Mass Burn Casualties Research Articles

Multi-disciplinary mass burn casualty simulation exercise

Disaster simulation exercises are important to test service processes, capabilities, and deficiencies and disaster response planning should encompass the entire multidisciplinary team over an extended period. Our service simulated a modest eight burn casualty scenario to test our service capabilities over a 10-week period across medical, nursing, and allied health professions. Requirements due to the mass burns casualty cohort were predicted in terms of theatre requirements, allied health treatment hours required, and nursing hours requirements. Prospective business-as-usual service provision data was also collected over the 10-week study period in respect to theatre utilisation, allied health workload, nursing hours and burns ward bed census. This data was then superimposed on predicted mass burn casualty requirements to gauge total workload demands over the study period. Results showed an expected significant initial spike in theatre requirements in the first week post mass casualty with ongoing deficiencies in theatre allocation occurring throughout the 10-week study period. Allied health staff were working at or near capacity in a business-as-usual setting with major spikes in workload demand occurring due to the mass burn casualty cohort. Total workload demands clearly exceeded current staff capacity for most of the allied health professions over the 10-week period. Bed census exceeded funded nursing bed capacity for all but seven days of the study period. Predicted combined nursing hours required exceeded funded capacity for all but two days. This simulation clearly demonstrated the high and immediate increase in workload demands across all professions over a prolonged 10-week period and that high business-as-usual demand can greatly affect staff capacity to cope with a mass casualty surge in admissions. It was able to provide evidence, and awareness, for leadership and management on the need for resources and resource re-allocation in a mass burn casualty scenario. It also informed a review of our current triggers for activating our SA Health Multiple Burns Plan.

MYOGLOBIN vs. HEMOGLOBIN BLOCKADE MODEL RELATED SMOKE GAS INHALATION - A COMPUTATIONAL ANALYSIS

To identify the pattern of myoglobin compared to hemoglobin blockade by the combustion products contained in the fire smoke using computational chemistry tools. The myoglobin unavailability can be a determining factor of the severity and consequences of smoke poisoning, generating the inability of patients to attempt evacuate themselves, compromising myocardial function, leading to crush syndrome-like effects and increasing of multi-organ failure to the victims of mass burn casualties event. In this study, it was used quantum chemical calculations performed with the Gaussian program suite using DFT/B3LYP/6-311G level of theory to optimize molecular geometries, calculate the molecular electrostatic potential, and obtain the vibrational spectrum. These calculations were applied to the myoglobin and hemoglobin model, thus studying their binding to the essential components of toxic fire smoke. Comparing the structural descriptors – frontier molecular orbitals, energy difference, electric dipole moment (μ), was obtained the highest values as belonging to hydrogen cyanide (2.9), which may explain its increased reactivity, meaning strong interaction with both myoglobin and hemoglobin, followed by hydrochloric acid (1.03) and carbon monoxide (0.122). Within the framework of complex intoxication generated by the inhalation of fire smoke, myoglobin is blocked in a temporal manner and according to a very similar pattern to hemoglobin. It follows that the significant rhabdomyolysis found in these patients is due not only to hypoxemia but also to the primary unavailability of myoglobin, and myocardial damage is also multifactorial. Although slightly discussed, the calculation of different structural and geometric descriptors for hydrochloric acid reveals for hydrochloric acid high values, suggesting binding affinities comparable to those of carbon monoxide. Molecular modeling programs allow for new approaches and can identify parameters or areas of their reference that influence the management of patients intoxicated with fire smoke components.

Use of the Braden Scale to Predict Injury Severity in Mass Burn Casualties.

