Planning for burn disasters: lessons learned from one hundred years of history

European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan

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.

"After The Fire"; The Legacy of College Dormitory Fire Twenty Years Later

In January of 2000 the team at The Burn Center at Saint Barnabas was confronted with what is to date, the single largest burn mass casualty incident since its doors opened in 1977. Looking back through history at other catastrophes shows that, even in the wake of these "landmark events", the lessons learned remain, so that perhaps all was not in vain. 2, 6, 7, 8, 9, 11, 13, 19 While this fire took place more than twenty years ago, its legacy is still being felt today. The following discussion examines some of the key lessons learned, and underscores the fact that positive change does come from tragedy.

Ranking hospitals' burn care capacity using cluster analysis on open government data

BACKGROUND AND OBJECTIVE

To deal with burn mass casualty incidents (BMCIs), various countries have established national or regional BMCI emergency response plans (ERPs). A burn care capacity ranking model for hospitals can play an integral role in ERPs by providing essential information to emergency medical services for distributing and handling mass burn patients. Ranking models vary across countries and contexts. However, Taiwan has had no such model. The study aims to develop a ranking model for classifying hospitals' burn care capacity in preparation for the development of a national BMCI ERP.

METHODS

Multiple methods were adopted. An expert panel provided consultations on data selection and clustering validation. Data on 116 variables from 535 hospitals were collected via open data platforms under the Ministry of Health and Welfare. Data selection and streamlining was conducted to determine 42 variables for cluster analysis. SAS 9.4 was used to analyze the data set -via a hierarchical cluster analysis using Ward's method, followed by a tree-based model analysis to identify the criteria for each cluster. Both internal and external cluster validation were performed.

RESULTS

Four clusters of burn care capacity were determined to be a suitable number of clusters. All hospitals were arranged into capacity levels accordingly. Results of the Kruskal-Wallis test showed that the difference between clusters were significant. Tree-based model analysis revealed four determining variables, among which the refined level of emergency care responsibility hospital was found to be most influential on the clustering process. Responses from the questionnaire were used as an external validation tool to corroborate with the cluster analysis results.

CONCLUSION

The use of open government data and cluster analysis was suitable for developing a ranking model to determine hospitals' burn care capacity levels in Taiwan. The proposed ranking model can be used to develop a BMCI emergency response plan and can also serve as a reference for using cluster analysis with open government data to rank care capacity or quality in other domains.

Are burn centers in German-speaking countries prepared to respond to a burn disaster? Survey-based study

Burn disasters present a challenge not only to burn centers but the entire healthcare system. Most burn centers worldwide are unprepared to deal with a burn disaster as it is an uncommon event. We investigated the status of burn center preparedness in German-speaking countries to respond to a burn disaster. Self-administered survey questionnaires were sent to the directors of burn centers; the questions of survey used before in a similar way in Belgium were translated into German language. Of the 46 questioned burn centers, 32 (78%) responded, including all of the German adult burn centers. A clear difference in the preparation status of the burn centers in the three countries was observed due to geopolitical factors such as decentralized healthcare systems. However, the healthcare system is generally well-prepared concerning command, transfer, and capacity to provide sustained supplies to handle a massive influx of patients. Nevertheless, there are some gaps in the areas of planning and preparation, funding for disaster activities, and regular training of staff for burn disasters. We call for a unified burn disaster plan and increased cooperation between burn centers and civil defense regarding communication and training. We strongly recommend the implementation of a special disaster fund and telemedicine in disaster management to circumvent shortages in burn staff.

Development of dynamic cell and organotypic skin models, for the investigation of a novel visco-elastic burns treatment using molecular and cellular approaches

BACKGROUND

Burn injuries are a major cause of morbidity and mortality worldwide. Despite advances in therapeutic strategies for the management of patients with severe burns, the sequelae are pathophysiologically profound, up to the systemic and metabolic levels. Management of patients with a severe burn injury is a long-term, complex process, with treatment dependent on the degree and location of the burn and total body surface area (TBSA) affected. In adverse conditions with limited resources, efficient triage, stabilisation, and rapid transfer to a specialised intensive care burn centre is necessary to provide optimal outcomes. This initial lag time and the form of primary treatment initiated, from injury to specialist care, is crucial for the burn patient. This study aims to investigate the efficacy of a novel visco-elastic burn dressing with a proprietary bio-stimulatory marine mineral complex (MXC) as a primary care treatment to initiate a healthy healing process prior to specialist care.

