European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan

BackgroundA European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities.MethodsThe European Burns Association’s disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022.RecommendationsThe resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.     

A systematic literature review of criteria and models for casualty distribution in trauma related mass casualty incidents

IntroductionMass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities.ObjectiveTo review models and criteria affecting the distribution of casualties during the trauma-related mass causality incidents.Materials and methodsA systematic literature search in the scientific databases which included: PubMed, Scopus and Web of Science was conducted. Relevant literature which was published before August 2017 was searched. Neither the publication date nor language limitations were considered in the literature search. All the trauma-related mass casualty incidents are included in this study. Two independent reviewers conducted the data extraction and quality assessment of the documents was considered using a checklist developed by the researchers.ResultsLiterature search yielded 4540 documents of which 493 were duplicated and removed. After reviewing the titles and abstracts of the remaining documents (4047), only 73 documents were considered relevant. Finally, the inclusion and exclusion criteria were applied and only 30 documents were considered for data extraction and quality assessment. The study found 491 criteria to be affecting the distribution of casualties following trauma-related mass casualty incidents. These are categorized as pre-hospital (triage, treatment and transport); hospital (space, staff, stuff, system / structure); incidents’ characteristics and others. The criteria which were extracted from the models are termed as “model extracted” while the other labeled as “author suggested”.ConclusionTo the best of our knowledge, this is the first systematic literature review on criteria affecting distribution of casualties following trauma-related mass casualty incidents based on the pre-hospital and hospital capacities.Systematic review registration numberThis review was registered in international prospective register of systematic reviews (PROSPERO) with registration number CRD42016049115.     

Mass chemical burn casualty: emergency management of 118 patients with alkali burn during a Matsa typhoon attack in Shanghai, China in 2005

BACKGROUND: This article reports a chemical burn incident that occurred on August 7th, 2005, when a Matsa typhoon hit Shanghai, China. This is the largest chemical burn incident reported in the literature for 20 years in China, involving 118 alkali burn patients who were rescued by the Burn Department of Shanghai Changhai Hospital independently. METHODS: The scene of the incident was investigated, and the clinical, emergency and hospitalized data of the patients were summarized. RESULTS: The main injurious chemical was a water solution of sodium hydroxide and ammonium chloride. The 118 victims were mostly young men with 5%TBSA deep thickness burn of both lower extremities, including 31 patients who had additional light coughing. Of 58 patients who were finally hospitalized, 42 patients received surgical treatment. Most of these patients recovered within 1 month. There were no deaths. DISCUSSION: Retrospective analysis of the therapeutic data of the incident demonstrates that pre-designed disaster planning for emergency management of mass burn patients, an effective command group, accurate assessment of pathological conditions, and correct allocation of different casualties are key elements in successful management in a mass casualty even involving burn patients. In addition, it is essential for specialized personnel to take part in emergency treatment of chemical burns.     

Mass Casualty Event During a Musical Parade: Lessons Learned

Objective  In the Netherlands, major incidents are sparse, and so there is a general feeling of a relatively low risk. Upon evaluating multiple casualty events (MCEs) in the Netherlands over the last 60 years, it is worth noting 39 major events. Our objective was to report the experiences from a mass casualty incident in an urban area, performing a critical evaluation of the response and outcome related to the scenario in order to learn from our past and to train for the future. Materials and Methods  In a retrospective patient record analysis we collected all of the data concerning an MCE we encountered in August 2006. Results  There were 21 casualties at the scene. Of our 19 patients, 12 were seen in the crash room. The average age of the patients was 30 years (range 22–53). In all, 87 X-rays, 1 ultrasound and 15 CT scans were performed. Four patients were admitted: ten patients received definitive wound treatment in the ED. Psychological support was given to all patients. One patient died three days later. Conclusion  Triage supported by one person and two trauma teams worked well. The amount of over- and undertriage was in line with the literature. Numbering the patients worked well but also caused enormous problems with the supporting facilities. Centralizing the trauma care yielded certain advantages; however, we must respect our surge capacity of 20 patients. When the number of patients surpasses 20, an alternative plan must be followed. This event has been an eye-opener for our organization; it has given us new tools to prepare for a potential new disaster. First Published on January 29, 2007. Doi 10.1080/15031430701688178     

Analgesic use in contemporary burn practice: Applications to burn mass casualty incident planning