BackgroundMass burn casualties impose an enormous burden on triage systems. The triage capacity of the Braden Scale for detecting injury severity has not been evaluated in mass burn casualties.Material/MethodsThe New Injury Severity Score (NISS) was used to dichotomize the injury severity of patients. The Braden Scale and other potentially indicative measurement tools were evaluated using univariate analysis and multivariate logistic regression. The relationships between the Braden Scale and other continuous variables with injury severity were further explored by correlation analysis and fitted with regression models. Receiver operating characteristic (ROC) curve analysis was used to validate triage capacity and compare prognostic accuracy.ResultsA total of 160 hospitalized patients were included in our study; 37 were severely injured, and 123 were not. Injury severity was independently associated with the Numerical Rating Scale (adjusted OR, 1.816; 95% CI, 1.035–3.187) and Braden Scale (adjusted OR, 0.693; 95% CI, 0.564–0.851). The ROC curve of the fitted quadratic model of the Braden Scale was 0.896 (0.840–0.953), and the cut-off value was 17. The sensitivity was 81.08% (64.29–91.44%) and the specificity was 82.93% (74.85–88.89%). Comparison of ROC curves demonstrated an infinitesimal difference between the Braden Scale and NISS for predicting 30-day hospital discharge (Z=0.291, P=0.771) and Intensive Care Unit admission (Z=2.016, P=0.044).ConclusionsThe Braden Scale is a suitable triage tool for predicting injury severity and forecasting disability-related outcomes in patients affected by mass burn casualty incidents.

A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns

BackgroundBurn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. MethodsThe TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children. ResultsIn adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups. ConclusionThe TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.

Initial white blood cell count and revised Baux score predict subsequent bloodstream infection in burn patients: A retrospective analysis of severe burn patients from the Formosa color dust explosion of 2015

Infections are the most common complications among hospitalized severe burn patients. However, limited literature reports early effective predictors of bloodstream infections (BSI) among burn patients. This study aimed to identify cost-effective biomarkers and valuable clinical scoring systems in the emergency department (ED) for the prediction of subsequent BSI in mass burn casualties. In 2015, a flammable cornstarch-based powder explosion resulted in 499 burn casualties in Taiwan. A total of 35 patients were admitted at Taipei Veterans General Hospital. These severe burn patients (median total body surface area [TBSA] 54%) were young and previously healthy. We assessed the potential of various parameters to predict subsequent BSI, including initial laboratory tests performed at the ED, TBSA, and multiple scoring systems. Fourteen patients (40.0%) had subsequent BSI. The most common causative pathogen was the Acinetobacter baumannii (Ab) group, mostly carbapenem resistant and associated with a poor outcome. The area under the receiver operating characteristic curve revealed that the revised Baux score, TBSA, and initial white blood cell count had excellent discrimination ability in predicting subsequent BSI (0.898, 0.889, and 0.821, respectively). The rate of subsequent BSI differed significantly at the cut-off points of revised Baux score >76, TBSA >55%, and WBC count >16,200/mm3. The initial WBC count at the ED, TBSA, and revised Baux score were good and cost-effective biomarkers for predicting subsequent BSI after burn injuries.

Long-term medical treatment of patients with severe burns at exposed sites.

BACKGROUNDBody parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas. In addition, residual wounds, scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas, which may affect patients’ appearance, movements, and mental health. However, inadequate attention has been paid to this issue which can result in problems, such as difficulty in healing, possibility of carcinoma, chronic pain and a heavy mental burden.AIMTo investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODSA retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment. A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds. Active and passive functional exercises with massage, Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands. A combination of physical, chemical and photoelectrical measures was adopted for anti-scar treatment. A psychological intervention and recovery guide was provided which corresponded to the patients’ psychological status.RESULTSCompared to patients who did not simultaneously receive the same treatment, patients who underwent systematic treatment recovered with a lower wound infection rate (P < 0.05), a shorter healing time (13.6 ± 3.2 d) compared with (19.1 ± 3.5 d) and more bearable pain during wound dressing at three days, one week and two weeks after a Chinese herbal bath (P < 0.05). Satisfactory results were achieved with regard to restored function of patients’ joints and blood supply to nerve endings, closure of the eyelids and the size of mouth opening tended to be normal, and only 7.1% of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7% in the control group. In addition, the color, thickness, vascular distribution and softness score of the scars improved (P < 0.01), and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSIONA better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair, limb functional exercise, anti-scar and psychological rehabilitation.

