ORIGINAL ARTICLE
Burn Disaster-Management Planning: A Preparedness Tool Kit Brian S. Joho, MSN, RN, Daniel Lozano, MD, MBA, FACS, Patrick Pagella, MSN, ARNP, Michael Wargo, MBA, RN, Hamed Amani, MD, FACS
It is vital that preburn center emergency providers have the knowledge and equipment needed to treat burn-injured patients should there be an extended delay in transporting the patients to a burn center as may be the case during a mass-casualty incident or weather-related emergency. Since 2007 a collaborative effort has been underway to build an emergency-response tool kit that provides to and draws from local, state, and federal resources. This tool kit is designed to fill knowledge deficits regarding burn treatment as well as address gaps in stockpiled treatment materials. This tool kit was implemented in four modules: provide equipment, provide guidance, provide education, and provide drill. Module one ensures that equipment needed for treating burn injuries is available to emergency providers. Module two ensures that policies and procedures congruent with the practice of the regional burn center are in place. Module three ensures that preburn center providers are provided education on modern burn care. Module four is to drill. The sum of the effort by the authors is the establishment of a tool kit that enhances the capabilities of preburn center emergency providers. Implementation has led to improved collaborative relationships, increased the awareness of available resources, and reduced knowledge deficit regarding burn care among preburn center providers. This tool kit provides greater continuity of care for all burn patients affected by a delay in transport to a burn center, and its modular structure makes it adaptable to other regions as a whole or in part. (J Burn Care Res 2014;35:e205–e216)
Burn victims require specialized treatment that many healthcare workers have little experience providing. During a mass-casualty incident (MCI) or weather-related emergency (WRE) patient transfer may be delayed because of a surge of patients overwhelming the healthcare infrastructure or the impacts a natural disaster or severe weather event may have on the patient transportation system. During these occasions responders with limited burn expertise may be called upon to treat burn-injured victims. For this reason it is imperative that first responders, mobile disaster medical response teams, and nonburn center hospital staff have the knowledge and
From the Lehigh Valley Health Network, Regional Burn Center, Allentown, Pennsylvania. Address correspondence to B.S. Joho, MSN, Lehigh Valley Health Network, Regional Burn Center,1200 S. Cedar Crest Blvd., 3rd Floor, Kasych Pavillion, Allentown, Pennsylvania 18104. Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000054
equipment needed to assist burn-injured patients while they await transport to a tertiary burn center. Since 2007 our institution has been implementing a collaborative, grassroots plan to ensure that all burn victims of an MCI or WRE in eastern Pennsylvania receive appropriate treatment. The ultimate goal of this plan is to create a network of resources that nonburn center providers can rely on to assist them successfully treat burn patients for up to 72 hours postinjury. By including the potential delay that may occur during a WRE we are able to describe a second use for the tool kit other than an MCI event. To achieve our goals, our program focuses on filling gaps in both emergency provider burn triage and treatment knowledge and availability of burn treatment materials. The tool kit was implemented in four stages: provide equipment, provide guidance, provide education, and provide opportunities to drill. The sum of this effort has been the establishment of a comprehensive, modular program designed to enhance the capabilities of preburn center emergency responders should they be required to care for e205
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a burn patient because of a delay in transfer to the regional burn center. Our disclaimer is that what is written here may not be an optimal disaster-management tool kit for every burn center looking to improve their region’s burn surge preparedness. It is what we feel works for our area, and some or all of what we have implemented may be applicable to other areas of similar demographic and geographic disposition. The modular nature of this tool kit allows for its application in part or in whole, depending on the resources needed and finances available.
