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Kearns RD, Flores CA, Arledge F, Hargrove P, Prats R, Kanter J, Sittig K, Barrios J, Phelan HA, Carter JE. Development of Prepositioned Burn Care-specific Disaster Resources for a Burn Mass Casualty Incident. J Burn Care Res 2023; 44:1428-1433. [PMID: 37095604 DOI: 10.1093/jbcr/irad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 04/26/2023]
Abstract
Disaster preparedness for a burn mass casualty incident (BMCI) must consider the needs of the first responders and community hospitals, who may be the first to receive those patients. Developing a more comprehensive statewide burn disaster program includes meeting with regional healthcare coalitions (HCCs) to identify gaps in care. Quarterly HCC meetings, which link local hospitals, emergency medical services (EMS) agencies, and other interested parties, are held around the state. We rely on the HCC's regional meetings to serve as a platform for conducting focus group research to identify gaps specific to a BMCI and to inform strategy development. One of the deficiencies identified, particularly in rural areas that infrequently manage burn injuries, was a lack of burn-specific wound care dressings that could support the initial response. Relying on this process, a consensus was created for equipment types and quantities, including a kit for storage. Furthermore, maintenance, supply replacement, and scene delivery processes were developed for these kits that could augment a BMCI response. The feedback from the focus groups reminded us that many systems report having infrequent opportunities to provide care for patients with burn injuries. In addition, several types of burn-specific dressings are expensive. With the infrequent occurrence, EMS agencies and rural hospitals reported that it was doubtful their agency/hospital would have more than a minimal stock of burn injury supplies. Therefore, developing supply caches that can be quickly mobilized and deployed to the impacted area was one of the deficiencies we identified and addressed through this process.
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Affiliation(s)
- Randy D Kearns
- College of Business Administration, University of New Orleans, Retired Clinical Assistant Professor, School of Medicine, University of North Carolina
| | - Carl A Flores
- Burn Center, University Medical Center, New Orleans, Louisiana, USA
| | - Frances Arledge
- HHS Hospital Preparedness Program Grant, Louisiana Hospital Association Research & Education Foundation, Baton Rouge, USA
| | | | - Rosanne Prats
- Emergency Preparedness & Response at Louisiana Department of Health & Hospitals, Baton Rouge, USA
| | | | - Kevin Sittig
- Louisiana State University Shreveport, Lafayette, USA
| | - Joey Barrios
- Our Lady of the Lourdes Regional Medical Center, Lafayette, Louisiana, USA
| | - Herb A Phelan
- Louisiana State University Health Sciences Center New Orleans, Burn Surgeon, University Medical Center, New Orleans, Louisiana, USA
| | - Jeffrey E Carter
- Louisiana State University - Health Sciences Center New Orleans, Burn Center Medical Director, University Medical Center, New Orleans, Louisiana, USA
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King B, Cancio LC, Jeng JC. Military Burn Care and Burn Disasters. Surg Clin North Am 2023; 103:529-538. [PMID: 37149388 DOI: 10.1016/j.suc.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Mass-casualty incidents can occur because of natural disasters; industrial accidents; or intentional attacks against civilian, police, or in case of combat, military forces. Depending on scale and type of incident, burn casualties often with a variety of concomitant injuries can be anticipated. The treatment of life-threatening traumatic injuries should take precedent but the stabilization, triage, and follow-on care of these patients will require local, state, and often regional coordination and support.
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Affiliation(s)
- Booker King
- North Carolina Jaycee Burn Center, University of North Carolina Chapel Hill, Burnett Womack Building, Campus Box 7206, Chapel Hill, NC 27599-7206, USA
| | - Leopoldo C Cancio
- U.S. Army Burn Center, U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX 78234-6315, USA
| | - James C Jeng
- University of California Irvine, 3800 West Chapman Avenue, Suite 6200, Orange, CA 92868, USA.
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Leclerc T, Sjöberg F, Jennes S, Martinez-Mendez JR, van der Vlies CH, Battistutta A, Lozano-Basanta JA, Moiemen N, Almeland SK. European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan. Burns 2023; 49:275-303. [PMID: 36702682 DOI: 10.1016/j.burns.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. METHODS The European Burns Association's disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. RECOMMENDATIONS The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.
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Affiliation(s)
- Thomas Leclerc
- Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France
| | | | - Serge Jennes
- Charleroi Burn Wound Center, Skin-burn-reconstruction Pole, Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Cornelis H van der Vlies
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Anna Battistutta
- Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - J Alfonso Lozano-Basanta
- Emergency Response Coordination Center, Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - Naiem Moiemen
- University Hospitals Birmingham Foundation Trust, Birmingham, UK; University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Stian Kreken Almeland
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway; Norwegian Directorate of Health, Department of Preparedness and Emergency Medical Services, Oslo, Norway.
