A New Triage Method for Burn Disasters: Fast Triage in Burns (FTB)

Abstract

BackgroundThere are few triage methods based on patient age and extent of burn. However, in case of mass casualties, age might be hard to define. Burn segregation in mass-casualty accidents requires an easy, fast, and effective method. Triage in burns should also segregate casualties requiring treatment in burn centers. The aim of this study was to create a proprietary segregation algorithm dedicated to mass-casualty incidents.Material/MethodsA retrospective analysis of 939 burned patients admitted to the Clinical Department of Burns, Plastic and Reconstructive Surgery, Military Institute of Medicine (MIM) in Warsaw and to the Center for the Treatment of Burns (CTB) in Siemianowice Śląskie in 2012 and 2013 was performed. The aim was to reveal which early factors could be used during segregation of burn victims in mass-casualty incidents on the battlefield and in civilian circumstances. Only easy and quick-to-evaluate factors that can be examined without medical equipment and laboratory tests were used in creating the proprietary triage algorithm.ResultsAs a result of our study, we created an algorithm for fast triage in mass-casualty situations. The algorithm is based on parameters that can be easily evaluated without additional equipment. To create the algorithm, we used factors that had the strongest impact on mortality prediction in severely burned patients, in multifactor analysis: advanced age (p<0.001. OR=1.04), extent of the deep burn (p<0.001. OR=1.1), and low systolic arterial pressure (p<0.001. OR=0.96).ConclusionsThe FTB (Fast Triage in Burns) algorithm is a new triage method dedicated for massive burn events in civilian circumstances. The FTB algorithm is a simple, quick, and credible means of segregating burn victims. The algorithm is dedicated to use in pre-hospital care, during mass-casualty events both in civilian and battlefield circumstances. The aim is to be able to evaluate burn victims immediately, without access to medical equipment or additional tests and to evaluate indications for burn center care. It is a unique method designed to be used during segregation in isolated burn mass-casualty incidents.

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

“…In addition, our research confirmed that the GCS, which principally assesses brain damage, might not be appropriate to assess trauma severity because of its poor correlation with the NISS (correlation coefficient was −0.511) [ 41 ]. A study of 939 burn patients showed that a deeper burn (OR=1.1, P <0.001) was a latent predictor of burn severity [ 19 ] but was less useful as a predictor of the outcomes of mass burn casualties because such incidents also involve many non-burn and non-inhalation injury patients. Other factors, such as vital signs [ 16 ], which previously had been considered relevant to burn and trauma, were shown to have no significant correlations with injury severity in our study.…”

“…Two trained medical experts independently reviewed the medical records and collected data using a standardized reporting template with clear definitions and codes. The patients’ vital signs evaluated at the time of admission to the hospitals were extracted [ 19 ], including systolic blood pressure (SBP), heart rate (HR), respiratory rate (RR), and body temperature. The shock index was calculated as the HR divided by SBP [ 16 ], and a high risk of shock was defined as a shock index ≥1.…”

“…Early application of the NISS in EDs seems impossible because complete and detailed diagnoses are unavailable in the EDs at the early stage of an emergency. Furthermore, the prognostic indicators to predict injury severity of mass burn casualties have not been sufficiently evaluated [ 19 ].…”

Evaluation of Bromelain-Based Enzymatic Debridement Combined with Laser Doppler Imaging and Healing of Burn Wounds

“…An appropriate treatment strategy is selected based on the assessment of burn depth [ 6 , 7 ]. Clinically, burns can be divided into superficial, which are treated conservatively, and deep burn wounds requiring surgical therapy [ 8 , 9 ]. An overly aggressive strategy of treatment for superficial burns will cause unnecessary damage to healthy tissues.…”