Management of multiple burn casualties in a high volume ED without a verified burn unit

The objective of the study was to evaluate the effectiveness of triage, tre atment, and transfer interventions on multiple burn casualties managed in a high volume ED that does not have a verified in-hospital burn unit. The ch arts of 11 male patients injured in a 1999 foundry explosion and brought to Baystate Medical Center (BMC), a level I trauma center, were reviewed. All patients sustained deep partial and full thickness burns. The injury sever ity score (ISS) ranged from 9 to 75. Five patients had total body surface a rea (TBSA) burns of 10% to 50% and 6 patients had TBSA burns of 70% to 95%. Transfer times from the scene to BMC ranged from less than 5 minutes to 22 minutes. All 11 were initially triaged, resuscitated, and evaluated at BMC . Of the 9 patients transferred to verified burn units, 8 were intubated, 6 of 6 had negative abdominal ultrasounds, 4 had undergone escharatomies, an d 1 had undergone bronchoscopy before transfer. Nine critically injured bur n patients with ISS of 9 to 75 were transferred from BMC to verified burn u nits. For 8 of these patients, the average time from triage, evaluation, an d treatment to transfer was 2 hours. The ninth patient was initially admitt ed overnight then promptly transferred after re-evaluation of his hand burn s indicated a need for more specialized care. Two of 9 transferred patients , both with ISS of 75 died. Although 7 other patients had prolonged and com plex courses, none of their subsequent complications were referable to miss ed injuries from this transferring facility. The resources and expertise of a high volume ED without an in-hospital burn unit can be effectively used in the initial resuscitation and treatment of multiple burn casualties. Coo rdinated responses among emergency medicine, trauma, anesthesia, and nursin g personnel are instrumental to the rapid triage, resuscitation, and treatm ent of critically injured burn patients. Future disaster planning should in corporate a clearly demarcated, ED command center led by an easily identifi able "captain of the ship," as well as more accurate patient identification systems and improved communications with family members. Copyright (C) 200 1 by W.B. Saunders Company.