The Wound Microbiology and the Outcomes of the Systemic Antibiotic Prophylaxis in a Mass Burn Casualty Incident.

This paper describes the wound microbiology and outcome of using systemic antibiotic prophylaxis (SAP) in mass burn casualties (MBC). The charts of 31 patients (mean age: 21 years, mean burn area: 42% of the total body surface area) injured in a dust explosion were reviewed for 1 month after the burn. Polymicrobial and rare pathogen wound infections (Acinetobacter junii, Aeromonas sobri, et al) were common in MBC due to sterility breech. Following the use of SAP for 2 to 14 days after admission, there was a reduction in wound infection rate from 45% at week 1 postburn to 10% at week 4. In addition, no blood stream infection occurred in the first week after the burns. Multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Candida albicans were the top three wound pathogens cultured. Multidrug-resistant microorganism infections were found in 39% of the patients, and the odds ratios for the these infections in burn patients with more than ≥40% total body surface area and in patients receiving two or more classes of antibiotics were 41.7 (95% confidence interval [CI] = 2.1-810.7, P = .01) and 9.9 (95% CI= 1.0-92.7, P = .04), respectively. Although SAP did not prevent wound or blood stream infections, no mortality occurred in our patients. A randomized controlled study is needed to investigate the impact of SAP on burn mortality in MBC.

Risk Factors for Multidrug-Resistant Acinetobacter baumannii Infections in a Mass Burn Casualty Incident.

They investigated the risk factors of multidrug-resistant Acinetobacter baumannii infections in 33 burn patients in a mass burn casualty. The independent variables included sex, burn size, vancomycin, ampicillin/sulbactam, cefazolin, meropenem, third-/fourth-generation cephalosporin, the number of classes of antibiotic used, and the number of days of antibiotic use. Multidrug-resistant A. baumannii infection was the outcome variable. Logistic regressions and structural equation model were used for statistical analysis. The average age was 21.7 years (range, 17-32 years; M = 11 [33%], F = 22 [67%]; mean burn area, 42% of the total body surface area; study period, June 28, 2015 to July 31, 2015). The incidence of infection was 39% (n = 13/33). For every percent increase in burn size, the odds of developing A. baumannii infections increased by 1.1 (P < .05). Similarly, the odds increased by 2.5 in every number increase in the classes of antibiotic used, by 1.2 in everyday increase in the days of antibiotic used, and by 12 in patients treated with vancomycin (P < .05). The correlations of these risk factors were demonstrated in a hypothetical structural equation model (P-value of chi-squared test > .05 and root mean square error of approximation < 0.05) in which burn size was the fundamental risk factor of multidrug-resistant A. baumannii infections. The model did not predict the emergence of multidrug-resistant A. baumannii infections. Conclusively, the risks of multidrug-resistant A. baumannii infections in burns are correlated with burn size, the number of classes of antibiotic used, the number of days of antibiotic use, and the prior use of vancomycin.

Excess mortality reduction given a “reduce patient mortality at all costs” scenario for mass burn casualties

ObjectiveThe aim of this study was to estimate the effect on medical resource use and mortality of full financial support from the government for treatment costs after a mass burn casualty event in Taiwan. MethodsAll patients with burn injuries from the event were included (n = 483). Each burn patient from this incident was matched to a separate burn patient identified from the National Health Insurance database. Medical care usage and mortality were compared between groups at 1-, 3-, 6-, 9-, and 12-month intervals. ResultsRegarding outpatient expenditure, burn patients from the mass casualty event had significantly higher levels of medical expenditure compared with their control counterparts at all intervals and levels of medical institution. For inpatient expenditure, patients from the mass casualty event only had higher expenditure for the first month, and excess procedures used by these patients mainly consisted of nonvital procedures such as rehabilitation training. The mortality rate was only slightly lower for this group of burn patients compared with their control counterparts. ConclusionsFull financial support by the government in terms of medical treatment may engender only marginal additional benefits in terms of mortality if burn treatment procedures are already well established in the country.