METHODS

A new versatile emergency burn dressing saturated in a >90% translucent water-based, sterile, oil-free gel and carrying a unique bio-stimulatory marine mineral complex (MXC) was developed. This dressing was tested using LabSkin as a burn model platform. LabSkin a novel cellular 3D-dermal organotypic full thickness human skin equivalent, incorporating fully-differentiated dermal and epidermal components that functionally models skin. Cell and molecular analysis was carried out by in vitro Real-Time Cellular Analysis (RTCA), thermal analysis, and focused transcriptomic array profiling for quantitative gene expression analysis, interrogating both wound healing and fibrosis/scarring molecular pathways. In vivo analysis was also performed to assess the bio-mechanical and physiological effects of this novel dressing on human skin.

RESULTS

This hybrid emergency burn dressing (EBD) with MXC was hypoallergenic, and improved the barrier function of skin resulting in increased hydration up to 24 h. It was demonstrated to effectively initiate cooling upon application, limiting the continuous burn effect and preventing local tissue from damage and necrosis. xCELLigence RTCA® on primary human dermal cells (keratinocyte, fibroblast and micro-vascular endothelial) demonstrated improved cellular function with respect to tensegrity, migration, proliferation and cell-cell contact (barrier formation) [1]. Quantitative gene profiling supported the physiological and cellular function finding. A beneficial quid pro quo regulation of genes involved in wound healing and fibrosis formation was observed at 24 and 48 h time points.

CONCLUSION

Utilisation of this EBD + MXC as a primary treatment is an effective and easily applicable treatment in cases of burn injury, proving both a cooling and hydrating environment for the wound. It regulates inflammation and promotes healing in preparation for specialised secondary burn wound management. Moreover, it promotes a healthy remodelling phenotype that may potentially mitigate scarring. Based on our findings, this EBD + MXC is ideal for use in all pre-hospital, pre-surgical and resource limited settings.

Traits and causes of environmental loss-related chemical accidents in China based on co-word analysis

Chemical accidents are major causes of environmental losses and have been debated due to the potential threat to human beings and environment. Compared with the single statistical analysis, co-word analysis of chemical accidents illustrates significant traits at various levels and presents data into a visual network. This study utilizes a co-word analysis of the keywords extracted from the Web crawling texts of environmental loss-related chemical accidents and uses the Pearson's correlation coefficient to examine the internal attributes. To visualize the keywords of the accidents, this study carries out a multidimensional scaling analysis applying PROXSCAL and centrality identification. The research results show that an enormous environmental cost is exacted, especially given the expected environmental loss-related chemical accidents with geographical features. Meanwhile, each event often brings more than one environmental impact. Large number of chemical substances are released in the form of solid, liquid, and gas, leading to serious results. Eight clusters that represent the traits of these accidents are formed, including "leakage," "poisoning," "explosion," "pipeline crack," "river pollution," "dust pollution," "emission," and "industrial effluent." "Explosion" and "gas" possess a strong correlation with "poisoning," located at the center of visualization map.

Disaster Planning: Financing a Burn Disaster, Where Do You Turn and What Are Your Options When Your Hospital Has Been Impacted by a Burn Disaster in the United States?

The cost associated with a single burn injured patient can be significant. The American healthcare system functions in part based on traditional market forces which include supply and demand. In addition, there are a variety of payer sources with disparate payment for the same services. Thus, when a group of patients with serious injuries needing complicated care are underinsured or uninsured, or lacks the ability to pay, the financial health of the organization providing the care can be undermined. When a medical disaster with significant numbers of burn injured patients occurs, the financial concerns can be compounded with this singular event. It is critical to be cognizant of the disaster-related financial resources available. Knowing where to turn and what may be available can help assure that the institution caring for this group of high cost patients does not simultaneously take on significant financial risk in the aftermath of the disaster. This article includes national (United States) financial data with respect to burn injury, and focuses on (United States) governmental financial resources during and after a disaster. This review includes identifying and discussing traditional financial support, as well as atypical but established programs where, during a disaster, health care institutions may be eligible for assistance to cover part or all of the associated costs.

