Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers.

JBUR-4251; No. of Pages 12 burns xxx (2014) xxx–xxx

Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.elsevier.com/locate/burns

Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers§ Randy D. Kearns a,*, James. H. Holmes IV.b, Mary Beth Skarote c, Charles B. Cairns d, Samantha Cooksey Strickland e, Howard G. Smith f, Bruce A. Cairns g a

North Carolina Burn Disaster Program, EMS Performance Improvement Center, University of North Carolina School of Medicine, United States b WFBMC Burn Center, Wake Forest Baptist Health System, Wake Forest University School of Medicine, United States c Healthcare System and Hospital Preparedness Program Coordinator, North Carolina Office of EMS, United States d Department of Emergency Medicine, University of North Carolina School of Medicine, United States e ESF8 Program Manager, Bureau of Preparedness and Response, Emergency Preparedness and Community Support/ Florida Department of Health, United States f Burn Center, Orlando Regional Medical Center, University of Central Florida College of Medicine, United States g North Carolina Jaycee Burn Center, University of North Carolina School of Medicine, United States

article info

abstract

Article history:

Response to the 2010 Haitian earthquake included an array of diverse yet critical actions.

Accepted 17 December 2013

This paper will briefly review the evacuation of a small group of patients with burns to burn

Keywords:

for the first time plans, groups, and organizations that had previously only exercised this

Disaster plan

process.

centers in the southeastern United States (US). This particular evacuation brought together

ESF-8 Burn disaster

The response to the Haitian earthquake was a glimpse at what the international community working together can do to help others, and relieve suffering following a

Burn surge

catastrophic disaster. The international response was substantial. This paper will trace

Burn mass casualty

one evacuation, one day for one unique group of patients with burns to burn centers in the

EMS

US and review the lessons learned from this process.

Haiti Earthquake

The patient population with burns being evacuated from Haiti was very small compared to the overall operation. Nevertheless, the outcomes included a better understanding of how

US TRANSCOM

a larger event could challenge the limited resources for all involved. This paper includes

Florida

aspects of the patient movement, the logistics needed, and briefly discusses reimbursement

North Carolina

for the care provided.

Southern Burn Disaster Plan

# 2013 Elsevier Ltd and ISBI. All rights reserved.

§ An abstract of this paper was previously presented as an oral presentation at the 2010 ABA Southern Burn Region Annual Conference in Memphis, Tennessee by the primary author for this paper and as a poster presentation at the 2011 National Disaster Medical System annual Conference in Dallas, Texas. * Corresponding author. Tel.: +1 919 843 5754. E-mail addresses: [email protected], [email protected] (R.D. Kearns). 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.12.015

Please cite this article in press as: Kearns RD, et al. Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers. Burns (2014), http://dx.doi.org/10.1016/j.burns.2013.12.015

JBUR-4251; No. of Pages 12

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1.

Introduction

On January 10 2010, a catastrophic 7.0 magnitude earthquake destroyed much of the Haitian capital of Port-A-Prince. It is estimated that 316,000 were killed and another 300,000 injured [1] as a result of the earthquake. Significant earthquakes typically include burns as one of the more common injuries [2–9]. Following the Haiti earthquake, the most common surgical interventions performed at one of the larger functioning hospitals (Partners in Health/ Zanmi Lasante Hospitals) for pediatric patients included ‘‘trauma and burns’’ [10]. One of the first operating field hospitals following the earthquake was provided by the Israeli Defense Forces Medical Corps. They reported approximately 10% of their more seriously injured as patients included burns [11]. One aspect of managing the patients with burns included international flights (evacuations) to US based hospitals for more complicated burn care. This paper will review the step by step evacuation of a small subset of those burn patients relying on processes that had never been used in a real world event. Other aspects of this paper include reviewing the complexities of these evacuations, a brief explanation of the groups who made this work, financing, and offer several specific lessons learned from this important example. This was a small group of patients. Yet, there are valuable process lessons learned which have implications for future burn disasters utilising international evacuations for specialty burn care.

2.

Background

When the earthquake occurred, there were approximately 25,000 Americans living in or visiting Haiti. More than 500 [12] Americans and Haitians with complicated injuries would eventually be evacuated for medical care, primarily to Florida hospitals (in the United States [US]). By January 20 2010, the medical evacuations had pushed much of the daily and conventional surge capacity [13] for Florida hospitals to their limits. By the early morning of January 25, still more injured patients, including several Haitians with critical burns, needed evacuation from the US Naval Ship (USNS) Comfort (a hospital ship). The overarching philosophy for US disaster operations, including medical evacuations relies on the National Response Framework (NRF) [14]. This framework includes coordination involving state (Florida) and federal (US) representatives for the Health and Medical Emergency Support Function, designated as (ESF-8) [15] and US military air resources; Transportation Command (TRANSCOM). The process used to manage a surge of burn injured patients in the region is detailed in the Southern Region Burn Disaster Plan (SRBDP) [16,17]. The burn patients needing evacuation posed a challenge since the first wave of evacuated American and Haitian burn patients had already pushed the Miami area burn center beyond conventional capacity [13]. Florida ESF-8, requested activation for the SRBDP to aid with receiving the burn-injured patients (It should be noted, this

was the first time this plan had been utilized during an actual disaster).

2.1.

Building codes and associated injuries

Burn mass casualty incidents (commonly referred to as burn disasters) for the US from 1900 to 2000 were reviewed by Barillo et al. [18]. A similar paper by Cavallini et al. [19] examined international burn disasters over the same period. Common findings included an association of fire related mortality decreases where technology and improved building codes were more prevalent [19]. Both papers identified favorable trends of reduced morbidity and mortality over the past 50 years. Peleg et al. also noted a correlation between decreases in earthquake associated injuries where technology and improved building codes were more prevalent [20].