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Ryan CM, Shapiro GD, Rencken CA, Griggs C, Jeng JC, Hickerson WL, Marino M, Goverman J, Kazis LE, Schneider JC. The Impact of Burn Size on Community Participation: A Life Impact Burn Recovery Evaluation (LIBRE) Study. Ann Surg 2022; 276:1056-1062. [PMID: 33351466 PMCID: PMC8265012 DOI: 10.1097/sla.0000000000004703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the association of burn size and community participation as measured by the LIBRE Profile. SUMMARY OF BACKGROUND DATA Burn size is an established clinical predictor of survival after burn injury. It is often a factor in guiding decisions surrounding early medical interventions; however, literature is inconclusive on its relationship to quality of life outcomes. METHODS This is a secondary data analysis of a cross-sectional survey of adult burn survivors. Self-reported data were collected between October 2014 and December 2015 from 601 burn survivors aged ≥18 years with ≥5% total body surface area (TBSA) or burns to critical areas. Sociodemographic characteristics were compared between participants with small burns (≤40% TBSA burned) and large burns (>40% TBSA burned). Ordinary least squares regression models examined associations between burn size and LIBRE Profile scale scores with adjustments for sex, current work status, burns to critical areas, and time since burn injury. RESULTS The analytic sample comprised 562 participants with data available for burn size. 42% of respondents had large burns (>40% TBSA burned) and 58% reported smaller burns (TBSA ≤40%). In adjusted regression models, patients with large burns tended to score lower on the Social Activities and Work & Employment scales ( P < 0.05) and higher on the Family & Friends scale ( P < 0.05). Participants with burns >40% TBSA scored lower for several individual items in the Social Activities scale and one item in the Work & Employment scale ( P < 0.05). CONCLUSIONS Increasing burn size was found to be negatively associated with selected items of Work & Employment and Social Activities, but positively associated with aspects of Family & Friend Relationships. Future longitudinal studies are necessary to assess and understand the long-term social impact of burn injuries on adult populations.
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Affiliation(s)
- Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Cornelia Griggs
- New York Presbyterian/Morgan Stanley Children’s Hospital Department of Pediatric Radiology and Surgery, New York, NY, USA
| | - James C. Jeng
- Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA
| | | | - Molly Marino
- Quality Measurement and Health Policy Program, RTI International, Waltham, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
- Spaulding Research Institute, Boston, MA
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Almeland SK, Depoortere E, Jennes S, Sjöberg F, Lozano Basanta JA, Zanatta S, Alexandru C, Martinez-Mendez JR, van der Vlies CH, Hughes A, Barret JP, Moiemen N, Leclerc T. Burn mass casualty incidents in Europe: A European response plan within the European Union Civil Protection Mechanism. Burns 2022; 48:1794-1804. [DOI: 10.1016/j.burns.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
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Almeland SK, Hughes A, Leclerc T, Ogura T, Hayashi M, Mills JA, Norton I, Potokar T. "Reply: Letter to the Editor on recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020.". Burns 2022; 48:482-484. [PMID: 34903407 DOI: 10.1016/j.burns.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Amy Hughes
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; Humanitarian and Conflict Response Institute (HCRI), University of Manchester, UK; Cambridge Hospital NHS Foundation Trust (Addenbrookes), Paediatric ICU Department, UK.
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France.
| | - Takayuki Ogura
- Tochigi Emergency and Critical Care Centre, Imperial Foundation Saiseikai, Utsunomiya Hospital, Japan.
| | - Minoru Hayashi
- St.Mary's Hospital, Department of Plastic and Reconstructive Surgery, Japan.
| | - Jody-Anne Mills
- Rehabilitation Programme, Department of NCD, World Health Organization, Geneva, Switzerland.
| | - Ian Norton
- World Health Organization (2014-2019), Geneva, Switzerland; Respond Global, Australia.
| | - Tom Potokar
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK; World Health Organization, Emergency Medical Teams Technical Working Group on Burns, Switzerland.
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A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns. Burns 2021; 47:1730-1738. [PMID: 33707086 DOI: 10.1016/j.burns.2021.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/18/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Burn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. METHODS The TWGB formula was numerically compared with 2-4 mL/kg/%TBSA for adults and the Galveston formula for children. RESULTS In adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20-25% and the 50-60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups. CONCLUSION The TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
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