BackgroundDetermining the amount of analgesics required will help burn centers improve their ability to plan for a burn mass casualty incident (BMCI). We sought to quantify the amount of analgesics needed in an inpatient burn population. We hoped that assessing the analgesic use in daily burn care practice will potentially help estimate opioid needs in a burn mass casualty incident (BMCI).MethodsWe included patients with burns covering equal to or less than 30% total body surface area (TBSA), admitted from spring 2013 to spring 2015. Patient records were reviewed for analgesics and adjuncts, pain scores, age and TBSA. The doses of the different opioids administered were converted into morphine equivalent doses (MED).ResultsWe enrolled 141 acute burn survivors with a mean TBSA of 8.2 ± 0.6%. The lowest daily average MED per person was 24.6 ± 2.0 mg MED, recorded on the day of injury. The daily average MED per person increased until it peaked at 52.5 ± 5.6 mg MED at day 8 post-burn. Then, it declined to 24.6 ± 3.4 mg MED by day 14. Bivariate regression analysis of average MED by TBSA showed a significant positive correlation (p < 0.001). The analysis of average MED by age showed a significant negative correlation (p < 0001).ConclusionOur study quantified opioid requirements in an inpatient burn population and identified TBSA (positively) and age (negatively) as significant predictors.     

Excess mortality reduction given a “reduce patient mortality at all costs” scenario for mass burn casualties

ObjectiveThe aim of this study was to estimate the effect on medical resource use and mortality of full financial support from the government for treatment costs after a mass burn casualty event in Taiwan.MethodsAll patients with burn injuries from the event were included (n = 483). Each burn patient from this incident was matched to a separate burn patient identified from the National Health Insurance database. Medical care usage and mortality were compared between groups at 1-, 3-, 6-, 9-, and 12-month intervals.ResultsRegarding outpatient expenditure, burn patients from the mass casualty event had significantly higher levels of medical expenditure compared with their control counterparts at all intervals and levels of medical institution. For inpatient expenditure, patients from the mass casualty event only had higher expenditure for the first month, and excess procedures used by these patients mainly consisted of nonvital procedures such as rehabilitation training. The mortality rate was only slightly lower for this group of burn patients compared with their control counterparts.ConclusionsFull financial support by the government in terms of medical treatment may engender only marginal additional benefits in terms of mortality if burn treatment procedures are already well established in the country.     

Australian major incident nomenclature: it may be a 'disaster' but in an 'emergency' it is just a mess

Background : A standardized major incident nomenclature has practical applications for medical communication and audit of the medical response to incidents. Methods : A telephone and fax survey of major incident nomenclature in State and Territory health service emergency management plans and ‘disaster’ legislation was carried out on 13 August 1999. Results : Within Australia there were a total of 13 different terms to describe incidents that could produce casualties: there were four definitions of the word ‘disaster’, eight definitions of the word ‘emergency’ and one definition of the word ‘incident’. Conclusion : Australia lacks a uniform system of classifying and recording mass casualty incidents. This prevents both the independent clinical audit of the medical response to an incident and the cross‐border comparison of the effectiveness of trauma systems to deal with multiple casualties. Australia’s geography highlights the need to develop a nomenclature that allows medical practitioners, in isolated environments, to accurately describe an incident and the medical support that is required. The Potential Injury‐Creating Event (PICE) nomenclature is a simple system to describe the functional impact of an event upon a community and the level of medical support required. It can be used to provide the basis for the uniform reporting of the medical management of major incidents within Australia.     

A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns

BackgroundBurn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines.MethodsThe TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children.ResultsIn adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups.ConclusionThe TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.     

Katastrophenschutzübung zum Massenanfall von Verletzten

The alert and deployment plan of the individual hospitals in Hamburg has been checked repeatedly in training exercises for catastrophe-based events, particularly the partial alert plan for managing mass casualty incidents. As part of the preparations for the Soccer World Cup 2006, various scenarios will be played out as simulations to adapt the chain of care provided by emergency medical services to suit the special requirements and conditions of this mass event. The medical and organizational management of an external incident with mass casualties will be run through in the central hospital emergency wards during an emergency drill. This article describes the preparation, organization, and documentation of these exercises. Carrying out these disaster control exercises under realistic conditions allows the hospitals to test the functionality of the workflows designated in their alert and deployment plans. These plans are reviewed and if necessary altered with the goal of further optimizing the structures, use of resources, and workflows to be best prepared for dealing with mass casualty incidents.     

