704 Lessons Learned from a Mass Disaster: Successful Institutional Planning and Preparedness

Introduction This abstract discusses the experience of a Burn disaster at the largest thermal power plant of the country, which was successfully managed at our center. The experience gained will hopefully help in the planning and management of similar disaster scenes in resource-constrained developing countries. Methods In a National thermal power plant, there was an explosion in the 500-megawatt unit. Hot fuel gases and steam escaped affecting close to 100 people working around the area. Twenty-six people succumbed to death and six victims who sustained burn injuries were referred to our trauma center where they were received about twenty-six hours after the injury. Despite having no infrastructure supporting the treatment of acute burns, proper planning and coordinated effort by all sectors and persons concerned were immediately initiated and ultimately all patients were discharged in a healthy state with no incidence of mortality or significant morbidity from the burns. Results All the six patients were males ranging from 25 to 45 years age and sustained 20% to 45% deep thermal burns over their bodies. All patients were initially evaluated in the emergency where triage was conducted, and four patients out of six were found to have symptoms of respiratory burns and carbon monoxide poisoning. One high dependency unit (HDU) was immediately converted to a burn ICU(Intensive care unit), and all these patients were nursed in isolation. Two patients had severe airway burns and had to be intubated and ventilated. These patients also required hyperbaric oxygen therapy to revert the carbon monoxide poisoning. Out of the six patients, two patients underwent tangential burn wound excision of both upper limbs and skin allograft placement procured from Skin bank. The other four patients underwent debridement, and allograft application subsequently. all the patients recovered from the burn injuries and were discharged with advice to continue rehabilitation at the regional center. This was one of a kind effort where a trauma center was converted to a full-fledged burn ICU to provide the best possible burn care to the victims. A team of 20 people consisting of Plastic Surgeons, Intensivists, Physiotherapists, Nutritionists, Infection Control Nurses, Wound Care Nurses, Hyperbaric oxygen therapist, and other support staff contributed immensely for management of these patients. Conclusions planned cooperation and prepared coordination between the team of doctors and other support staff are the key in the successful management of a disaster. Applicability of Research to Practice In the event of a mass disaster a level 1 trauma center was immediately converted to a facility equipped to handle burns. This experience gained may be useful in the future in the planning and management of similar disaster scenes in developing countries with limited resources.