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Developing Developing Hospital & Hospital & RegionalRegional
Burn Disaster Burn Disaster PlansPlans
David J. Barillo, MD, FACSDavid J. Barillo, MD, FACS
Chair, ABA Region IVChair, ABA Region IV
Commander, BST-2Commander, BST-2
© 2005 burndisaster.com© 2005 burndisaster.com
DISCLAIMER
This presentation contains draft material which may or may not appear in the final
edition of the Region IV disaster plan
© Copyright 2005
• The material in this presentation exclusive of government documents is copyrighted
• Permission is granted for unrestricted use as long as the source is credited
© 2005 burndisaster.com© 2005 burndisaster.com
Overview
• ABA Regionalization
• Developing the Region IV plan
• Burn Center disaster plans
© 2005 burndisaster.com© 2005 burndisaster.com
Overview
• ABA Regionalization
• Developing the Region IV plan
• Burn Center disaster plans
© 2005 burndisaster.com© 2005 burndisaster.com
Disaster Plan
• One size will not fit all
• Develop a guide to writing YOUR OWN disaster plan
© 2005 burndisaster.com© 2005 burndisaster.com
Under development:
• A Region IV guide to writing your own
burn center disaster plan
© 2005 burndisaster.com© 2005 burndisaster.com
Planning Team• Need to consider everyone that you would interface with in a
disaster:
• Regional burn centers• State OEM / EMS• Regional EMS• Nursing• OT/ PT/ RT• Emergency Dept• Trauma Service• Pediatric, Medical and Surgical Services• Pharmacy• Local Government• Hospital Administration
Who has a disaster plan with the words ‘burn center’ in it ? Who has a disaster plan with the words ‘burn center’ in it ? © 2005 burndisaster.com© 2005 burndisaster.com
Planning Team
• Keep the working group small so that work can actually get done
• Keep others in the loop as the plan is developed
• SELECT A LEADER !
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Find a Common Language
• Anyone on the team not trained in ICS / NIMS should complete on-line courses before any planning is started
• Review the National Response Plan
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Review / Coordinate Existing Plans
• The worst plan is no plan. The next worse is two plans
• Start with EMS / ED/ Trauma Service / Hospital / OEM
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Hazards Identification
• What are the dangers in town ?– Chemical plants– Railways– Ports– Farming / grain storage / anhydrous ammonia– Meth labs– Nursing homes– Colleges – Airports
• What are the regional hazards?
• Terrorists
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Hazards Identification
• What is the unit history?
• What has happened in the past that sent many patients to the BC?
• What were your biggest incidents ?
• What regional disasters have occurred in the past ?
• What is the MASCAL experience of other burn centers?
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Assess Response Capabilities
• Burn Center/Hospital/local• ER capacity• Bed capacity• Building capacity• Nurses• Operating rooms• Intubation supplies• IV fluids• Bronchoscopes and technicians to run/clean them• Drugs• Other supplies
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Assess Response Capabilities
• Regional / National– EMS / Fire– Other hospitals– Other burn centers– Transport capabilities– State Assets (NG)– Federal assets (DMAT/ military)
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Now can we write the plan?
• Not quite
• Decide on definitions, terms, roles, and responsibilities
© 2005 burndisaster.com© 2005 burndisaster.com
A burn MASCAL can result in:
• Chemical exposure where injury needs to be ruled out
• Just burn injury
• Just inhalation injury
• Burn injury with inhalation injury
• Multiple trauma with minimal burn injury ( + / - inhalation)
• Multiple trauma with massive burn injury ( + / - inhalation)
Is ER, burn, trauma or pulmonary in charge?Is ER, burn, trauma or pulmonary in charge?© 2005 burndisaster.com© 2005 burndisaster.com
Keep in mind:
• Surgeons may not be available for triage or management
• Initial care, intubation and resuscitation may be done in other ICUs by other intensivists including medical intensivists
• The nurses that help will not be burn nurses and maybe not even surgical nurses. They cannot be relied upon to keep the residents out of trouble
• A surgical intern may be the most qualified person managing a critical patient for the first 24 hours
Plan for the lowest common denominatorPlan for the lowest common denominator
© 2005 burndisaster.com© 2005 burndisaster.com
Communications
• Patients are going to be stuffed into unfamiliar floors or units which may or may not have convenient phones
• Outside telephones will overload or might even be intentionally shut off
• Cellphones will overload or towers may be lost
• The trunked radio system probably won’t work
• Digital radio systems are 100% or 0%
Plan for alternatives!Plan for alternatives!© 2005 burndisaster.com© 2005 burndisaster.com
Communications
• Wireless carriers have priority access systems
• Analog VHF simplex FM portable radios
• Amateur radio clubs (www.arrl.org)
• SATCOM
write the plan
• Review and revise the plan
• Keep reviewing and revising until everyone can sign off on it
– Administration– ER– Trauma– Medicine/Surgery/Peds– All ICU directors
© 2005 burndisaster.com© 2005 burndisaster.com
Test the Plan
• Run a MASCAL drill and see how the plan works
• Revise the plan
• Set up a mechanism for annual review
• Run a drill at least once a year
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SUMMARY
• All things work best in a system
• The worst plan is no plan. The next worse is two plans
• Plan locally, think regionally
• Everyone signs off on the plan
• PRACTICE THE PLAN !
• Revise the plan at least annually
© 2005 burndisaster.com© 2005 burndisaster.com
Resources
• Prevention: www.burnandfireprevention.org
• Region IV disaster planning: www.burndisaster.com
• Journal of Burn Care and Rehabilitation March April 05• American Burn Association www.ameriburn.org• Department of Homeland Security: www.dhs.gov• FEMA: www.fema.gov• National Disaster Medical System : http://ndms.dhhs.gov• Burn Specialty Team 2: www.bst2.org
© 2005 burndisaster.com© 2005 burndisaster.com