Review of Recent Large-Scale Burn Disasters Worldwide in Comparison to Preparedness Guidelines

The US National Bioterrorism Hospital Preparedness Program indicates that each care facility must have "a plan to care for at least 50 cases per million people for patients suffering burns or trauma" to receive national funding disaster preparedness. The purpose of this study is to evaluate whether this directive is commensurate with the severity recent burn disasters, both nationally and internationally. We conducted a review of medical journal articles, investigative fire reports, and media news sources for major burn disasters dating from 1990 to present day. We defined a major burn disaster as any incident with ≥50 burn injuries and/or ≥ 30 burn-related deaths. We compared existing preparedness guidelines with the magnitude of recent burn disasters using as reference the 2005 U.S. Health and Human Services directive that each locale must "have a plan to care for at least 50 cases per million people for patients suffering burns or trauma." We reported the number of actual casualties for each incident, and estimated the number of burn beds theoretically available if the "50 [burn-injury] cases per million people" directive were to be applied to metropolitan areas outside the United States. Seven hundred fifty-two burn disaster incidents met our inclusion criteria. The majority of burn disasters occurred in Asia/Middle East. The incidence of major burn disasters from structural fires and industrial blasts remains constant in high-income and resource-restricted countries during this study period. The incidence of terrorist attacks increased 20-fold from 2001 to 2015 compared with 1990 to 2000. Recent incidents demonstrate that if current preparedness guidelines were to be adopted internationally, local resources including burn-bed availability would be insufficient to care for the total number of burn casualties. These findings underscore an urgent need to organize better regional, national, and international collaboration in burn disaster response.

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.

Disaster Preparedness and Response for the Burn Mass Casualty Incident in the Twenty-first Century

The effective and efficient coordination of emergent patient care at the point of injury followed by the systematic resource-based triage of casualties are the most critical factors that influence patient outcomes after mass casualty incidents (MCIs). The effectiveness and appropriateness of implemented actions are largely determined by the extent and efficacy of the planning and preparation that occur before the MCI. The goal of this work was to define the essential efforts related to planning, preparation, and execution of acute and subacute medical care for disaster burn casualties. This type of MCI is frequently referred to as a burn MCI."

Management of the Formosa Color Dust Explosion: Lessons Learned from the Treatment of 49 Mass Burn Casualty Patients at Chang Gung Memorial Hospital

BACKGROUND

This article reports the emergency management of a mass casualty disaster occurring on June 27, 2015, in New Taipei, Taiwan, as a fire erupted over a large crowd, injuring 499 people. Lessons learned in burn care treatment and disaster preparedness are analyzed through following the specific surgical response and patient outcomes of one hospital involved in the disaster response.

METHODS

Information regarding the fire and emergency management was obtained from the Ministry of Health and Welfare of Taiwan. Patient-specific data were obtained from Chang Gung Memorial Hospital's patient records.

RESULTS

A mass casualty management system was immediately initiated by the Ministry of Health and Welfare, which contacted local hospitals to prepare for the influx of patients with severe burn injuries. In response, Chang Gung Memorial Hospital called 336 medical personnel to the emergency room for the management of 49 burn patients and divided emergency management roles among chief physicians. The mean burn total body surface area of patients presenting to this hospital was 44.2 percent (range, 10 to 90 percent). No deaths occurred in the first 48 hours after the explosion. As of 3 months after the incident, only 12 deaths had resulted from this accident, all resulting from sepsis and organ failure.

CONCLUSIONS

Taiwan's effective mass casualty preparation plans, highly trained medical personnel, and large centers capable of treating burn patients allowed 499 injured patients to be successfully transferred and treated in hospitals across Taiwan. Lessons learned from this disaster response can be integrated into existing disaster management plans to aid in the response to mass casualty tragedies.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Advanced Burn Life Support for Day-to-Day Burn Injury Management and Disaster Preparedness: Stakeholder Experiences and Student Perceptions Following 56 Advanced Burn Life Support Courses

Educational programs for clinicians managing patients with burn injuries represent a critical aspect of burn disaster preparedness. Managing a disaster, which includes a surge of burn-injured patients, remains one of the more challenging aspects of disaster medicine. During a 6-year period that included the development of a burn surge disaster program for one state, a critical gap was recognized as public presentations were conducted across the state. This gap revealed an acute and greater than anticipated need to include burn care education as an integral part of comprehensive burn surge disaster preparedness. Many hospital and prehospital providers expressed concern with managing even a single, burn-injured patient. While multiple programs were considered, Advanced Burn Life Support (ABLS), a national standardized educational program was selected to help address this need. The curriculum includes initial care for the burn-injured patient as well as an overview of the burn centers role in the disaster preparedness community. After 4 years and 56 classes conducted across the state, a survey was developed including a section that measured the perceptions of those who completed the ABLS educational program. The study specifically examines questions including whether clinicians perceived changes in their burn care knowledge, skills and abilities, and burn disaster preparedness following completion of the program? including whether clinicians.

