In recent years, the world has been confronted with a growing number of challenges, including the COVID-19 pandemic, plane crashes, earthquakes, and conflicts. These events have underscored the critical importance of having robust health emergency preparedness and response systems in place.

On November 24, 2024, the World Health Organization (WHO) released Standards and Recommendations for Burns Care in Mass Casualty Incidents. This document provides valuable guidance on effectively managing burn patients during large-scale disasters or mass casualty events.

The main goal of these standards is to ensure that care is delivered promptly and efficiently, while also addressing the unique challenges that arise in such circumstances. This involves offering clinical guidelines, establishing triage protocols, allocating resources effectively, and promoting coordination among healthcare providers and emergency responders to manage burn injuries in mass casualty scenarios.

By following these standards and recommendations, healthcare professionals can enhance their preparedness and response to mass casualty incidents involving burn patients, ultimately leading to improved outcomes and lives saved. In this discussion, we will explore the key takeaways and insights regarding the guideline’s recommendations for burns care in mass casualty incidents (MCI). Please be aware that this list does not cover all major points. For a comprehensive list of recommendations, please refer to the summary provided here or access the full text guideline on the WHO website.

Key Takeaways

Triage and Prioritization:

  • Triage is pivotal in managing burn injuries during mass casualty events. It involves rapid assessment of burn severity and prioritization of care based on clinical urgency. 
  • The process unfolds in three stages: (1) on-scene triage; (2) triage upon arrival at the first receiving facility; and (3) definitive triage following surgical debridement and wound cleaning. 
  • Common triage frameworks, such as the START (Simple Triage and Rapid Treatment) system, categorize patients into immediate, delayed, and minor care categories to guide treatment decisions.

Initial Assessment and Stabilization:

  • The initial approach should prioritize airway management, breathing, and circulation (ABCs), following standard trauma care protocols. 
  • Fluid resuscitation is paramount to prevent shock, with the Parkland formula commonly utilized to guide burn fluid management. 
  • Cooling of the burn wound with potable water (at room or cool temperatures) should be initiated promptly and can continue for up to three hours post-injury.

Burn Severity Classification:

  • Burn severity is classified based on depth (superficial, partial-thickness, full-thickness) and the total body surface area (TBSA) affected. This classification directs clinical management, resource allocation, and decisions regarding referral to specialized burn care units.
    • Minor Burns: Patients with <20% TBSA superficial/partial-thickness burns and no involvement of special areas (e.g., face, hands, feet, genitalia) may be managed as outpatients with appropriate follow-up.
    • Major Burns: Patients with >20% TBSA burns or those with deep dermal burns or involvement of special areas should be referred to a specialized burn unit for expert care. Transfer to a dedicated burn center should be strongly considered.

Resource Allocation:

  • During mass casualty incidents, judicious allocation of medical resources—such as medications, supplies, and personnel—is essential to maximize patient survival. 
  • Pre-identified burn care facilities and specialized units should be coordinated to ensure patients requiring advanced care are transferred efficiently.

Treatment Facilities and Transportation:

  • An organized triage area and effective transport system are crucial for the timely and efficient movement of burn patients to appropriate care facilities. 
  • Transport considerations must account for the management of pain and airway protection, ensuring patient stability during transfer.

Pain Management:

  • Effective pain control is critical to burn care. Options include opioid analgesics, local anesthetics, or sedatives, with selection based on the patient’s condition and care stage. 
  • Early and adequate pain management is essential for minimizing complications and optimizing patient outcomes.

Infection Control:

  • Preventing infection is a key aspect of burn management. Proper wound care, including sterile dressing changes, is essential in reducing the risk of sepsis.
  • Routine prophylactic antibiotic use is not recommended; antibiotics should only be prescribed when clinically indicated, such as in cases of significant contamination or when infection is suspected.

Interagency Coordination:

  • Successful response to mass casualty burn incidents requires seamless coordination across agencies, including fire, emergency medical services (EMS), military, and public health sectors. 
  • Timely communication and resource-sharing are critical to ensuring that burn patients receive prompt and effective care.

By establishing a set of universal quality standards and protocols, this guideline serves as the foundation for improved interoperability among national, regional, and international capacities. It aims to foster a common language and approach across various disciplines to advance a comprehensive and coordinated response to burn care in MCIs. These standards and recommendations are designed to improve the survival and recovery of burn victims in mass casualty situations, while also maximizing the efficiency of limited resources and personnel.

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