Factors for consideration in developing a plan to cope with mass burn casualties

Multi-disciplinary mass burn casualty simulation exercise

Disaster simulation exercises are important to test service processes, capabilities, and deficiencies; disaster response planning should encompass the entire multidisciplinary team over an extended period. Our service simulated a modest eight burn casualty scenario to test our service capabilities over a 10-week period across medical, nursing, and allied health professions. Requirements due to the mass burns casualty cohort were predicted in terms of theatre requirements, allied health treatment hours required, and nursing hours requirements. Prospective business-as-usual service provision data were also collected over the 10-week study period with respect to theatre utilisation, allied health workload, nursing hours, and burns ward bed census. These data were then superimposed on predicted mass burn casualty requirements to gauge total workload demands over the study period. Results showed an expected significant initial spike in theatre requirements in the first week post mass casualty, with ongoing deficiencies in theatre allocation occurring throughout the 10-week study period. Allied health staff were working at or near capacity in a business-as-usual setting with major spikes in workload demand occurring due to the mass burn casualty cohort. Total workload demands clearly exceeded current staff capacity for most of the allied health professions over the 10-week period. Bed census exceeded funded nursing bed capacity for all but seven days of the study period. Predicted combined nursing hours exceeded funded capacity for all but two days. This simulation clearly demonstrated the high and immediate increase in workload demands across all professions over a prolonged 10-week period and that high business-as-usual demand can greatly affect staff capacity to cope with a mass casualty surge in admissions. It was able to provide evidence, and awareness, for leadership and management on the need for resources and resource re-allocation in a mass burn casualty scenario. It also informed a review of our current triggers for activating our SA Health Multiple Burns Plan.

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.