1. Region IV Burn Mass Casualty Plan
David J. Barillo, MD, FACS
Chair, ABA Region IV
Commander, FEMA Burn Specialty Team 2

2. Websites: www.burndisaster.com www.bst2.org
JBCR Mar-April CCM Jan 05
Websites:

3. MASS CASUALTY INCIDENT
‘ the number of patients and severity
of their injuries exceeds the capacity
of the institution’ (ATLS)

4. MASS CASUALTY INCIDENT
500 BURNS ?
50 BURNS ?
5 BURNS ?
2 VIPs ?
REF: JBCR 2005;26:189

5. DEVELOPING THE
REGION IV PLAN

6. Region IV
Region 3
Region 4
Region 5
Region 6
© 2005 burndisaster.com

7. Anniston Army Depot 2 million pounds sulfur mustard
1.5 million pounds of VX + 1 million pounds of sarin
23,415 tons of rockets and barrels requiring decontamination
At least 800 nerve gas rockets that are leaking
35,000 residents living within a 9 mile radius / 250,000 within 30 miles
© 2005 burndisaster.com

8. Goal:
How can we best help each other when a disaster occurs within Region IV and one or more burn centers are overwhelmed?
© 2005 burndisaster.com

9. Criteria Simple Scalable Flexible
Written for and driven by the end user
Applicable to national emergencies
© 2005 burndisaster.com

10. Driven by the End User
The “BOG” BC Director decides if and when to activate plan
BC Director decides how far to activate plan
BC Director decides when disaster is over
© 2005 burndisaster.com

11. Components Each burn center writes their own disaster plan
A regional burn mutual – aid system
Pre-planning (who is ‘next-up’ for overflow admissions ? )
Regional communications hub
© 2005 burndisaster.com

12. Region IV Plan
The key to the Region IV Burn Disaster Plan is the designation of an experienced burn doctor who is NOT located at the disaster hospital as the “Incident Commander”
This person makes phone calls: you go back to the ED and manage patients

13. Burn Center Disaster Plan
One size will not fit all
Development of a guide to writing YOUR OWN disaster plan
Integrate into hospital Emergency Response Program
© 2005 burndisaster.com

14. Preplanning: regional capabilities and preferences

16. Region IV
Region 3
Region 4
Region 5
Region 6
© 2005 burndisaster.com

18. Region IV Communications Center (R4CC)
A location outside of the disaster area when one or more experienced burn surgeons can make phone calls and transfer arrangements on your behalf
Has lists of critical phone numbers, BC capabilities and transport assets within the region
Has copies of the pre-plans of who goes where
Has a list of transport distances
© 2005 burndisaster.com

19. Region IV Communications Center
Ideally co-located at an EMS Dispatch center, county or state EOC or similar facility with existing commo capability and staff
Birmingham AL TCC
TCC already keeps track of bed and asset availability within regional trauma system
Availability of 2 Burn Centers, Regional Trauma Center, at least 4 experienced burn surgeons
A back-up Center also needs to be designated
© 2005 burndisaster.com

20. Stages
OPEN
FULL
DIVERT
OFFLOAD
RETURN
© 2005 burndisaster.com

21. OPEN
The burn center is open and available for referrals, either local or distant
ACTION: R4CC has the center listed as open
© 2005 burndisaster.com

22. FULL
There is no disaster but the burn center is full, there are no other ICU beds open and there is no one transferrable out of the burn center
© 2005 burndisaster.com

23. FULL
ACTION: BC Director notifies next closest burn center(s) of full status. Region IV Comm Center (R4CC) notified to mark unit as ‘full’
Decision to accept or transfer new patients made by BC Director on case-by-case basis.
Overflow to next closest burn center(s)
© 2005 burndisaster.com

24. DIVERT There is a Mass Casualty Incident (MASCAL) in progress
The burn center can presently handle all patients
No further patients from the incident are expected
© 2005 burndisaster.com

25. DIVERT ACTION: BC Director notifies R4CC
R4CC notifies next-closest burn centers that they will get subsequent local admissions.
R4CC provides heads-up notification to other Region IV burn centers and to BST-2 and NDMS
The affected burn center automatically closes to all new admissions for predetermined period (48 – 72 hr) at which time BC Director will reassesses status
© 2005 burndisaster.com

26. OFFLOAD There is a mass casualty incident in progress
The burn center is overloaded and not able to handle all patients OR
Additional patients from the incident are expected OR
The situation is ongoing ,unstable or unpredictable
© 2005 burndisaster.com

27. OFFLOAD
ACTION: BC Director notifies R4CC that offloading will be needed
R4CC notifies all regional burn centers, NDMS, BST-2 and ABA Central Office
R4CC checks on availability of beds/transport
R4CC awaits further input from BC Director
© 2005 burndisaster.com

28. OFFLOAD
BC Director notifies R4CC of number/condition of patients requiring transfer
Local BC handles situation for first 24 hours
R4CC schedules transport and acceptance of burn patients at regional burn centers
At hours, transport teams start arriving to offload patients
If needed, NDMS Burn Specialty Teams arrive within several days to work in 2 week shifts until situation resolved
Pre-empt the Hospital CEO response to CNN trucks in the parking lot
© 2005 burndisaster.com

29. OFFLOAD The process is driven by the end-user! THE BC DIRECTOR
Decides if and when to declare ‘offload’
Can decide which patients stay and which patients go
(or can delegate this to R4CC)
Can decide where and how to send patients or can leave this to R4CC
Can decide to ask for or to refuse NDMS help
The process is driven by the end-user!
© 2005 burndisaster.com

30. RETURN The disaster is over or under control
The BC is again accepting new patients
Plans are made to start transferring offloaded patients back to the BC closest to home (if you and the patient want to!!)
© 2005 burndisaster.com

31. RETURN ACTION: BC Director notifies R4CC of ‘return’ status
R4CC marks the BC as ‘available’
BC Director can contact accepting burn centers and make individual decisions regarding transfer of patients back
BC Director can decide to leave patients where they are
© 2005 burndisaster.com

32. The Big Controversy
Do you transport patients away from the disaster to other burn centers OR
Do you transport burn care professionals into the disaster area ?
© 2005 burndisaster.com

33. Region IV Plan answer: IT DEPENDS ! Flexibility
Within this plan we can do either, both, or neither as the situation dictates
Decision made by by the end-user
© 2005 burndisaster.com

34. Implementation Present to May :
Regional Disaster Committee develops guide to writing the hospital disaster plan
BC directors inventory resources and existing disaster plans
ABA meeting : one additional day working on plan, meet as a group to approve draft plan
May – November:
Burn Centers write disaster plans
Disaster Committee drafts regional plan
November: Meet as a group to revise/approve final regional plan
© 2005 burndisaster.com

35. SUMMARY There is little burn surge capacity or capability in the US
Burn disasters are uncommon
Treatable (living) burn patients comprise a small percentage of the total injured, but consume an enormous proportion of the resources
Months after the fun is over, burn patients are still there
Even small community hospitals can manage MASCALS with appropriate planning and practice
Your next disaster will likely involve patients and will result from something in your community catching fire

36. Disaster Planning “Talk the Talk” – Learn NIMS See the big picture
The worst plan is
no plan- the next
worse is two plans

37. ‘never confuse enthusiasm with capability’ GEN Peter Schoomaker

38. www.burndisaster.com www.bst2.org dave@bst2.org