Standards and Recommendations for Burns Care in Mass Casualty Incidents
Fluid Management Recommendations
For patients in mass burn incidents, treat with oral fluid resuscitation and where possible, supplement with intravenous (IV) fluid depending on patient need, clinical resources and provider discretion.
For patients in mass burn incidents, use standard formulae for calculation of fluid resuscitation requirements.
General Technical Standards
- As part of their mass casualty or disaster plan, it is recommended that Member States include specific provisions for a potential mass burn incident.
- Burn Assessment Teams (BATs) serve advisory, clinical and coordination roles while Burn Specialist Teams (BSTs) serve a primary clinical role.
- Member States should consider creating a national BAT or having bilateral or regional agreements to request BATs from neighbouring countries as part of their national EMT system and their national emergency response plan.
- BSTs may be best shared regionally among multiple countries, either sourced from one larger country, and/or with contributions from experts and resources in nearby countries within the region.
- Medical evacuation (MEDEVAC) may be a subset of coordination activities requiring specialized clinical support. Countries must consider the inclusion of a MEDEVAC coordination function within their national coordination mechanisms.
Coordination Technical Standards
- While primary responsibility of coordination of EMTs remains with the appropriate national authority, during mass burn incidents, BATs and BSTs can support coordination at national and regional levels.
- In the event of a mass burn incident, and when national capacities are exceeded or specialized care support is required, countries should consider activation of mechanisms for possible international medical evacuation.
Triage Technical Standards
- During a mass burn incident, three phases of triage should occur:
- (1) onscene;
- (2) on arrival at the first receiving health facility; and
- (3) definitive triage after surgical scrub/wound cleaning. On-scene, a standardized triage system for mass casualty incidents (MCIs) should be utilized, followed by a burn injury severity assessment determined mainly from percent total body surface area (%TBSA) burn estimation rather than depth assessment, as appropriate.
- The %TBSA burn estimation tool utilized on-scene should reflect the tool most familiar to first responders. However, should guidance be required, the Wallace Rule of Nines estimation tool can be used for adults and the modified Rule of Nines for children.
- The decision to assign a patient to the “expectant” or “non-survivable” triage category should be made no earlier than when the patient arrives at the first receiving health facility.
Additional Technical Standards
- First aid for burns should include cooling, analgesia, cleaning, dressing and tetanus considerations.
- Cooling of the burn wound can occur from 10 minutes to three hours after the injury was sustained using potable/drinking water at room or cool temperatures.
- Basic wound cleaning includes removing debris and irritants from the wound. Advanced cleaning should occur on arrival at the first receiving hospital with appropriate analgesia and/or sedation. If further extensive cleaning is required, a surgical scrub can be undertaken in the operating theatre with anaesthesia.
- Choice of dressing should be based on the characteristics of the wound, point of application, availability of dressing type, resource requirements of dressing and the ability of a patient to return for follow-up visits.
- Tetanus vaccination should be up to date as per local guidelines and practices. Booster and/or immunoglobulin should be given as indicated.
- Antibiotics should not be routinely given prophylactically to burns patients unless otherwise specifically clinically indicated.
- Patients with <20% TBSA superficial/partial thickness burns and no special area burns may be discharged with adequate outpatient support, such as social and community support, with a clear care pathway communicated.
- Patients with >20% TBSA and/or deep dermal or special area burns should be evaluated by an experienced burn care specialist as they may require ongoing in-patient care. Consider transferring these patients to a specialist burn care centre.
- Procedures that may be performed by non-burn surgeons include advanced wound cleaning, surgical scrub, escharotomy and fasciotomy. Excision, enzymatic debridement, grafting, local tissue rearrangements, flaps and contracture releases are examples of procedures that should be performed by surgeons skilled in burns care and/or by surgeons supported by relevant clinical expertise.
- Rehabilitation requirements should be considered for all patients (based on burn severity and location of the burn) on arrival at the first receiving hospital.
- Active and passive exercises, positioning, splinting and functional retraining should commence at the earliest phase of care, once vital functions are stable and considering precautions such as related trauma, wound breakdown, graft frailty, attached wires, low blood pressure, or infection.
- Adequate analgesia should be administered prior to rehabilitation interventions as pain can reduce participation and performance.
- Compression therapy and massage should be used early to minimize scarring and manage oedema.
- It is recommended that BATs and BSTs have the capability to support the initial care of chemical, biological, radiological and nuclear (CBRN) patients in the event of a CBRN MCI.
Recommendation Grading
Disclaimer
Overview
Title
Standards and Recommendations for Burns Care in Mass Casualty Incidents
Authoring Organization
World Health Organization
Publication Month/Year
November 25, 2024
Last Updated Month/Year
November 25, 2024
Document Type
Guideline
Country of Publication
Global
Document Objectives
Caring for burns patients from the incident scene to definitive treatment can be a complex, resource-consuming process with the potential to overwhelm health system capacity. This document provides practical guidance for building capacity and capability for burns care from clinical, human resources and operational perspectives. It is therefore recommended that guidance in this document be applied to any contexts in which the local health system might struggle to cope and require surge support. The objective is to ensure the establishment and enhancement of specialist burn EMTs and surge capacities that are ready and able to deliver timely, effective and high-quality burns care in response to mass burn incidents, ultimately saving lives and alleviating suffering.
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Emergency care, Hospital, Medical transportation, Operating and recovery room
Intended Users
Nurse, nurse practitioner, paramedic emt, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D002056 - Burns, D054527 - Mass Casualty Incidents
Keywords
mass casualty events, burns, burn care
Source Citation
Standards and recommendations for burns care in mass casualty incidents. Geneva: World Health Organization; 2024 (Emergency Medical Teams). Licence: CC BY-NC-SA 3.0 IGO.