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NYC Hospitals Ready to Help Burn Patients if Disaster Strikes

Monday June 28, 2010
Stony Brook (N.Y.) University Medical Center staff, from left, Diane Carlson, RN, director of nursing support services; Connie Kraft, RN, coordinator of the regional resource center for emergency preparedness; and Leo DeBobes, CSP, assistant administrator of emergency management and administrative director of the Suffolk Regional Resource Center.
Stony Brook (N.Y.) University Medical Center staff, from left, Diane Carlson, RN, director of nursing support services; Connie Kraft, RN, coordinator of the regional resource center for emergency preparedness; and Leo DeBobes, CSP, assistant administrator of emergency management and administrative director of the Suffolk Regional Resource Center.
(Photo courtesy of Stony Brook)
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During a disaster, New York and New Jersey hospitals will be called upon to care for patients who are seriously compromised and have complex needs, such as burn patients. About 20% to 30% of patients injured in a mass casualty event, such as 9/11 or a chemical spill, will have serious burns, says Kathe M. Conlon, RN, BSN, CEM, MSHS, burn emergency preparedness education coordinator at Saint Barnabas Health Care System in West Orange, N.J.

Travel initially may be restricted because of blocked roads or grounded aircraft, so transferring patients to burn hospitals may not be possible. To fill the gap, ICUs are likely to be called upon while transportation to burn hospitals is arranged.

New Jersey Takes Command

According to the American Burn Association, The Burn Center at Saint Barnabas Medical Center in Livingston is the only burn center in New Jersey. As a result, Saint Barnabas plays a pivotal role in disaster planning with the Department of Health and Senior Services in New Jersey, Conlon says. The two have partnered to develop a burn mass casualty response system that includes a burn Medical Coordination Center to triage and disperse patients.

In the event of an epidemic or disaster on the East Coast, emergency personnel could use the MCC as a command and control center to direct emergency responders to take patients to hospitals equipped to care for them. “In the event of a disaster, the MCC, which has advanced communication equipment, will be activated to coordinate with the nine other MCCs, other hospitals and the New Jersey Department of Health,” Conlon says. “Because they are a burn MCC, the Saint Barnabas experts will be able to coordinate with facilities from Maine to Washington, D.C., who are members of the Eastern Regional Burn Disaster Consortium. The goal is to get patients to the most appropriate New Jersey hospital for their initial stabilization care, and then to move them to burn centers for burn care,” Conlon says.

As soon as patient transfer is safe, the MCC will place patients into burn units according to a tier matrix based on the American Burn Association Mass Casualty Triage Grid. The grid uses patient age and burn size — calculated as a percentage of total body surface area — to assign one of five levels of care to each individual, from “Outpatient,” those who have a high expectation of survival and a good outcome, to “Expectant,” those who have less than a 10% likelihood of survival.

The order of placements into burn units will be based on the triage grid. Those in the middle tier will be transferred to burn units as quickly as possible, as their survival and good outcome is dependent on aggressive, specialized treatment. The other levels of care will be transferred as quickly as appropriate beds can be located. The burn MCC will contact other members of the consortium for assistance as needed.


Stony Brook (N.Y.) University Medical Center staff, from left, Diane Carlson, RN, director of nursing support services; Connie Kraft, RN, coordinator of the regional resource center for emergency preparedness; and Leo DeBobes, CSP, assistant administrator of emergency management and administrative director of the Suffolk Regional Resource Center.
(Photo courtesy of Stony Brook)
Burn Carts Prep New York

In 2005, New York City organized a working group led by NewYork-Presbyterian/Weill Cornell Medical Center to formulate a plan to respond to a mass casualty incident. Nicole Leahy, RN, MPH, manager of the burn center, burn outreach and professional education programs, and Angela Rabitts, RN, MS, research specialist at the burn center, have been involved in this planning group. There are four burn centers in New York City that account for about 70 burn specialty beds — NewYork-Presbyterian/Weill Cornell Medical Center, Staten Island University Hospital, Jacobi Medical Center and Harlem Hospital Center. In a disaster they would be expected to accommodate 150% of capacity for the first three to five days. Triage will be based on American Burn Association guidelines, collaboration and planning.

“Sharing ideas to get patients the best care is what the work group is about,” Leahy says. “We are piloting educational modules to start the process of training staff to be ready to meet the challenge, should it arise. We are working on the design of a ‘virtual burn consultation center’ where experts can triage, field calls and advise regarding treatment.”

As part of the New York City Burn Disaster Plan, the New York City Department of Health provided all the participating hospitals a burn cart with enough specialized burn care dressings and supplies to perform twice daily dressing changes for five critically injured adults.

Staten Island could be cut off from ground transport in an emergency if the bridges to New York and New Jersey were affected, says Marc Tempesta, RN, BS, MBA, administrative director of burn services at The Jerome L. Finkelstein, MD, Regional Burn Center at Staten Island University Hospital.

When a gas refinery plant exploded about five years ago, SIUH found out they were ready and their plan worked. “Staff takes ownership of the specialty — they called in to see if they were needed,” Tempesta says.

As coordinator of the regional resource center for emergency preparedness at Stony Brook (N.Y.) University Medical Center, Connie Kraft, RN, MSN, CEN, has coordinated with the New York State Department of Health, Office of Health Emergency Preparedness to implement a plan for a response to a large event. As the only burn center in Suffolk County, the staff of expert clinicians has initiated an outreach education program for professionals at other hospitals so they also are ready accept an unexpected surge of patients.

Kraft estimates that nearly 100 clinicians, including nurses, physician assistants, nurse practitioners and physicians have been trained to manage burn patients in the event of a mass casualty incident. As an everyday resource, the staff designed a poster detailing burn management for distribution to other hospitals.

As part of the regional surge plan, Kraft says New York State grant money has funded burn carts similar to those provided in New York City. These carts have been distributed to participating hospitals.


Marylisa Kinsley, RN, BSN, is a freelancer for Nursing Spectrum. To comment, e-mail editorNY@nursingspectrum.com.
Burn ABCs

Caring for burns is a complex and specialized field, but there are some basics every nurse should know, according to Diane Carlson, RN, MS, CPNP, CNAA-BC, director of nursing support services at Stony Brook (N.Y.) University Medical Center. She notes the first approach to caring for these patients is the same as any injured patient.

The primary assessment survey includes:

• Airway maintenance with cervical spine protection

• Breathing and ventilation

• Circulation (assessment of vital signs, skin color, insertion of two large bore IV catheters, Doppler ultrasound exam of extremities)

• Deficits, neurological and others

• Exposing the patient, including removing any jewelry so a complete survey of the injury can be done, and there will be no constriction if there is edema

The extent of a burn can be estimated using the “rule of nines,” where each arm and the head are considered to be 9% of the body surface and the anterior and posterior trunk and legs are each 18%. Another estimate is to use the size of the patient’s hand, including fingers, to represent 1% of the total body surface area.

Carlson says it’s important to be aware that these patients can deteriorate abruptly, and the initial conversation with the patient may be the only chance to get a complete history of circumstances surrounding the injury as well as medical history, such as allergies, medication/alcohol, drugs, last meal time and last tetanus immunization. A dry, warm blanket should be provided, and intravenous hydration per Advanced Burn Life Support fluid resuscitation formula should be instituted with adjustments made according to the patient response assessed by urine output.