WHO ARE WE? To give an idea of how this tool kit is being applied it is important to understand our coverage area and the emergency-response assets within it. Our burn center is located in the third-most densely populated area of Pennsylvania. We are located 30 miles east of New Jersey and 60 miles north of Philadelphia, Pennsylvania. Our standard catchment area extends over 4500 square miles, ranging from southern New York to northern Maryland and from western New Jersey to central Pennsylvania. We do not regularly receive patients from the city of Philadelphia as there are three burn centers within or close to the city, which serve that densely populated urban center. However, the region we do regularly serve has a population of over five million, with most people residing in the many scattered, medium-sized cities.1 Other burn centers that overlap our geographic vicinity include the three in Philadelphia, two in Pittsburg, Pennsylvania, 300 miles to the west, one in Livingston, New Jersey, 80 miles to the east, one
in Baltimore, Maryland, 150 miles to the south and one in Syracuse, New York, 200 miles to the north.2
STATE AND REGIONAL DISASTER RESPONSE ASSETS Pennsylvania is divided into nine Counter Terrorism Taskforces (CTTFs) that are tasked with assisting and/or directing an emergency response to MCIs and WREs. (Figure 1 shows Pennsylvania CTTF boundaries). On top of responding to an MCI or WRE some of the CTTFs also warehouse catches of medical equipment that can be quickly deployed should a shortage of medical supplies occur. Our burn center is located in the Northeast Pennsylvania (NEPA) CTTF and has to date forged relationships with the leadership of this group as well as other taskforces in our greater coverage area. Building and maintaining these relationships is a central part of our burn center’s surge preparedness plan. By ensuring an ongoing partnership with the regional CTTFs we improve the capability of our e mergency-response assets to effectively respond to an MCI or WRE. Our burn center is also a member of the Eastern Regional Burn Disaster Consortium (ERBDC), an association of all the burn centers located in the northeast United States, from Washington, DC, to Portland, Maine. Based in Livingston, New Jersey, the ERBDC has the capability to act as a communications hub between burn centers to assist with the secondary triage of burn patients. The consortium also has a mobile burn-response team that can be deployed should additional burn resources be needed at the scene of an incident or at a hospital that is experiencing a burn patient surge.3
Figure 1. Boundaries of the Pennsylvania Counter Terrorism Task Forces.
Journal of Burn Care & Research Volume 35, Number 4
In addition to the nine CTTFs and the ERBDC our region is also fortunate to have a comprehensive network of Emergency Medical Service (EMS) providers. Broken up into 16 councils, the Pennsylvania state EMS network includes over 1000 ground and air ambulance services.4 The healthcare providers of the EMS system make up the backbone of the state’s ability to respond to the emergency healthcare needs of all Pennsylvanians.
Noticeable Gaps Despite multiple layers of first response, collaboration between area hospitals, and large quantities of warehoused medical equipment, the ability to appropriately triage, treat, and transfer large numbers of burn-injured patients remained inconsistent. Emergency healthcare providers, who may rarely see a burn patient in their everyday practice, were still at risk of under- or overtriaging patients, and should transport to a burn center be delayed emergency department (ED) staff may not have the best resources to address the needs of severely burned patients. Disaster-management leadership was unaware of all the burn resources available to them, and healthcare providers, even if they were Advanced Burn Life Support–certified, only received education on how to treat a burn patient for up to 24 hours. These gaps existed despite the fact that the mission of many local disaster-management teams is to provide quality care to all patients up to 72 hours postincident. Because of these gaps our burn center decided to become an active participant in Pennsylvania emergency-response planning.
