developing hospital & regional burn disaster plans david j. barillo, md, facs chair, aba region...

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


Overview

• ABA Regionalization

• Developing the Region IV plan

• Burn Center disaster plans


Disaster Plan

• One size will not fit all

• Develop a guide to writing YOUR OWN disaster plan


Under development:

• A Region IV guide to writing your own

burn center disaster plan


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 !


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


Review / Coordinate Existing Plans

• The worst plan is no plan. The next worse is two plans

• Start with EMS / ED/ Trauma Service / Hospital / OEM


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


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?


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


Assess Response Capabilities

• Regional / National– EMS / Fire– Other hospitals– Other burn centers– Transport capabilities– State Assets (NG)– Federal assets (DMAT/ military)


Now can we write the plan?

• Not quite

• Decide on definitions, terms, roles, and responsibilities


6 Blind Men Describing Elephant

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


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


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


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


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


http://www.amberiburn.org/



http://www.fema.gov/

http://ndms.dhhs.gov/

http://www.bst2.org/

developing hospital & regional burn disaster plans david j. barillo, md, facs chair, aba region...

Documents

elephant slide

burn center disaster

burn mascal

worst plan

national response plan

regional hazards

regional disasters

planning team