ABA Southern Region Burn disaster plan: the process of creating and experience with the ABA southern region burn disaster plan

The Southern Region of the American Burn Association began to craft a regional plan to address a surge of burn-injured patients after a mass casualty event in 2004. Published in 2006, this plan has been tested through modeling, exercise, and actual events. This article focuses on the process of how the plan was created, how it was tested, and how it interfaces with other ongoing efforts on preparedness. One key to success regarding how people respond to a disaster can be traced to preexisting relationships and collaborations. These activities would include training or working together and building trust long before the crisis. Knowing who you can call and rely on when you need help, within the context of your plan, can be pivotal in successfully managing a disaster. This article describes how a coalition of burn center leaders came together. Their ongoing personal association has facilitated the development of planning activities and has kept the process dynamic. This article also includes several of the building blocks for developing a plan from creation to composition, implementation, and testing. The plan discussed here is an example of linking leadership, relationships, process, and documentation together. On the basis of these experiences, the authors believe these elements are present in other regions. The intent of this work is to share an experience and to offer it as a guide to aid others in their regional burn disaster planning efforts.

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.

Disaster planning: the past, present, and future concepts and principles of managing a surge of burn injured patients for those involved in hospital facility planning and preparedness

The 9/11 attacks reframed the narrative regarding disaster medicine. Bypass strategies have been replaced with absorption strategies and are more specifically described as "surge capacity." In the succeeding years, a consensus has coalesced around stratifying the surge capacity into three distinct tiers: conventional, contingency, and crisis surge capacities. For the purpose of this work, these three distinct tiers were adapted specifically to burn surge for disaster planning activities at hospitals where burn centers are not located. A review was conducted involving published plans, other related academic works, and findings from actual disasters as well as modeling. The aim was to create burn-specific definitions for surge capacity for hospitals where a burn center is not located. The three-tier consensus description of surge capacity is delineated in their respective stratifications by what will hereinafter be referred to as the three "S's"; staff, space, and supplies (also referred to as supplies, pharmaceuticals, and equipment). This effort also included the creation of a checklist for nonburn center hospitals to assist in their development of a burn surge plan. Patients with serious burn injuries should always be moved to and managed at burn centers, but during a medical disaster with significant numbers of burn injured patients, there may be impediments to meeting this goal. It may be necessary for burn injured patients to remain for hours in an outlying hospital until being moved to a burn center. This work was aimed at aiding local and regional hospitals in developing an extemporizing measure until their burn injured patients can be moved to and managed at a burn center(s).

Burn care in disaster and other austere settings

In some circumstances, burn care must be delivered in a simple manner without the luxury of modern resources. Such circumstances include care in low- and middle-income countries, war zones, and mass casualty incidents. Triage decisions need to be made carefully, allowing the focus of limited personnel and equipment on those most likely to survive. Simple techniques can be used to help many burn victims, such as utilizing oral resuscitation formulas for burn resuscitation. Although even the best attempts at preparation often fall short, there are many benefits from planning and training.

On the horizon: research priorities in burns for the next decade

This review demonstrates that many advances have been made in burn care that have made dramatic differences in mortality, clinical outcomes, and quality of life in burn survivors; however, much work remains. In reality, the current standard of care is insufficient and we cannot be satisfied with the status quo. We must strive for the following goals: no deaths due to burn, no scarring, and no pain. These particular goals have only begun to be confronted.

An Analysis of Mass Casualty Incidents in the Setting of Mass Gatherings and Special Events

OBJECTIVES

Mass gatherings (MGs) and special events typically involve large numbers of people in unfamiliar settings, potentially creating unpredictable situations. To assess the information available to guide emergency services and onsite medical teams in planning and preparing for potential mass casualty incidents (MCIs), we analyzed the literature for the past 30 years.

METHODS

A search of the literature for MCIs at MGs from 1982 to 2012 was conducted and analyzed.