MODULE 1: EQUIP Planning/Development As previously stated our disaster plan was implemented in four modules: Equip, Provide Guidance, Educate, and Drill. The first module was initiated in 2007 in collaboration with the NEPA and the east central Pennsylvania CTTFs. The goal of this module was to ensure that healthcare providers have easily accessible and useful equipment available to use in the event an MCI or a WRE delays patient transfer to a burn center. Determining what to equip, how much to equip, and who to equip were the dominating questions in early planning. What was decided on consists of multiple, small-sized carts that would augment ED supplies and house the equipment necessary to treat up to one severely (>30% total body surface area) or three moderately (
Burn Disaster-Management Planning: A Preparedness Tool Kit Brian S. Joho, MSN, RN, Daniel Lozano, MD, MBA, FACS, Patrick Pagella, MSN, ARNP, Michael Wargo, MBA, RN, Hamed Amani, MD, FACS
It is vital that preburn center emergency providers have the knowledge and equipment needed to treat burn-injured patients should there be an extended delay in transporting the patients to a burn center as may be the case during a mass-casualty incident or weather-related emergency. Since 2007 a collaborative effort has been underway to build an emergency-response tool kit that provides to and draws from local, state, and federal resources. This tool kit is designed to fill knowledge deficits regarding burn treatment as well as address gaps in stockpiled treatment materials. This tool kit was implemented in four modules: provide equipment, provide guidance, provide education, and provide drill. Module one ensures that equipment needed for treating burn injuries is available to emergency providers. Module two ensures that policies and procedures congruent with the practice of the regional burn center are in place. Module three ensures that preburn center providers are provided education on modern burn care. Module four is to drill. The sum of the effort by the authors is the establishment of a tool kit that enhances the capabilities of preburn center emergency providers. Implementation has led to improved collaborative relationships, increased the awareness of available resources, and reduced knowledge deficit regarding burn care among preburn center providers. This tool kit provides greater continuity of care for all burn patients affected by a delay in transport to a burn center, and its modular structure makes it adaptable to other regions as a whole or in part. (J Burn Care Res 2014;35:e205–e216)
Burn victims require specialized treatment that many healthcare workers have little experience providing. During a mass-casualty incident (MCI) or weather-related emergency (WRE) patient transfer may be delayed because of a surge of patients overwhelming the healthcare infrastructure or the impacts a natural disaster or severe weather event may have on the patient transportation system. During these occasions responders with limited burn expertise may be called upon to treat burn-injured victims. For this reason it is imperative that first responders, mobile disaster medical response teams, and nonburn center hospital staff have the knowledge and
From the Lehigh Valley Health Network, Regional Burn Center, Allentown, Pennsylvania. Address correspondence to B.S. Joho, MSN, Lehigh Valley Health Network, Regional Burn Center,1200 S. Cedar Crest Blvd., 3rd Floor, Kasych Pavillion, Allentown, Pennsylvania 18104. Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000054
equipment needed to assist burn-injured patients while they await transport to a tertiary burn center. Since 2007 our institution has been implementing a collaborative, grassroots plan to ensure that all burn victims of an MCI or WRE in eastern Pennsylvania receive appropriate treatment. The ultimate goal of this plan is to create a network of resources that nonburn center providers can rely on to assist them successfully treat burn patients for up to 72 hours postinjury. By including the potential delay that may occur during a WRE we are able to describe a second use for the tool kit other than an MCI event. To achieve our goals, our program focuses on filling gaps in both emergency provider burn triage and treatment knowledge and availability of burn treatment materials. The tool kit was implemented in four stages: provide equipment, provide guidance, provide education, and provide opportunities to drill. The sum of this effort has been the establishment of a comprehensive, modular program designed to enhance the capabilities of preburn center emergency responders should they be required to care for e205
Journal of Burn Care & Research July/August 2014
e206 Joho et al
a burn patient because of a delay in transfer to the regional burn center. Our disclaimer is that what is written here may not be an optimal disaster-management tool kit for every burn center looking to improve their region’s burn surge preparedness. It is what we feel works for our area, and some or all of what we have implemented may be applicable to other areas of similar demographic and geographic disposition. The modular nature of this tool kit allows for its application in part or in whole, depending on the resources needed and finances available.
