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

Websites: www.burndisaster.com www.bst2.org JBCR Mar-April 2005 CCM Jan 05 Websites: www.burndisaster.com www.bst2.org

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

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

DEVELOPING THE REGION IV PLAN

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

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

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

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

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

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

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

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

Preplanning: regional capabilities and preferences

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

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

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

Stages OPEN FULL DIVERT OFFLOAD RETURN © 2005 burndisaster.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 10-15 patients and will result from something in your community catching fire

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

‘never confuse enthusiasm with capability’ GEN Peter Schoomaker

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