The Southern Region Burn Disaster Plan David J. Barillo, MD, FACS COL, MC, USAR Commander, NDMS Burn Specialty Team 2

Southern Region Plan PURPOSE: to put onto paper the excellent network of cooperation and collaboration that already exists in the Southern Region GOAL: How can we best help each other when a disaster occurs within the Region and one or more burn centers are overwhelmed?

Southern Region Plan The key to the Region 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

Southern Region Plan 0 – 48 HOURS: You manage the disaster 48 hrs + : The Cavalry arrives to offload patients 3-5 days: NDMS teams show up if you request them

Criteria Simple Scalable Flexible Written for and driven by the end user Applicable to national emergencies

Driven by the End User The “Boots on the Ground” BC Director decides if and when to activate plan BC Director decides how far to activate plan BC Director decides when disaster is over

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

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

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

Preplanning: regional capabilities and preferences

Southern Region Communications Center (SRCC) 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

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

Stages OPEN FULL DIVERT OFFLOAD RETURN

OPEN The burn center is open and available for referrals, either local or distant ACTION: SRCC has the center listed as open

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 BC Director notifies next closest burn center(s) of full status. SRCC 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)

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

DIVERT ACTION: BC Director notifies SRCC SRCC notifies next-closest burn centers that they will get subsequent local admissions. SRCC 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

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

OFFLOAD ACTION: BC Director notifies SRCC that offloading will be needed S4CC notifies all regional burn centers and ABA Central Office SRCC checks on availability of beds/transport SRCC awaits further input from BC Director

OFFLOAD BC Director notifies SRCC of number/condition of patients requiring transfer Local BC handles situation for first 24 –48 hours SRCC schedules transport and acceptance of burn patients at regional burn centers. Accepting hospital does the transport 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

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 SRCC) Can decide where and how to send patients or can leave this to SRCC Can decide to ask for or to refuse NDMS help The process is driven by the end-user!

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!!)

RETURN ACTION: BC Director notifies SRCC 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

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 ?

Southern Region 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

Implementation Plan approved at Southern Region meeting at ABA, Spring 2005 TCC has agreed to initially serve as SRCC at no cost Planning Team working on Transfer Agreements BC Directors fill out information forms Online = January ?

‘never confuse enthusiasm with capability’ GEN Peter Schoomaker