WHO ARE WE? To give an idea of how this tool kit is being applied it is important to understand our coverage area and the emergency-response assets within it. Our burn center is located in the third-most densely populated area of Pennsylvania. We are located 30 miles east of New Jersey and 60 miles north of Philadelphia, Pennsylvania. Our standard catchment area extends over 4500 square miles, ranging from southern New York to northern Maryland and from western New Jersey to central Pennsylvania. We do not regularly receive patients from the city of Philadelphia as there are three burn centers within or close to the city, which serve that densely populated urban center. However, the region we do regularly serve has a population of over five million, with most people residing in the many scattered, medium-sized cities.1 Other burn centers that overlap our geographic vicinity include the three in Philadelphia, two in Pittsburg, Pennsylvania, 300 miles to the west, one in Livingston, New Jersey, 80 miles to the east, one
in Baltimore, Maryland, 150 miles to the south and one in Syracuse, New York, 200 miles to the north.2
STATE AND REGIONAL DISASTER RESPONSE ASSETS Pennsylvania is divided into nine Counter Terrorism Taskforces (CTTFs) that are tasked with assisting and/or directing an emergency response to MCIs and WREs. (Figure 1 shows Pennsylvania CTTF boundaries). On top of responding to an MCI or WRE some of the CTTFs also warehouse catches of medical equipment that can be quickly deployed should a shortage of medical supplies occur. Our burn center is located in the Northeast Pennsylvania (NEPA) CTTF and has to date forged relationships with the leadership of this group as well as other taskforces in our greater coverage area. Building and maintaining these relationships is a central part of our burn center’s surge preparedness plan. By ensuring an ongoing partnership with the regional CTTFs we improve the capability of our e mergency-response assets to effectively respond to an MCI or WRE. Our burn center is also a member of the Eastern Regional Burn Disaster Consortium (ERBDC), an association of all the burn centers located in the northeast United States, from Washington, DC, to Portland, Maine. Based in Livingston, New Jersey, the ERBDC has the capability to act as a communications hub between burn centers to assist with the secondary triage of burn patients. The consortium also has a mobile burn-response team that can be deployed should additional burn resources be needed at the scene of an incident or at a hospital that is experiencing a burn patient surge.3
Figure 1. Boundaries of the Pennsylvania Counter Terrorism Task Forces.
Journal of Burn Care & Research Volume 35, Number 4
In addition to the nine CTTFs and the ERBDC our region is also fortunate to have a comprehensive network of Emergency Medical Service (EMS) providers. Broken up into 16 councils, the Pennsylvania state EMS network includes over 1000 ground and air ambulance services.4 The healthcare providers of the EMS system make up the backbone of the state’s ability to respond to the emergency healthcare needs of all Pennsylvanians.
Noticeable Gaps Despite multiple layers of first response, collaboration between area hospitals, and large quantities of warehoused medical equipment, the ability to appropriately triage, treat, and transfer large numbers of burn-injured patients remained inconsistent. Emergency healthcare providers, who may rarely see a burn patient in their everyday practice, were still at risk of under- or overtriaging patients, and should transport to a burn center be delayed emergency department (ED) staff may not have the best resources to address the needs of severely burned patients. Disaster-management leadership was unaware of all the burn resources available to them, and healthcare providers, even if they were Advanced Burn Life Support–certified, only received education on how to treat a burn patient for up to 24 hours. These gaps existed despite the fact that the mission of many local disaster-management teams is to provide quality care to all patients up to 72 hours postincident. Because of these gaps our burn center decided to become an active participant in Pennsylvania emergency-response planning.
MODULE 1: EQUIP Planning/Development As previously stated our disaster plan was implemented in four modules: Equip, Provide Guidance, Educate, and Drill. The first module was initiated in 2007 in collaboration with the NEPA and the east central Pennsylvania CTTFs. The goal of this module was to ensure that healthcare providers have easily accessible and useful equipment available to use in the event an MCI or a WRE delays patient transfer to a burn center. Determining what to equip, how much to equip, and who to equip were the dominating questions in early planning. What was decided on consists of multiple, small-sized carts that would augment ED supplies and house the equipment necessary to treat up to one severely (>30% total body surface area) or three moderately (
