of a largescale disaster in a developed country or the need to provide care in an austere or far-forward environment. In this monograph, we discuss adaption and modification of normal burn wound practices to accommodate austere or disaster environments.

What's in a name? Recent key projects of the committee on organization and delivery of burn care

The Committee for the Organization and Delivery of Burn Care (ODBC) was charged by President Palmieri and the American Burn Association (ABA) Board of Directors with presenting a plenary session at the 45th Meeting of the ABA in Palm Springs, CA, in 2013. The objective of the plenary session was to inform the membership about the wide range of the activities performed by the ODBC committee. The hope was that this session would encourage active involvement within the ABA as a means to improve the delivery of future burn care. Selected current activities were summarized by key leaders of each project and highlighted in the plenary session. The history of the committee, current projects in disaster management, regionalization, best practice guidelines, federal partnerships, product development, new technologies, electronic medical records, and manpower issues in the burn workforce were summarized. The ODBC committee is a keystone committee of the ABA. It is tasked by the ABA leadership with addressing and leading progress in many areas that constitute current challenges in the delivery of burn care.

An update on the regional organizations of the american burn association.

In 1985, the American Burn Association (ABA) created 10 regions in the United States and charged the Chiefs of these regions with the development of regional disaster plans. Now more than 25 years after this mandate, the ABA’s Organizational and Delivery of Burn Care Committee assessed the status of regional development. The extant region leaders were contacted by email and queried as to the activities of their region and their opinion as to the success or failure of the regionalization initiative. Several regional organizational meetings were attended at the annual ABA meeting and many phone interviews were conducted to clear up any conflicting information. The original map of the burn regions was based on the American College of Surgeons Committee on Trauma regions, but these have undergone significant redistricting. The organizational structure, age, and activities of the regions vary significantly. The financial costs of maintaining a regional organization and holding an annual meeting are a major concern for most regions. For the most part the regional organizations are a good source of professional networking and a cost-effective source of continuing medical education/continuing education units for burn centers. The regionalization experiment of the ABA been reasonably successful in its first 25 years, but the ABA and the regions should take this opportunity to consider the next steps for the regions in the coming 25 years.

District of Columbia emergency healthcare coalition burn mass casualty plan: development to exercise date

The District of Columbia Emergency Healthcare Coalition (DC EHC) brought together a Burn Task Force to tackle the issue of mass burn care in a metropolitan area in light of limited local burn center resources. This article outlines the development of the mass burn care plan. Using a tiered treatment approach, mass burn victims would be transported first to burn centers within the area, followed by nonburn center trauma centers, and finally to nonburn and nontrauma center acute care facilities. Once activated the Burn Task Force would triage and coordinate transfer of mass burn patients within the District for further care at burn centers using a strong link with the Eastern Regional Burn Disaster Consortium. This plan was exercised in the spring of 2014 to test all of the components. To strengthen mass burn care, this plan, put in place for the District of Columbia, has been expanded to include the National Capital Region as well.