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

Accepted 5 December 2009.

Abstract

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.

Keywords: Mass burn casualties, Burn disasters, Major burn incidents, Burn teams, Burn care, Surge capacity, Triage, Disaster preparedness, Mass casualty incident, Burn center

a Public Health Service, State of Vaud, Lausanne, Switzerland

b Emergency Service, University Hospital Center (CHUV), Lausanne, Switzerland

c Emergency Service, Regional Hospital, La Chaux-de-Fonds, Switzerland

d Burn Treatment Center, Percy Military Instruction Hospital, Clamart, France

e Burn Treatment Center, IMTR Hospital, Loverval, Belgium

f Samu 25, Jean Minjoz University Hospital, Besançon, France

g Adult Burn Center, Plastic and Reconstructive Surgery Department, University Hospital, Zurich, Switzerland

h Coordinated Medical Services, Former Surgeon General, Swiss Armed Forces, Ittigen, Switzerland

i Plastic and Reconstructive Surgery Service and Burn Center, University Hospital Center (CHUV), Lausanne, Switzerland

j Pediatric Burn Center, Plastic and Reconstructive Surgery, University Children's Hospital, Zurich, Switzerland

k Department of Anesthesia and Intensive Care Medicine, University Hospital, Basel, Switzerland

l Adult Intensive Care Service and Burn Center, University Hospital Center (CHUV), Lausanne, Switzerland

Corresponding author at: Service de la santé publique, Rue Cité Devant 11, 1014 Lausanne, Switzerland. Tel.: +41 21 316 44 61; fax: +41 21 316 44 55.

PII: S0305-4179(09)00585-3

doi:10.1016/j.burns.2009.12.003

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