Developing Hospital & Regional Burn Disaster Plans David J. Barillo, MD, FACS Chair, ABA Region IV Commander, BST-2 © 2005 burndisaster.com
DISCLAIMER This presentation contains draft material which may or may not appear in the final edition of the Region IV disaster plan
© Copyright 2005 The material in this presentation exclusive of government documents is copyrighted Permission is granted for unrestricted use as long as the source is credited © 2005 burndisaster.com
Overview ABA Regionalization Developing the Region IV plan Burn Center disaster plans © 2005 burndisaster.com
Overview ABA Regionalization Developing the Region IV plan Burn Center disaster plans © 2005 burndisaster.com
Disaster Plan One size will not fit all Develop a guide to writing YOUR OWN disaster plan © 2005 burndisaster.com
Under development: A Region IV guide to writing your own burn center disaster plan © 2005 burndisaster.com
Planning Team Need to consider everyone that you would interface with in a disaster: Regional burn centers State OEM / EMS Regional EMS Nursing OT/ PT/ RT Emergency Dept Trauma Service Pediatric, Medical and Surgical Services Pharmacy Local Government Hospital Administration Who has a disaster plan with the words ‘burn center’ in it ? © 2005 burndisaster.com
Planning Team Keep the working group small so that work can actually get done Keep others in the loop as the plan is developed SELECT A LEADER ! © 2005 burndisaster.com
Find a Common Language Anyone on the team not trained in ICS / NIMS should complete on-line courses before any planning is started Review the National Response Plan © 2005 burndisaster.com
Review / Coordinate Existing Plans The worst plan is no plan. The next worse is two plans Start with EMS / ED/ Trauma Service / Hospital / OEM © 2005 burndisaster.com
Hazards Identification What are the dangers in town ? –Chemical plants –Railways –Ports –Farming / grain storage / anhydrous ammonia –Meth labs –Nursing homes –Colleges –Airports What are the regional hazards? Terrorists © 2005 burndisaster.com
Hazards Identification What is the unit history? What has happened in the past that sent many patients to the BC? What were your biggest incidents ? What regional disasters have occurred in the past ? What is the MASCAL experience of other burn centers? © 2005 burndisaster.com
Assess Response Capabilities Burn Center/Hospital/local ER capacity Bed capacity Building capacity Nurses Operating rooms Intubation supplies IV fluids Bronchoscopes and technicians to run/clean them Drugs Other supplies © 2005 burndisaster.com
Assess Response Capabilities Regional / National –EMS / Fire –Other hospitals –Other burn centers –Transport capabilities –State Assets (NG) –Federal assets (DMAT/ military) © 2005 burndisaster.com
Now can we write the plan? Not quite Decide on definitions, terms, roles, and responsibilities © 2005 burndisaster.com
6 Blind Men Describing Elephant
A burn MASCAL can result in: Chemical exposure where injury needs to be ruled out Just burn injury Just inhalation injury Burn injury with inhalation injury Multiple trauma with minimal burn injury ( + / - inhalation) Multiple trauma with massive burn injury ( + / - inhalation) Is ER, burn, trauma or pulmonary in charge? © 2005 burndisaster.com
Keep in mind: Surgeons may not be available for triage or management Initial care, intubation and resuscitation may be done in other ICUs by other intensivists including medical intensivists The nurses that help will not be burn nurses and maybe not even surgical nurses. They cannot be relied upon to keep the residents out of trouble A surgical intern may be the most qualified person managing a critical patient for the first 24 hours Plan for the lowest common denominator © 2005 burndisaster.com
Communications Patients are going to be stuffed into unfamiliar floors or units which may or may not have convenient phones Outside telephones will overload or might even be intentionally shut off Cellphones will overload or towers may be lost The trunked radio system probably won’t work Digital radio systems are 100% or 0% Plan for alternatives! © 2005 burndisaster.com
Communications Wireless carriers have priority access systems Analog VHF simplex FM portable radios Amateur radio clubs ( SATCOM
write the plan Review and revise the plan Keep reviewing and revising until everyone can sign off on it –Administration –ER –Trauma –Medicine/Surgery/Peds –All ICU directors © 2005 burndisaster.com
Test the Plan Run a MASCAL drill and see how the plan works Revise the plan Set up a mechanism for annual review Run a drill at least once a year © 2005 burndisaster.com
SUMMARY All things work best in a system The worst plan is no plan. The next worse is two plans Plan locally, think regionally Everyone signs off on the plan PRACTICE THE PLAN ! Revise the plan at least annually © 2005 burndisaster.com
Resources Prevention: Region IV disaster planning: Journal of Burn Care and Rehabilitation March April 05 American Burn Association Department of Homeland Security: FEMA: National Disaster Medical System : Burn Specialty Team 2: © 2005 burndisaster.com