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Burn Disaster Preparedness and the Southern Region of the United States

Randy Kearns, DHA, MSA, James Holmes IV, MD, FACS, Bruce Cairns, MD, FACS
Volume: 106 Issue: 1 January, 2013

Abstract:

Disasters with significant numbers of burn-injured patients create incredible challenges for disaster planners. Although not unique to burn care, high-intensity areas of speciality such as burns, pediatrics, and trauma quickly become scarce resources in a disaster.


All disasters are local, but regional support is critical in burn disaster planning. On a day-to-day basis, burn bed capacity can be problematic. A review of the literature and our experiences, including mathematical modeling and real events, reaffirm how rapidly we can overwhelm our resources.


This review includes the Southern Burn Plan, created by the burn centers of the American Burn Association’s Southern Region, should there be a need for additional hospital burn beds (capacity) and burn care (capability) in response to a disaster. This article also explores planning and preparedness developments and describes options to improve our efforts, including training and education.


It is incumbent upon everyone in the healthcare profession to become comfortable managing burn-injured patients until the patients can be moved to a burn center. Understanding the regional capacity, capability, and when a surge of patients may require the practice of altered standards of care is essential for those involved in medical disaster preparedness.

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References:

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2. American Burn Association. Burn care resource directory. http://www.ameriburn.org/BCRDPublic.pdf. Accessed September 10, 2012.
 
3. US Census. 2010 population data. http://2010.census.gov/2010census/data. Accessed June 15, 2011.
 
4. American Burn Association. Resources for optimal care of the injured patient. http://www.ameriburn.org/Chapter14.pdf. Published 2006. Accessed September 10, 2012.
 
5. American Hospital Association. AHA hospital statistics 2009 annual survey, 2011 edition. http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html. Accessed September 10, 2012.
 
6. Holmes JH, Carter JE, Neff LP, et al. The effectiveness of regionalized burn care: an analysis of 6,873 burn admissions in North Carolina from 2000 to 2007. J Am Coll Surg 2011; 212: 487–493.
 
7. van Harten SM, Bierens JJ, Welling L, et al. The Volendam fire: lessons learned from disaster research. Prehosp Disaster Med 2006; 21: 303–309.
 
8. Barillo DJ, Dimick AR, Cairns BA, et al. The Southern Region burn disaster plan. J Burn Care Res 2006; 27: 589–595.
 
9. Cairns BA, Stiffler A, Price F, et al. Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion. J Burn Care Res 2005; 26: 144–150.
 
10. Barillo DJ, Goode R. Fire fatality study: demographics of fire victims. Burns 1996; 22: 85–88.
 
11. Harrington DT, Biffl WL, Cioffi WG. The Station nightclub fire. J Burn Care Rehabil 2005; 26: 141–143.
 
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15. Vandenberg V, Amara R, Crabtree J, et al. Burn surge for Los Angeles County, California. J Trauma 2009; 67 (2 suppl): S143–S146.
 
16. Kearns RD, Cairns BA, Holmes I, et al. The North Carolina Burn Surge Disaster Plan for Emergency Medical Services and Hospitals. Chapel Hill, University of North Carolina, 2012, 85.
 
17. Gamelli RL, Purdue GF, Greenhalgh DG, et al. Disaster management and the ABA plan. J Burn Care Rehabil 2005; 26: 102–106.
 
18. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep 2009; 3 (2 suppl): S59–S67.
 
19. American Burn Association. Burn center referral criteria. http://www.ameriburn.org/BurnCenterReferralCriteria.pdf. Published 2006. Accessed September 10, 2012.
 
20. American Burn Association. 2011 National Burn Repository. Report of data from 2001–2010, Vol 72011. http://www.ameriburn.org/2011NBRAnnualReport.pdf. Accessed September 10, 2012.
 
21. Barillo DJ, Jordan MH, Jocz RJ, et al. Tracking the daily availability of burn beds for national emergencies. J Burn Care Rehabil 2005; 26: 174–182.
 
22. Barillo DJ, Renz E, Broger K, et al. An emergency medical bag set for long-range aeromedical transportation. Am J Disaster Med 2008; 3: 79–86.
 
23. Renz EM, Cancio LC, Barillo DJ, et al. Long range transport of war-related burn casualties. J Trauma 2008; 64 (2 suppl): S136–S145.
 
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25. Chung KK, Blackbourne LH, Wolf SE, et al. Evolution of burn resuscitation in Operation Iraqi Freedom. J Burn Care Res 2006; 27: 606–611.
 
26. Department of Homeland Security. National Response Framework. www.fema.gov/pdf/emergency/nrf/nrf-core.pdf. Published January 2008. Accessed September 10, 2012.
 
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28. Saffle JR, Gibran N, Jordan M. Defining the ratio of outcomes to resources for triage of burn patients in mass casualties. J Burn Care Rehabil 2005; 26: 478–482.
 
29. Kearns RD, Holmes JH 4th, Cairns BA. Burn Education: Perceptions after 56 Advanced Burn Life Support Courses.Chapel Hill: University of North Carolina; 2012; 7.

CME:

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