2. Components Each burn center writes own disaster plan Region IV plan: –A regional mutual – aid system –Pre-planning (who is ‘next-up’) Regional communications hub © 2005 burndisaster.com

3. Criteria Simple Scalable Flexible Written for and driven by the end user © 2005 burndisaster.com

4. Driven by the End User 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

5. 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

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

8. 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 Tentative choice: 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

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

10. OPEN The burn center is open and available for referrals, either local or distant ACTION: R4CC has the center listed as open, status updated as needed over internet © 2005 burndisaster.com

11. 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

12. 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

13. 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

14. 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 The affected burn center automatically closes to all new admissions for predetermined period (5-7 days) at which time BC Director reassesses status © 2005 burndisaster.com

15. 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

16. 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

17. 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 24-48 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

18. OFFLOAD 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

19. 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

20. 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

21. 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

22. 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

23. 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 : Region IV meeting to work on plan May – November: Burn Centers write disaster plans Disaster Committee drafts regional plan November: Meet as a group to revise/approve regional plan © 2005 burndisaster.com

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