Dedicated mass-casualty incident hospitals: An overview

IntroductionHospitals worldwide are preparing for mass casualty incidents (MCIs). The Major Incident Hospital in the Netherlands was constructed 25 years ago as a dedicated hospital for situations wherein a sudden increase in medical surge capacity is mandated to handle an MCI. Over the years, more initiatives of dedicated MCIs have arisen. Herein, we compared the MCI facilities from three countries considering the reasons for construction and the functionality.MethodsThree dedicated mass casualty hospitals and one hospital with a largely fortified structure were compared. The centres were located in the Netherlands, Italy, and Israel. Between August 2015 and January 2016, structured interviews were conducted with representatives of the hospitals’ medical operations. The interviews focussed on general information regarding the need for MCI preparedness and scenarios that require preparation, reasons for construction, hospital missions, and the experiences gained including training.ResultsAll dedicated MCI hospitals had a common policy wherein they sought to create normal work circumstances for the medical staff by using similar equipment and resources as in normal hospitals. The MCI hospitals’ designs differed substantially, as determined by the threats faced by the country. In Europe, these hospitals are designed as a solution to surge capacity and function as buffer hospitals offering readily available, short term, additional medical capacity to the local health care system. Israel faces constant threat from long-term conflicts; during the 2006 war, several hospitals suffered direct missile impacts. Therefore, Israeli MCI hospitals are designed to be fortified structures offering shelter against both conventional and non-conventional warfare and intended as a long-term solution during siege situations.ConclusionSeveral dedicated MCI hospitals are presently being constructed. During construction, the local circumstances should be taken into account to determine the functionality for both short-term solutions for surge capacity and as fortified structures to withstand under-siege situations.     

Are surgical residents prepared for mass casualty incidents?

OBJECTIVE: We hypothesized that resident education is inadequate with respect to management of mass casualty incidents that may involve chemical, biological, and nuclear exposures. METHODS: Chief level residents in surgery (n = 10), emergency medicine (n = 10), and anesthesia (n = 8) were asked to complete a survey questionnaire. Responses were tabulated and statistically analyzed with Mann-Whitney Rank Sum, Student's t test, and Kruskal-Wallis one-way analysis of variance. RESULTS: All of the residents were similar with respect to age, sex, and intended setting of clinical practice. Only a single resident reported military experience. Two residents (7.1%) had administered medical care while wearing a protective suit. Compared with emergency medicine residents, surgical residents reported significantly less formal teaching in mass casual incidents (P = 0.02), trauma triage (P = 0.01), and nuclear, biological, chemical agents (P = 0.002). When surgical residents were compared with anesthesia residents, there was significantly less training for surgical residents in nuclear, chemical, and biological agents (P = 0.02). Multiple/mass casualty incident experience did not differ between residents. However, the most common incident involved only three to five patients with blunt trauma. Emergency medicine residents were significantly more comfortable in treating patients with exposure to anthrax (P = 0.01), sarin (P = 0.04), and nuclear exposure (P = 0.01). CONCLUSIONS: Surgical residents have significantly less formal training in mass casualties, triage, and chemical, biological, and nuclear exposures than residents in other specialties. Therefore, surgical residents are less comfortable treating these types of patients. Because surgeons often are expected to take leadership roles in mass casualty incidents, surgical education should be modified to match or exceed that of other specialties.     

Disasters and mass casualties: I. General principles of response and management

Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world.     

The café fire on New Year's Eve in Volendam, the Netherlands: description of events

AIM OF STUDY: The café fire at Volendam occurred shortly after midnight on the first of January 2001 and resulted in one of the worst mass burn incidents in recent Dutch history. The aim of this study was to provide insight into medical and organisational requirements of a major burns incident. METHODS: Shortly after the fire, two university hospitals and a burn center in the region of the accident developed a plan for evaluation of medical care given during and after this major burn incident. A multidisciplinary research group investigated the management of victims at the scene, in the emergency departments (ED) and during admission in the hospitals. All 245 casualties were included in this study. RESULTS: A brief severe fire occurred in a crowded cafe with around 350 young visitors on a small embankment of a relatively isolated town, resulting in a unusually high number of severely injured burn victims. Four died immediately. The ensuing rescue effort was hampered by poor access and chaotic circumstances. At the scene of the incident, mobile medical teams ensured orderly transport and treatment priority for the injured. There were 245 victims with a median total body surface area burned of 12%. Inhalation injury was present in 96 patients. A total of 182 victims were admitted, with 112 to intensive care. Ten patients died in the hospital. Seventy-eight patients were secondarily transported, many to specialised centers in the Netherlands and abroad. In total, 36 hospitals in three countries participated. CONCLUSION: An incident with high numbers of burn victims poses a challenge to any health care system. The difficult circumstances at the site demonstrated the need for robust organisational structures. The primary and secondary distribution of patients required coordination, general hospitals were able to provide initial medical care to these major burn casualties.     