RESULTS

Of the 290 MCIs included in this study, the most frequently reported mechanism of injury involved the movement of people under crowded conditions (162; 55.9%), followed by special hazards (eg, airplane crashes, pyrotechnic displays, car crashes, boat collisions: 57; 19.6%), structural failures (eg, building code violations, balcony collapses: 38; 13.1%), deliberate events (26; 9%), and toxic exposures (7; 2.4%). Incidents occurred in Asia (71; 24%), Europe (69; 24%), Africa (48; 17%), North America (48; 27%), South America (27; 9%), the Middle East (25; 9%), and Australasia (2; 1%). A minimum of 12 877 deaths and 27 184 injuries resulted.

CONCLUSIONS

Based on our findings, we recommend that a centralized database be created. With this database, researchers can further develop evidence to guide prevention efforts and mitigate the effects of MCIs during MGs. (Disaster Med Public Health Preparedness. 2014;0:1-7).

Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers

Response to the 2010 Haitian earthquake included an array of diverse yet critical actions. This paper will briefly review the evacuation of a small group of patients with burns to burn centers in the southeastern United States (US). This particular evacuation brought together for the first time plans, groups, and organizations that had previously only exercised this process. The response to the Haitian earthquake was a glimpse at what the international community working together can do to help others, and relieve suffering following a catastrophic disaster. The international response was substantial. This paper will trace one evacuation, one day for one unique group of patients with burns to burn centers in the US and review the lessons learned from this process. The patient population with burns being evacuated from Haiti was very small compared to the overall operation. Nevertheless, the outcomes included a better understanding of how a larger event could challenge the limited resources for all involved. This paper includes aspects of the patient movement, the logistics needed, and briefly discusses reimbursement for the care provided.

Challenges in the provision of skin in the UK: the use of human deceased donor skin in burn care relating to mass incidents in the UK

This article aims to discuss the role of deceased donor skin within the treatment of burn injuries with particular reference to the management of major burn disasters. The article begins with a review of wound healing before progressing to outline the development of the current modern day approach to burns surgery from its historical origins and the role of deceased donor skin within this. A detailed review of mass disasters within the UK over the past 29 years provides an indication as to the frequency and extent of mass disasters that might be predicted to occur. Combining this with a recent review of allograft requirements within burns surgery at a regional UK centre allows for more accurate planning and stockpiling of deceased donor skin reserves. UK awareness and emergency preparedness for major burn disasters can thus be improved.

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System(®) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n=13) preventable deaths and 15.5% (n=11) preventable complications; simulation II, 11.4% (n=8) preventable deaths and 11.4% (n=8) preventable complications. The last T1 patient was evacuated after 7h in simulation I, compared with 5h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

Shaking stress aggravates burn-induced cardiovascular and renal disturbances in a rabbit model

The aim of this study was to address the effects of shaking stress (a.k.a. physical agitation) on burn-induced remote organ injury and to evaluate the application of delayed fluid resuscitation to treat severe burns under shaking conditions. Healthy adult male rabbits, weighing 2.50±0.40 kg, were randomly assigned to the following groups: control group, burn group, and burn+shaking group. One half of burned animals received a 6-h delayed fluid resuscitation and the other half remained untreated. Cardiovascular hemodynamics and functional and pathological changes of the heart and kidney were examined. Compared to normal controls, untreated burned animals showed decreased hemodynamic parameters, increased serum lactic acid, and severe myocardial inflammation. The burn-induced hemodynamic abnormalities and cardiac injury were aggravated by shaking stress. Burn injury led to reduced urine volume, elevated serum creatinine and blood urea nitrogen, and formation of erythrocyte casts in renal tubules. Shaking stimulation worsened the burn-associated functional and pathological changes of the kidney. Fluid resuscitation markedly mitigated cardiac and renal injury in burned animals, and, to a lesser extent, in the presence of shaking stimulation. Shaking stimulation aggravates burn-induced cardiovascular and renal disturbances. Delayed fluid resuscitation attenuates cardiac and renal damages in burn injury under shaking conditions.

