Burn Disaster Response Planning in New York City: Updated Recommendations for Best Practices.
Since its inception in 2006, the New York City (NYC) Task Force for Patients with Burns has continued to develop a city-wide and regional response plan that addressed the triage, treatment, transportation of 50/million (400) adult and pediatric victims for 3 to 5 days after a large-scale burn disaster within NYC until such time that a burn center bed and transportation could be secured. The following presents updated recommendations on these planning efforts. Previously published literature, project deliverables, and meeting documents for the period of 2009-2010 were reviewed. A numerical simulation was designed to evaluate the triage algorithm developed for this plan. A new, secondary triage scoring algorithm, based on co-morbidities and predicted outcomes, was created to prioritize multiple patients within a given acuity and predicted survivability cohort. Recommendations for a centralized patient and resource tracking database, plan operations, activation thresholds, mass triage, communications, data flow, staffing, resource utilization, provider indemnification, and stakeholder roles and responsibilities were specified. Educational modules for prehospital providers and nonburn center nurses and physicians who would provide interim care to burn injured disaster victims were created and pilot tested. These updated best practice recommendations provide a strong foundation for further planning efforts, and as of February 2011, serve as the frame work for the NYC Burn Surge Response Plan that has been incorporated into the New York State Burn Plan.
Review of meeting minutes and the 11 deliverables of the draft response plan was performed
Working group review guidelines (qualitative)
Hierarchical BDRH matrix with modified guidelines
Creation of a working group, monthly meetingsDevelopment of recommendations for best practices required coordinatedinvolvement of hospitals, government agencies and other health care institutions
Describe a draft response plan for the tiered triage, treatment, or transportation of 400 adult and pediatric victims (50/million population) of a burn disaster for the first 3 to 5 days after injury using regional resources.
Operational feasibility of these guidelines has not yet been tested nor established
Existing burn center referral guidelines were modified into a hierarchical BDRH matrix, which would vector certain patients to local or regional burn centers for initial care until capacity is reached.
The overarching goal of the guidelines was to outline a disaster response that allows for large numbers of burn injured victims to be cared for 3 to 5 days afteran event until such time that tertiary burn care can be secured or the patient is safe for discharge with appropriate follow-up outpatient care.
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