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

Region IV Burn Region IV Burn Mass Casualty Mass Casualty

PlanPlan

David J. Barillo, MD, FACSDavid J. Barillo, MD, FACS

Chair, ABA Region IVChair, ABA Region IV

Commander, FEMA Burn Specialty Team 2Commander, FEMA Burn Specialty Team 2

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 3Region 3

Region 4Region 4

Region 5Region 5

Region 6 Region 6

© © 2005 burndisaster.com2005 burndisaster.com

Anniston Army Depot

2 million pounds sulfur mustard2 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


Goal:

• How can we best help each other when a disaster occurs within Region IV and one or more burn centers are overwhelmed?


Criteria

• Simple

• Scalable

• Flexible

• Written for and driven by the end user

• Applicable to national emergencies


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


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


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


Preplanning: regional capabilities and preferences

HOSPITAL NAME:

Hospital Address:

Data for this sheet was last entered on:

Regional Mutual Aid agreement signed? Date: Burn Center Disaster plan completed? Date:Regional Transfer Agreement signed? Date:ABA verified: Date:

Burn center configuration: burn ward with ICU and stepdown beds

and other burn-related activities burn ICU with stepdown patients on regular floors

no separate burn unit: utilize regular ICU and floor beds

Adult and pediatric patients?

Pediatric patients only? age limitations:Adult patients only? age limitations:

step-down patients housed on regular floors

Normal burn ICU bed capacity:Normal burn stepdown capacity:Average daily census: % pediatric:Average number of annual admissions: % pediatric:Average number of days burn center closed to admissions in one year:

Surge Capabilities: (as designated by Center)

surge capability without impacting normal operations: percent of daily census:(stay open to new admissions) ICU beds:

Region IV

Region 3Region 3

Region 4Region 4

Region 5Region 5

Region 6 Region 6


Atlanta Augusta Baton Rouge Birmingham Chapel Hill Charleston CharlottesvilleAtlanta x 151 532 148 381 326Augusta 151 x 683 299 306 175

Baton Rouge 532 683 x 399 926 843

Birmingham 148 299 399 x 530 474Chapel Hill 381 306 926 530 x 309 233Charleston 326 175 843 474 309 x

Charlottesville 233 x

Chattanooga 115 266 542 143 446 441Cincinnati 470 587 899 517 504 683Columbus 581 698 1010 628 506 652Gainesville 333 337 584 455 551 325Greenville 424 569 245 280 806 744 907Huntington 348Lexington 388 505 834 536 470 557Little Rock 532 683 441 384 861 858Louisville 467 584 796 397 541 636Memphis 395 546 480 247 725 721Miami 666 621 917 810 835 602Mobile 337 443 195 262 709 644Nashville 243 394 620 221 513 562Norfolk 583 471 1115 731 198 515Orlando 445 410 696 589 625 391Richmond 538 444 1103 686 165 488

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


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


Stages

• OPEN

• FULL

• DIVERT

• OFFLOAD

• RETURN


OPEN

• The burn center is open and available for referrals, either local or distant

• ACTION: R4CC 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


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)


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 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


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 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


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


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!The process is driven by the end-user!© © 2005 burndisaster.com2005 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!!)


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


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 ?


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


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


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.comwww.burndisaster.comwww.bst2.orgwww.bst2.org

[email protected]@bst2.org

Documents

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