Posttraumatic stress symptoms after exposure to two fire disasters: comparative study

This study investigated traumatic stress symptoms in severely burned survivors of two fire disasters and two comparison groups of patients with "non-disaster" burn injuries, as well as risk factors associated with acute and chronic stress symptoms. Patients were admitted to one out of eight burn centers in The Netherlands or Belgium. The Impact of Event Scale (IES) was administered to 61 and 33 survivors respectively of two fire disasters and 54 and 57 patients with "non-disaster" burn etiologies at 2 weeks, 3, 6, 12 and 24 months after the event. We used latent growth modeling (LGM) analyses to investigate the stress trajectories and predictors in the two disaster and two comparison groups. The results showed that initial traumatic stress reactions in disaster survivors with severe burns are more intense and prolonged during several months relative to survivors of "non-disaster" burn injuries. Excluding the industrial fire group, all participants' symptoms on average decreased over the two year period. Burn severity, peritraumatic anxiety and dissociation predicted the long-term negative outcomes only in the industrial fire group. In conclusion, fire disaster survivors appear to experience higher levels of traumatic stress symptoms on the short term, but the long-term outcome appears dependent on factors different from the first response. Likely, the younger age, and several beneficial post-disaster factors such as psychosocial aftercare and social support, along with swift judicial procedures, contributed to the positive outcome in one disaster cohort.

30 years of burn disasters within the UK: guidance for UK emergency preparedness

AIM

To review casualty profiles of major UK burn disasters over the last 30 years in order to provide guidance to aid burn and emergency service planning and provision so as to improve emergency preparedness for future national disasters.

METHODS

A review of published literature was undertaken for disasters within the UK that had occurred between 1980 and 2009. Those producing 10 or more casualties with at least one sustaining cutaneous burns injuries were included. Frequency and extent of burns were recorded and analysed.

RESULTS

In total 37 disasters were included in this study, their frequency of occurrence falling over the 30 years reviewed. Burns tended to make up a small proportion of all casualties and were often relatively small in size with only 3 disasters having more than 5 patients with >10% burns.

DISCUSSION

This paper can help guide appropriate staffing and bed capacity planning for regional burns units and provide realistic figures to guide scenarios for national emergency training exercises. Due to the infrequent nature of major disasters, Critical Care, Trauma Care and Burn Care Networks will all need to be closely integrated and their implementation rehearsed so as to ensure optimal response to a major national disaster.

Multidisciplinary team response to a mass burn casualty event: outcomes and implications

OBJECTIVES

To describe the characteristics of patients with burn injury admitted to a major trauma hospital in Melbourne following the Black Saturday bushfires of 7 February 2009, and to provide a detailed analysis of the hospital's response to the crisis.

DESIGN, SETTING AND PARTICIPANTS

A retrospective chart review of ambulance and hospital records of patients admitted to the Victorian Adult Burns Service (VABS) at The Alfred Hospital (The Alfred) following the bushfires.

MAIN OUTCOME MEASURES

Patient characteristics and outcomes: age, sex, total and full thickness body surface area burnt, type and site of burn, hospital and intensive care unit length of stay (LOS) and receipt of standard burn care practices. Estimated glomerular filtration rate, theatre time and LOS data for the bushfire cohort compared with corresponding data for historical cohorts from VABS and from a similar institution in New Zealand.

RESULTS

Nineteen patients were admitted to VABS over the first 48 hours after the bushfires. Of these, nine patients were subsequently admitted to The Alfred's intensive care unit. Most patients (74%) were men with a mean age of 52.7 years (SD, 12.4 years). Seventeen patients (89%) underwent at least one surgical procedure, which resulted in 4355 minutes of theatre time for the bushfire cohort in the first week. Hospital LOS was similar for the bushfire and New Zealand cohorts. Compared with the VABS historical cohort, there was a higher incidence of abnormal renal function among the bushfire cohort patients.

CONCLUSIONS

Although relatively few patients with severe burns were admitted to VABS, significant increases in resource allocation were required to manage them in terms of additional theatre time, consumables and staffing. The experience of VABS may aid planning for future mass burns casualty events.

Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan

INTRODUCTION

Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.

METHODS

Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.

RESULTS

Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources.

CONCLUSIONS

Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.

The role of the plastic surgeon in disaster relief

Awareness of large-scale disasters among members of the medical community and the public at large has been heightened by recent events such as the 1995 Oklahoma City bombing incident, the 2001 World Trade Center attack, and the 2005 London Underground bombings. Experience with these events has highlighted the critical role of surgical specialists, including plastic surgeons. As part of their residency, plastic surgeons are trained in acute trauma management. In addition, they also are required to demonstrate expertise in the assessment and treatment of soft-tissue injuries, upper extremity trauma, facial fractures, and both operative and nonoperative burn management. Accordingly, the plastic surgeon is among the most qualified of physicians to provide specialized injury care, especially in the disaster medicine setting. In turn, training programs should include key elements of incident command and catastrophe relief.