Understanding Burn Care

Pre-Planning

The best course for burn injuries is to plan ahead and be prepared. Starting the right care at the right time is key to having improved outcomes. Delaying treatment, or not recognizing when a burn center is the right place for treatment, has a lifelong impact for the patient. The American Burn Association (ABA) and healthcare coalitions in your states can guide your preparation and provide standardized documents to assist in this process.

It is important to recognize that pre-hospital care may have to change in response to a mass casualty incident (MCI). Large numbers of injured, fewer resources and limited access to hospitals, including burn centers, will impact key decisions being made at the scene or by the incident commander. To address these concerns, the ABA has developed burn mass casualty (BMCI) incident triage and referral criteria that differs from day-to-day burn care.

Determine Your Preparedness

• Does your agency have a pre-plan, SOG and/or transfer agreement related to burn injuries?
• What is the BMCI plan for burn emergencies in your area? Is it compatible with the hospital MCI plan?
• Do your partners’ SOGs follow ABA standards of care? If not, how will they reconcile with the SOGs you have prepared?
• Have non-burn center medical facilities within your area that may care for burn patients been trained in BMCI protocol?

Declare a BMCI

• Prior to the declaration of a BMCI, test the guidelines to ensure collaboration between all entities involved in healthcare and emergency medical response. If gaps or problems are identified, make appropriate revisions to the system.
• Terminology differences undermine the best laid plans, causing confusion and misunderstanding. Pre-planning with all involved agencies is the best strategy to avoid this and improve communication.
• Declaring a BMCI should not be taken lightly. It can trigger a significant rollout of resources and time by a variety of personnel and agencies. Document clear rules for declaring a BMCI, and include it in facility SOGs.

Preparation for Declaring a BMCI

• Who or what agency is able to make the BMCI declaration?
• What is your BMCI plan?
• How might this declaration impact or change as the incident progresses and evolves?
• How might normal operations such as triage, transfer or treatment be affected?
• What assistance can be anticipated from other facilities or agencies within the local area, state, region, or national level?

Definition of Terms

Pre-Plans: Pre-plans generally consist of a review of potential events or emergencies in order to better prepare a response that considers details about the physical landscape, potential patients or facility layout. Pre-plans are generally documented and available as a tool to be used during an emergency. Understanding and preparing for these aspects of an emergency before an incident occurs allows personnel to function more efficiently and effectively during an actual emergency.

Standard Operating Guidelines (SOG): SOGs provide a template of operations to be implemented in relation to a specific situation. SOGs are based upon a needs assessment to categorize tasks, define terminology and identify the steps necessary to address issues or concerns. SOGs should be designed to work in concert with other agencies that may respond or participate in the specific emergency.

Transfer Agreement: A Transfer Agreement (TA) is a document between facilities who have agreed to transfer or receive patients requiring specialized care not available at the receiving facility. In the event of a BMCI, TAs may be in place to facilitate patient transfer from surge burn centers to non-effected burn centers. These agreements are usually initiated by healthcare facilities in advance of an incident and after consultation with legal counsel.

Burn Mass Casualty Incident (BMCI): A disaster or BMCI can carry very different meanings by different agencies. In order to communicate effectively, pre-plans and SOGs should be designed to utilize similar definitions of BMCIs. Rather than define those here, agencies are encouraged to use their combined efforts to standardize their definition of this term. Refer to the ABA for more information on BMCI.