Ballistics, bombs and burns
BURNS
JE Greenwood
Royal Adelaide Hospital, Adelaide, SA
Historically, mass casualty incidents which generate large numbers of burn injuries are characterized by appalling mortality. Even when occurring in major population centres in developed nations, the focus of management relies heavily on accurate and effective triage and subsequently on the efficient use of available resources in the appropriate patient.
The Burns Unit at the Royal Adelaide Hospital (RAH) receives burns from a catchment area of some 2.4 million square kilometers which contains a population of around 1.7 million. The catchment area includes the entire Northern Territory.
Following natural disasters like the Ash Wednesday fires and the global propensity of major fire incidents to occur in football stadia, shopping malls, modes of transport etc, it was decided to establish a Burns Assessment Team (BAT) in South Australia to cope with potential fire disaster affecting population densities outside Metropolitan Adelaide1. The team’s formation was rubber-stamped by the RAH Trauma Committee in February 2002.
On October 12th 2002, two strategically placed bombs destroyed a large proportion of the tourist areas of Kuta Beach in Bali, Indonesia killing 202 people of which 88 were Australian. The huge majority of major Australian casualties were retrieved by the RAAF and brought to the Royal Darwin Hospital (RDH) where the major incident plan allowed controlled triage, resuscitation, stabilization, emergency surgery, dressing and dispersal, largely within 18 hours of the arrival of the first patients in the early hours of Monday 14th.
The BAT was dispatched to Darwin accompanying two Mediflight Retrieval Teams as part of South Australia’s response to aid the effort in Darwin. Whilst facilities at the RDH were tuned to manage burn injuries up to 20% TBSA, the arrival of large volumes of very large burn injuries threatened to rapidly expend available resources and decompensate the hospital. It was clear also that patients with major burn injuries would not remain at the RDH but would be transferred to tertiary burn units around Australia to make best use of national burn care resources and optimize patient outcome by spreading the load.
The presentation explores some of the issues behind the establishment of the BAT, its role in Darwin and the subsequent management of the 8 patients transferred to Adelaide, including their injury patterns, surgical timing issues, infective complications and outcomes.
Time of Presentation
Saturday 13 May 2006 - 1330-1500
References
1 JE Greenwood, AP Pearce ‘The case for the establishment of a Burns Assessment Team for South Australia’ Prehospital Disaster Medicine 2006;21(1):45-52.