Management of Major Burns in 37 Casualties of a Colored Powder Explosion: Experience of the Linkou Burn Center in Taiwan.

On June 27, 2015, a colored powder explosion occurred in Taiwan. As a result, 499 people were injured, and over 200 people were in critical condition because of severe burns. Forty-nine casualties were transported to the Chang Gung Memorial Hospital. We undertook a single-center retrospective observational study using clinical data for 37 patients with major burns with more than 20% total burn surface area (TBSA). We describe the experience of managing patients with acute burn injuries in these patients. Patient-specific data were analyzed and expressed as mean ± standard deviation. Thirty-seven major burn patients were admitted to our hospital. The mean ± SD age was 22.5 ± 5 years. The mean ± SD TBSA was 48.9% ± 20%. All patients were stabilized within 6 hours after admission, and no patient experienced hypothermia or hypovolemia. We performed 95 debridement procedures and 88 skin grafts. A mean of 5.6 surgeries were performed for each patient. The mean ± SD hospital stay was 62 ± 32 days. The ratio for hospital days/%TBSA was 1.36, and hospital charges/hospital days ratio was US $973 a day for surviving patients. Two mortalities (2/37, 5.4%) were reported: one was related to cardiac insult, and another was caused by sepsis. We share our experience in managing 37 major burn patients in a colored powder explosion to improve the holistic care in modern mass burn casualties. Aggressive early debridement and skin grafting reduced hospital stay and costs.

Beyond surge: Coping with mass burn casualty in the closest hospital to the Formosa Fun Coast Dust Explosion

PurposeTo provide an insight into the challenges faced by the closest hospital to the Formosa Fun Coast Dust Explosion (FFCDE) disaster scene, and to examine how the hospital staff adapted to cope with the mass burn casualty (MBC) in their overcrowded emergency department (ED) after the disaster. Material and methodsThe critical incident technique was used for the investigation. Data was gathered through in-depth individual interviews with 15 key participants in this event. The interview data was combined with the medical records of the FFCDE patients and admission logs to build a detailed timeline of ED workload. Process tracing analysis was used to evaluate how the ED and other units adapted to deal with actual and potential bottlenecks created by the patient surge. ResultsFifty-eight burn patients were treated and registered in approximately six hours while the ED managed 43 non-FFCDE patients. Forty-four patients with average total body surface area burn 51.3% were admitted. Twenty burn patients were intubated. The overwhelming demand created shortages primarily of clinicians, ED space, stretchers, ICU beds, and critical medical materials for burn care. Adaptive activities for the initial resuscitation are identified and synthesized into three typical adaptation patterns. These adaptations were never previously adopted in ED normal practices for daily surge nor in periodical exercises. The analysis revealed adaptation stemmed from the dynamic re-planning and coordination across roles and units and the anticipation of bottlenecks ahead. ConclusionIn the hospital closest to the FFCDE disaster scene, it caused an overwhelming demand in an already crowded, beyond-nominal-capacity ED. This study describes how the hospital mobilized and reconfigured response capacity to cope with overload, uncertainty, and time pressure. These findings support improving disaster planning and preparedness for all healthcare entities through organizational support for adaptation and routine practice coping with unexpected scenarios.

Greeting the new era: reflection on the 60 years of Chinese burn medicine

As an initial member of burn medicine in China, I am lucky to participate in the activity of writing paper for the journal to celebrate the 60th anniversary of the founding of burn medicine in China. It is a chance to introduce my clinical work, laboratory study, and teaching. I review the development of burn surgery to make some points in the transformation and development of burn surgery, some suggestions for better coordination between burn surgery and critical care medicine during emergency support for mass burn casualties. Furthermore, I wish that some of the differences in opinions and experience in burn care could be studied and conformed in order to form relatively uniform opinion which might benefit the successors.

Corrigendum to "Responding to mass burn casualties caused by corn powder at the Formosa Water Park in 2015" [Journal of the Formosan Medical Association (2015) 1151-1153

Corrigendum to "Responding to mass burn casualties caused by corn powder at the Formosa Water Park in 2015" [Journal of the Formosan Medical Association (2015) 1151-1153

Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study

BackgroundThe triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan.MethodsThis study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention.ResultsThe patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4–98.3%) and a specificity of 86.7% (62.1–96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity.ConclusionsThe current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.