Complex chemical burns following a mass casualty chemical plant incident: how optimal planning and organisation can make a difference

Introduction

Four employees at a chemical plant sustained extensive chemical burns following the explosion of a pipeline containing 100% sulphuric acid. We describe the management of these patients from the initial ED triage through to discharge from hospital in life and limb threatening chemical burns.

Methods

Four patients who sustained chemical burns to the torso and extremities are reviewed. Data was retrieved from patient case notes and operating theatre logbooks.

Results

Four patients sustained chemical burns during the blast and were immediately transferred to a local ED where a prompt referral was made to the burns service. All patients were male aged 25–59 years (mean 46.5). Burn size was 2–50% BSA (mean 22.5). Following RFDS transfer to the state burns service two patients required immediate excisional surgery. In these patients the chemical burn involved full thickness skin loss with extensive underlying muscle and neurovascular damage. One patient required immediate above knee amputation of one leg and fascial burn excision of the other. The other patient required fascial burn excision of both legs followed by Integra placement 24 h later. Both patients had prolonged hospital stays due to the complex nature of their injuries requiring multiple trips to theatre and lengthy rehabilitation. The two patients with smaller burns had straightforward surgery and an unremarkable recovery.

Conclusion

Early communication following this mass casualty incident allowed for organisation of tertiary services and early radical surgery which was life saving. Management lessons were learnt following this mass casualty chemical burn incident.     

Beyond surge: Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion

PurposeTo provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster.Material and methodsThe critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge.ResultsFifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead.ConclusionIn the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation and routine practice coping with unexpected scenarios.     

Medical management after indoor fires: a review

Fires involving mass burn casualties require extreme efforts and flexibility from the regular health care system. The café fire in Volendam, which occurred shortly after midnight on the first of January 2001, resulted in the worst indoor mass burns incident in Dutch history. During the extensive medical evaluation of this disaster, it became obvious that information on similar incidents is relatively scarce in the literature. This article systematically reviews the existing information in the medical literature on indoor fires and provides findings and knowledge used in the evaluation of the medical management after indoor fires and for future mass burn casualty preparedness, mitigation and response. METHODS: A literature review was undertaken for burn disasters with characteristics similar to the indoor Volendam fire disaster. In all fires, the following aspects were investigated: characteristics of the fire; the initial emergency response; triage and on-site treatment; primary and secondary distribution; hospital admission; severity of the sustained injuries and mortality. RESULTS: A total of nine similar indoor fires were selected. The number of people involved was reported in seven fires (range 137-6000). All reports provided the mortality rate (range 1.4% to over 50%). Data regarding the emergency response could be collected in half of the studies. On-scene triage was performed in five fires. The number of hospitals participating in the primary distribution ranged from 1 to 19. Except for the Volendam fire, all patients were primarily distributed to general hospitals. CONCLUSION: Characteristics of indoor fires, which are relevant for disaster preparedness, mitigation and response are not frequently reported in medical literature. The current articles on indoor fires, mainly report on numbers of casualties and the mortality. Limited data are available to provide insight in the characteristics of management and medical treatment and to come up with suggestions for improvement of future burn incidents management. The evaluation of disasters should be based on uniform methods and structured reports and effective record keeping is essential to achieve this.     

Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020

Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities – led in part by the World Health Organisation Emergency Medical Team (EMT) initiative.Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not – the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters.Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to:1) review literature on burn care in MCIs; and2) define and agree on recommendations for burn care in MCIs.The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.     

Multiple casualty incidents: the prehospital role of the anesthesiologist in Europe

The recent increase in incidents involving mass casualties has emphasized the need for a planned and coordinated prehospital emergency medical response, with medical teams on-site to provide advanced trauma life support. The special skills of the anesthesiologist make his/her contribution to prehospital emergency care particularly valuable. The United Kingdom's emergency medical services system is operated paramedically like that in the United States, and is based on rapid evacuation of casualties to hospital emergency medical facilities. In contrast, the French approach is based on the use of its emergency care system SAMU, where both structured dispatching and on-site medical care is provided by physicians, including anesthesiologists. In this article, the lessons learned from multiple casualty incidents in Europe during the past 2 decades are considered from the standpoint of the anesthesiologist.     

The role of patient flow and surge capacity for in-hospital response in mass casualty events

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.     

Mass casualty incidents with multiple burn victims: Rationale for a Swiss burn plan

Introduction

Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.

Methods

Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.

Results

Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20–30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources.

Conclusions

Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.