Burn surge plans finalized

A series of fiery explosions rocked Asia in the summer of 2015. In June, a flammable powder exploded during a concert in Taiwan, severely burning close to 500 people. Then, in August, 165 people were killed and nearly 1,000 injured when 800 tons of ammonium nitrate accidentally detonated in the Chinese port city of Tianjin. In both cases, the local health systems were overwhelmed, with one hospital in Tianjin treating almost 300 patients in four hours.

A later analysis of the Tianjin incident found that many patients had been overtriaged. Still, the two disasters were a wake-up call for the U.S., which has a limited number of designated burn centers overall and an acute shortage of burn centers for pediatric patients. If similar incidents occurred here, it's unlikely existing centers could provide care for all the patients needing it.

Minnesota, for example, has two verified burn centers — Hennepin County Medical Center and Regions Hospital, both in metropolitan areas. Licensed for a total of 25 beds, they can surge up to 50 patients.

Deborah O. Teske, a certified emergency manager with the emergency management team at Mayo Clinic's campus in Rochester, Minnesota, says in the event of a large burn incident, a lot of people in Minnesota would have no place to go.

To help address this problem, many states are now creating burn surge plans to provide interim care for patients when existing burn centers are overwhelmed. Minnesota's plan, which was finalized in October 2016, requires that each of the state's eight public health regions develop its own burn surge strategy. The joint plan for the southeast and south central regions was finalized in October. It's available on the Disaster Preparedness page of the Southern Minnesota Regional Trauma Advisory Committee (SMRTAC) website and via a link at the end of this article.

How it works

In Minnesota, each region designates a burn surge facility that will temporarily care for patients when burn center capacity is exceeded. These facilities don't normally provide definitive care for burn patients, but have the resources and training to support them for up to 72 hours. Mayo Clinic Hospital, Saint Marys campus, in Rochester, Minnesota, is the designated burn surge facility for the southeastern and southern regions. Burn surge facilities are asked to take as many patients as possible, but management of definitive care remains the responsibility of the two state burn centers.

"The plans try to stay as close to usual practice as possible," Teske says. "If the burn centers can accommodate all the casualties in a mass burn event, then the state burn plan isn't activated, and normal protocols are followed. But if burn center capacity is exceeded, then the regional and state burn plans are activated and patients will go to a burn surge hospital for stabilization. They are initially treated for six to 72 hours — long enough for the burn centers to find definitive care for them."

Burn surge hospitals are not intended to replace burn centers, but they do serve as regional points of contact during a burn surge response and maintain ongoing communication with state burn centers relative to treatment and plans for definitive care. They also provide essential burn care, including resuscitation, fluid management, and airway, pain and infection control. And they have real-time access to burn experts and at least one provider who is certified in Advanced Burn Life Support.

Sometimes patients may benefit from transfer to a burn center in another state instead of treatment at a burn surge hospital in Minnesota. In that case, Nebraska Medical Center in Omaha will provide coordination of bed availability at accredited burn association centers throughout the Midwest.

EMS and receiving hospitals

The regional guidelines emphasize that first responders, Emergency Medical Services (EMS) and providers at first receiving hospitals and burn surge centers should have the knowledge and skills to provide initial treatment and supportive care for burn patients. Smaller hospitals, in particular, must be able to stabilize patients before transport to a burn center or auxiliary hospital.

"What is mainly required are airway management and pain control, which is not substantially different from what Level III and IV hospitals already do," Teske says. "The initial call would go to the burn centers, as usual, but if they are at capacity, then Mayo Clinic, as the designated burn surge center, would take those patients. If anyone feels overwhelmed in an emergency situation, they can call the regional health team multicoordination center to activate regional support. The main point is that in the event of a large burn incident, help is available."

For more information

Regional Mass Casualty Incident (MCI) Plan. Southern Minnesota Regional Trauma Advisory Committee. 2016.