Clinical features, outcomes, and molecular characteristics of an outbreak of Staphylococcus haemolyticus infection, among a mass-burn casualty patient group, in a tertiary center in northern Taiwan.

We reported an outbreak of Staphylococcus haemolyticus (SH) infection in a group of young patients (mean age 21.6) simultaneously hospitalized due to a mass-burn incident. This study analyzed the clinical features of these patients and the microbiological characteristics of the outbreak. All 50 patients hospitalized for burns were enrolled, and their clinical differences were analyzed based on culture results. A drug sensitivity test and pulsed-field gel electrophoresis (PFGE) were conducted to analyze the microbiological difference between SH isolates from the mass-burn casualty patients (the study group) and SH isolates from other patients hospitalized during the same period (the control group) with the intention of identifying the strain of SH outbreak. Patients with isolated SH (N=36) had a significantly higher disease severity (higher revised Baux score, APACHE II score, and concurrent bacteremia rate), and a significantly poorer clinical outcome (longer ICU and hospital stay, and longer MV usage). Significant differences in the phenotype (antibiotics drug sensitivity test) and genotype (PFGE typing) were observed between the study and control groups. The dominant PFGE type C identified among the study group was related to poorer outcomes in a subgroup analysis. A dominant PFGE type of SH infection was found in these mass-burn casualty patients. Pathogenesis or virulence factors may have contributed to our results. Further study of isolated SH should be conducted.

Reflection on rescue and treatment of mass burn casualties in 21st century

The rescue and treatment of mass burn casualties is a test for both the burn treatment level and the disaster emergency response ability of a country or a region. In recent years, burn disasters happened occasionally around the world despite of the improvement of safety level in production and the awareness of fire prevention. On one hand, mass burn casualty events caused catastrophic damages to human health. On the other hand, they also promoted the development of burn treatment and disaster medicine. This paper may provide some references for further improving the management of mass burn casualties in the future by reviewing several typical cases of burn disaster rescue and treatment in the world since the 21st century.

Goal-Directed Fluid Resuscitation Protocol Based on Arterial Waveform Analysis of Major Burn Patients in a Mass Burn Casualty

Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. We conducted a retrospective cohort study of 43 major burn patients at the Tri-Service General Hospital after the Formosa Fun Coast Dust Explosion on June 27, 2015. Because of the limited capacity of intensive care units (ICUs), 23 intubated patients were transferred from the burn wards or emergency department to the ICU within 24 hours. Fluid administration was adjusted to achieve a urine output of 30 to 50 mL/h, cardiac index greater than 2.5 L/min/m, and stroke volume variation (SVV) less than 12%. The hourly crystalloid fluid infusion rate was titrated based on SVV and hourly urine output. Of the 23 critically burned patients admitted to the ICU, 13 patients who followed the goal-directed fluid resuscitation protocol within 12 hours postburn were included in the analysis. The mean age (years) was 21.8, and the mean total body surface area (TBSA) burned (%) was 68.0. The mean Revised Baux score was 106.8. All patients sustained inhalation injury. The fluid volumes administered to patients in the first 24 hours and the second 24 hours (mL/kg/% total body surface area) were 3.62 ± 1.23 and 2.89 ± 0.79, respectively. The urine outputs in the first 24 hours and the second 24 hours (mL/kg/h) were 1.13 ± 0.66 and 1.53 ± 0.87, respectively. All patients achieved the established goals within 32 hours postburn. In-hospital mortality rate was 0%. The SVV-based goal-directed fluid resuscitation protocol leads to less unnecessary fluid administration during the early resuscitation phase. Clinicians can efficaciously manage the dynamic body fluid changes in major burn patients under the guidance of the protocol.

