Bushfire toll should force hospital response rethink

  Bushfire toll should force hospital response rethink

5 July 2009

published by www.weeklytimesnow.com.au

A study into how Melbourne’s leading burns units dealt with the Black Saturday bushfires earlier this year has found there were fewer severe burns cases than expected because of the high mortality rate.

The research, published in the Medical Journal of Australia, suggests authorities must take this into account when planning to cope with future fires.

“Bushfire disasters are characterised by high mortality and relatively few survivors with serious burn injuries,” the study states.

“This is important in planning a disaster response.”

The Alfred Hospital and the Royal Children’s Hospital were put on high alert on the evening of February 7 to accept major burns patients.

Initial estimates suggested they would be inundated with more than 100 severe cases.

Non-burns patients were directed to other hospitals, with the Royal Melbourne experiencing a 100 per cent increase in trauma presentations to its emergency department over the first three days.

Some 10 additional intensive care unit (ICU) beds were created at The Alfred with a further 15 available if required.
Usually, someone with burns covering 10 per cent or more of their body is admitted to a specialist burns unit.

But in a mass casualty situation a severe burn is defined as one to 20 per cent of the body.

On Black Saturday, in light of the expected influx, presentations were limited to patients with burns to more than 30 per cent of their body.

In the end, however, only 24 victims were sent to the two specialist burns units in the first 72 hours – 20 adults to The Alfred and four children to the Royal Children’s.

Two of those admitted to the The Alfred died. One patient at the children’s hospital didn’t recover from their injuries.

The study says while the “initial triage criterion” for referral was set at those with burns to 30 per cent of the body, that rule wasn’t followed once authorities realised the small number of patients who’d survived.

It suggests the process should be reviewed.

“The value of varying normal criteria for referral to a burns centre requires further discussion, as patients may be disadvantaged by delayed referral.”

But the study, written by Alfred emergency doctor Peter Cameron and colleagues, acknowledges such decisions are complicated.

Even though there was a low number of patients with serious burns, they required substantial surgical attention.

The adults at The Alfred spent 50 hours in theatre between them in the first 72 hours of the Black Saturday disaster.

The severity and extent of serious airway burns was much greater than normally seen.

“This was presumably related to the severe heat generated by the fires and the inhalation of dust and debris,” the study states.

Further, if authorities implement better warning systems, the picture could be vastly different next time.

“Evidence from other natural disasters suggest that improved early warning systems would result in lower mortality and a higher number of patients reaching hospitals, with lower overall deaths.”

The Black Saturday fires claimed 173 lives.

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