747 Developing a Burn Mass Casualty Incident (BMCI) Plan for a State (first Steps)

Introduction A burn mass casualty incident (BMCI) occurs when a disaster involves many injured patients who have specific burn injuries. For this particular state, there are four burn centers. They range in size from 4–20 beds. The area hazards include: Methods A meeting was arranged for the burn center directors. Burn surgeons, along with burn center nursing staff, evaluated a series of “predefined patients” distributed over a compressed timeline during the hourlong exercise. The participants had not previously seen the “patients” nor were they aware of their injuries until the exercise controller released the information. The exercise controller was provided by a state emergency response coordination agency. The exercise followed a meeting that discussed efforts to standardize emergency medical services (EMS) care in the state, and route burn patients through the state call center to the most appropriate burn center. The final hour of the morning focused on the tabletop exercise, followed by a “hot-wash” (debriefing). Results The scenario included 20 patients staggered over the morning with each surgeon considering capacity and capability to manage the theoretical patients who ranged in age from 1 month to 81 years old (Median 24, Mean 28.2) with a TBSA range of 0 to 73 (Median 6, Mean 12.85). There were 4/20 patients intubated on arrival, and an additional 7/16 had “soot tinged sputum.” 16/20 arrived by EMS. Assuming this was a Type III Burn Disaster (meaning burn event only), all four burn center directors reported under ideal circumstances; they could absorb these patients into their respective hospital systems. However, it was also clear that while all could admit, sustaining all of these patients over an extended period may be problematic and potentially require a transfer. It was also discussed that had the severity of burn injury changed for two or more patients, it could have led to exceeding the capability/capacity for most of the burn centers. Conclusions The key to this event was to identify a trigger point for each facility. Every disaster plan requires a trigger or triggers meaning an activation point to begin treating an event based on their BMCI (or burn surge) plan. The next logical step in this process is to analyze further the capabilities and capacities that will inform the planning process as it evolves. Applicability of Research to Practice A working BMCI plan could improve resource utilization during disasters.