The role of preliminary hospitals in the management of a mass burn casualty disaster

PurposeThe Formosa Fun Coast explosion is an internationally-known event that occurred in Taiwan on June 27th, 2015. The blast involved 495 casualties in total, with 253 patients receiving 2nd degree or deeper burns on greater than 40% of the total body surface area (TBSA). Questions were raised regarding whether these victims were sent to the appropriate hospitals or not. Therefore, we analyzed the effect of the initial admission destination in this study. Material and methodsWe retrospectively reviewed all of the victims from the explosion who were sent to the emergency department of Linkou and Keelung Chang Gung Memorial Hospitals. Patients were divided by direct admission and received via transfer. The basic demographics, the efficacy of the initial resuscitation and the clinical outcomes were analyzed. ResultsIn total, forty-six patients were included. Thirty-five of them were primarily admitted, and eleven of them were received via transfer. Between the two groups, there was no significant difference in the resuscitation outcome. The ratio of delaying intubation was similar (14.3% vs 27.3%, p=0.322). The rate of delayed-detected ischemic events was significantly increased in the referral group (0% vs 27.3%, p=0.001). However, there was no amputation event in either group. No difference in mortality was observed between groups (5.7% vs 9.1%, p=0.692). ConclusionOur preliminary findings suggest that local hospitals are capable of providing high-quality acute care to mass casualty burn victims. Our results suggest that patients with suspected limb ischemia should be rapidly transferred to a regional burn center to ensure optimal care. Systemic pre-planning such as employing telemedicine and personnel collaboration, should be considered by the administration to maximize the function of preliminary hospitals in burn care.

Work Stress, Resilience, and Professional Quality of Life Among Nurses Caring for Mass Burn Casualty Patients After Formosa Color Dust Explosion.

A Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This tragedy inundated hospitals across northern Taiwan with an unprecedented number of burn patients. It caused extreme pressure and challenges for nurses. The purpose of this study is to investigate factors associated with nurses' work stress, resilience, and professional quality of life in caring for dust exposure patients. A cross-sectional survey data was collected from nurses in caring for dust explosion patients. A total of 83 nurses in burn unit, plastic surgery ward, and reconstructive microsurgery unit returned valid data for analysis. Structured questionnaires included demographic inventory, Nurse Stress Checklist, Connor Davidson Resilience Scale, and Professional Quality of Life Scale version 5. The study results showed that work stress deteriorated the professional quality of life, while resilience was a protective factor. Significant positive relationships were observed between work stress, burnout, and secondary traumatic stress. Results of hierarchical regression analysis indicated that resilience helps to ease the deterioration effect of secondary traumatic stress. Results confirm the importance of both work stress and resilience in explaining aspects of professional quality of life. More importantly, resilience was shown as a significant variable impacting level of secondary trauma stress. Intervention in promoting resilience should be targeted in order to reduce secondary trauma among nurses after facing disastrous mass causality incidents.

The significance of changes in platelet concentration during the early phase after severe burn injury in a Chinese mass casualty

BackgroundChanges in platelet concentration are common in severe burn patients. Platelets play a key role in the course of disease. This study aims to explore the significance of platelet concentration during the course of the disease in victims of a mass burn casualty.MethodsA total of 180 patients were involved in the “8.2” Kunshan explosion accident in China. The examined data included age, gender, total burn area (% TBSA), third-degree burn area (% TBSA), and platelet concentration within the first 5 days after the burn injury. The patients were divided into two groups according to four indicators (resuscitation, acute respiratory distress syndrome, acute kidney injury, septic shock). We collected several types of data for the patients and divided the patients into a complication group and non-complication group according to the diagnostic criteria. We analyzed the platelet concentration of the two groups using t tests to determine whether significant differences were present. P values < 0.05 were considered statistically significant.ResultsThe group with successful resuscitation had higher platelet concentration than the failure group on day 3 and day 5. The patients who suffered from acute kidney injury (AKI) and septic shock had a lower platelet concentration than non-sufferers on day 3 and day 5.ConclusionsThe platelet concentration of burn patients can dynamically reflect the pathophysiological changes of the body. It can be used as an early objective indicator of prognosis in mass burn casualty cases.