Burns injury - PACT - ESICM

Burn mass casualties
Mass casualty burn disasters are a highly challenging issue for several reasons:
specialised burn beds are limited, the majority of healthcare personnel are not
experienced in treating burn victims, and burn treatment is time, manpower and
resource consuming. Analysis of several landmark fires in the US between 1900 and
2000 showed that most victims had fatal injuries and died on the scene or within 24
hours. Another large group was those patients with minimal burns that could be
treated as outpatients suggesting that fire disasters produce relatively few patients
requiring inpatient burn care. Since hospitals have limited surge capacities in the
event of burn disasters, a special approach to both pre-hospital and hospital
management of these victims is required to avoid overwhelming local resources; no
objective criteria exist which define how to triage patients in such a situation. A
table classifying patients according to their anticipated survival from burn injury was
created some years ago to help and assist with this difficult task.
Specialised rescue and care can be adequately met at all levels of need by deploying
mobile burn teams to the scene but such teams are not widely available. Burn
specialists should nevertheless assist with both primary and secondary triage,
contribute to initial patient management and offer advice to non-specialised
designated hospitals that provide acute care for burn patients with TBSA 30% TBSA depending of course on numbers.
A triage suggestion is provided below based on the Swiss burn plan.
Type of hospital Up to 50 victims >50 victims
Burn centre
Burns >20% TBSA
Children: >10% TBSA
Inhalation
Burns 10-20% TBSA
Children : 5-10% TBSA
Burns >30% TBSA
Children >15% TBSA
University teaching or major
regional
Adults 10–30% TBSA
Children 5–15% TBSA
Inhalation
Smaller community hospital None Adults