Planning for major burns incidents by implementing an accelerated Delphi technique

doi:10.1016/S0305-4179(02)00107-9

Burns

Volume 28, Issue 5, August 2002, Pages 413-418

https://doi.org/10.1016/S0305-4179(02)00107-9 Get rights and content

Abstract

Objective: This paper presents a series of practical guides for use in planning and responding to a major incident involving large numbers of burns casualties.

Method: The guidance is based on the findings of an expert Delphi study published as an accompanying paper.

Results: The guidance covers preparation and all aspects of the response from prehospital care and hospital care to resolution recovery. Emphasis is placed on the management of the secondary/tertiary care interface as this is the point at which significant difficulties may arise. The importance of local interpretation of guidelines is emphasised.

Conclusion: This practical guide for emergency planners will improve the preparation and response to a major incident involving burns.

Introduction

Four to Five major incidents occur in the UK each year [1]. However, the standard of planning for major incidents has been repeatedly questioned [2]. In particular, concerns have been raised about specific planning for “special” incidents such as paediatric [3], radiation [4] and chemical [5] incidents. Burn incidents share the characteristics of special incidents in that small numbers of casualties will rapidly overwhelm available services resulting in the decompensation [6], [7] of any major incident.

An accompanying paper [8] reports the findings of an expert panel using a Delphi technique to develop principles for the management of major incidents involving burns. However, as with previous Delphi studies [9] further refinement of the findings is necessary to produce usable guidance.

This paper should be interpreted with reference to local circumstances and services. However, the difficulties in managing an incident with large numbers of burns are the same in all countries, although, we used a group based in the UK, the principles of planning should be widely applicable.

Practical advice is given on preparation, prehospital and hospital responses, specialist services and the recovery phases of a major incident involving burns.

Section snippets

Preparation

We have considered three aspects of preparation: planning, equipment and training.

Prehospital phase

Current MIMMS guidelines for the medical management of major incidents should be used (command, safety, communication, assessment). However, specific aspects of command may be influenced in burn incidents.

Reception

The reception phase of the major incident should be controlled by the chief triage officer (usually a senior emergency physician). Additional considerations for the chief triage officer in a burns major incident are shown in the action card in Table 3.

A physician or nurse with experience in the assessment of burns should assist with initial triage decisions. All patients should have an assessment of their burn injury using a Lund and Browder chart. All patients should be considered for carbon

Summary

Although, burns major incidents are rare their effect may be devastating. Good planning and preparation is essential if optimal casualty care is to be delivered. This paper has shown how the ideas from an expert Delphi panel can be implemented into a practical set of instructions to deal with a burns major incident. Our guidance should be able to be applied in most areas but may require some modification to take account of local circumstances. Using this paper, all hospitals with Emergency

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European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan
2023, Burns
Citation Excerpt :
Depending on the national situation and organization, as exemplified in existing plans, a BMCI national preparedness plan can be: either a separate dedicated plan [21,44–47,55], or an addition to or part of general preparedness plans [48,56].
A 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.
The 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.
The 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.
Mass casualty incidents with multiple burn victims: Rationale for a Swiss burn plan
2010, Burns
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In case of a major incident with more than five victims with burns >20% Total Burn Surface Area (TBSA), an on-call senior burn surgeon can decide to mobilize one or more BATs each comprised of two experienced burn surgeons and a senior nurse. These BATs can be deployed either to the scene of the incident or a nearby community hospital to assess burn injuries and offer advice and medical assistance (resuscitation, identify if escharotomy is required, support the Medical Incident Command Team, transfer burn patients to the appropriate facility) in coordination with a National Burn Bed Bureau (NBBB) [6,12–14]. Since 1990, the Belgian Burn Association has been implementing a mass burn casualty response plan called “BABI plan” including information about burn-bed availability 24/7 from a coordinated national call center.
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.
Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.
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.
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.
Quality assessment of clinical practice guidelines for adaptation in burn injury
2010, Burns
Citation Excerpt :
An additional 27 citations had been identified through handsearching in reference lists of papers, and web site searches of CPG resources. After screening for relevance and other preset inclusion criteria, we retained 24 CPGs for further evaluation and critical appraisal [13–36]. Reasons for exclusion are shown in Fig. 1.
A number of clinical practice guidelines (CPGs) are available for managing burn injury patients but clinical practice is highly variable. We report the first steps to trans-contextual adaptation of international burn CPGs to local settings.
Key clinical topics and questions to be covered in the final guideline were defined and prioritized. Systematic search between 1990 and 2008 retrieved 546 citations, of which 24 were CPGs on the general and intensive care of burn patients. Assessment of the clinical content of CPGs was carried out. Methodological quality of CPGs was evaluated using the AGREE instrument.
Of the 24 CPGs evaluated, 10 (42%) were evidence-based. All major burn topics were covered by at least one CPG, but no single CPG addressed all areas important in terms of outcomes. According to the AGREE criteria, 2 CPGs (8%) were strongly recommended, 14 with provisos or alterations (58%) and the rest were not recommended for adaptation.
Although existing CPGs for the management of burn may accurately reflect agreed clinical practice, most performed poorly when evaluated for methodological quality. Future CPG efforts addressing these methodological shortcomings would add substantially to the improved management of burned patients.
A Scoping Review of the Essential Components of Emergency Medical Response Systems for Mass Casualty Incidents
2023, Disaster Medicine and Public Health Preparedness
An international expert delphi study to determine research needs in major incident management
2012, Prehospital and Disaster Medicine
Burns assessment team as part of burn disaster response
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View full text

Planning for major burns incidents by implementing an accelerated Delphi technique

Abstract

Introduction

Section snippets

Preparation

Prehospital phase

Reception

Summary

Injury

Burns

Major incidents in Britain in the past 28 years: the case for the centralised reporting of major incidents

J. Epidemiol. Commun. Health

Are we ready for the next major incident: analysis of hospital major incident plans

BMJ

Delphi study for care of children in major incidents

Arch. Dis. Child