2.2. Planning for a surge of burn injured patients and several burn disasters One of the first efforts to develop a civilian burn center disaster plan was reported by Wachtel et al. [21]. International Burn Disasters that influenced and stimulated disaster planning and preparedness efforts during the 1990s included the Bijlmermeer disaster (The Netherlands) where a 747 airliner struck an apartment building leaving 43 dead and 100 injured (1993) [22], and the Gothenburg (Sweden) disaster leaving 63 dead and 213 injured (1998) [23–27]. A similar disaster to the Gothenburg disaster occurred in Volendam (The Netherlands) resulting in 14 deaths with 245 injuries (2001) [28–32]. For the US, a major earthquake near Los Angeles (1994) included a number of burn injured patients [9]. However, it was the 9/11 attacks (2001) that changed the course and intensity of medical disaster planning in the US. One focus included building trauma and burn surge capacity [18,33–41]. Partly in response to this focus, the American Burn Association (ABA) published burn disaster guidelines and the ABA Disaster Plan (2005) [42]. Concurrently, representatives from the ABA Southern Burn Region developed the SRBDP [16,17,43]. This SRBDP serves as a framework for coordinating patient movements should one of the regional burn centers exceed capacity following a disaster.

2.3.

Regional definition

Each geographical area of the US is recognized as a region for the purpose of working with federal partners in the aspect of disaster planning and response. The area closest to Haiti and much of what is considered the ‘‘South’’ (of the US) is known as Region IV. Region IV includes the US states of; NC, SC, GA, FL, TN, MS, AL, and KY.

2.4.

Region IV Unified Planning Coalition (UPC)

In the aftermath of the 2004 and 2005 hurricanes that ravaged the South, Region IV ESF-8 leadership began to routinely meet to improve hurricane preparedness. By 2006, this somewhat unofficial alliance became a more organized group known as the Unified Planning Coalition (UPC), and thus the Region IV, ESF-8 UPC was created. One of the North Carolina roles with



the Region IV ESF-8 UPC leadership included regional burn surge planning. The aim was to collaborate with existing programs such as the SRBDP and stakeholders such as the healthcare community.

2.5.

Region IV UPC and the SRBDP

The Region IV ESF-8 UPC and the Southern Burn representatives had exercised the SRBDP through events such as the 2009 US Presidential Inauguration which attracted 4 million to Washington, DC. The inauguration tested the plan through communication on a daily basis (for the four days leading up to and including the day of the inauguration) quantifying capacity to accept additional patients for all of the regional burn centers as well as those further up the US east coast (represented by the Eastern Burn Disaster Consortium) [44]. The intent was to measure and report to the US Department of Health and Human Services (DHHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) the number of available beds and surge capacity [45] for each burn center. The aim of the effort was to develop a better understanding of the capacity for a burn disaster relying on US east coast hospitals. While regional burn centers were notified following a Raleigh (NC, USA) area industrial plant explosion in 2009 [46] (7/71 patients with burns), no interstate patient movements took place. Patients with burns from the Haiti Earthquake were the first interstate patient movements that relied on concepts in the SRBDP.

3. January 10–24 2010, day of the earthquake and the first two weeks Disaster response poured into Haiti from around the world, including representatives of the US Department of State (DOS), US DHHS/ASPR, US DHS/FEMA and multiple branches of the US Military. Typically, patients were managed at the various field hospitals established. International responders, including the US, offered their respective citizens in Haiti the option to return to their respective countries, with a priority for those injured going to home hospitals. The largest of the portable hospitals arrived in the form of the USNS Comfort [47,48]. However, it could not tie up to the Port-a-Prince dock because debris in the port waters following the earthquake. Thus, all patients being moved to the USNS Comfort were flown by medevac helicopters. Once patients on the USNS Comfort were identified for transfer to the US mainland for additional care, they would again be transported by helicopter medevac, to the field hospital adjacent to the airport until they could be moved to a C-130. The Americans represented the greatest number of foreign nationals in Haiti at the time of the earthquake and over the next several weeks, 20,000+ including 500+ were flown to the US. In addition to the critically injured patients [47,49,50] being evacuated to Florida hospitals, other humanitarian flights were taking place relying on US Military aircraft and personnel coordinated through TRANSCOM. Florida Emergency Management and Florida ESF-8 officials worked with the US DHHS to receive minimally injured Americans and Haitian nationals to either Atlanta, GA or Charleston, SC [51].

3

The more seriously injured were flown to the Ft. Lauderdale, Florida (FLL) airport on board C-130s (The C-130 is a large cargo airplane commonly used by the US Military to transport troops and equipment and can be configured as a flying hospital.) [52] Crews managing the care of the patients included Critical Care Air Transport Teams (CCATT) [53]. Of those flown to FLL, 175 evacuated patients were still hospitalized on January 24 in Florida hospitals which combined with daily local demands, had reached their limits for conventional surge capacity [13]. (The 24 h clock is used throughout this paper to reflect much of the communications specifically as it was received representatives involved in the response. While most of the activity occurred in the Eastern Standard Time Zone, the time is noted as local time (L) which is used when more than one time zone is involved in an operation.)

4. January 25 2010 05:45L EVAC56711, Florida hospitals full, evacuations to other states for specialty care January 25, the Miami, Florida area Burn Center reported they were unable to receive additional patients. A message was sent to Florida ESF-8 coordination by TRANSCOM requesting to manifest up to 16 burn-injured patients with 20 previously discussed trauma patients. The anticipated arrival time in Miami by C-130 was scheduled for 19:35L. Shortly before 07:00L, Florida ESF 8 [15] and the Region IV UPC contacted the Southern Region Burn contact to request regional assistance based on the SRBDP. A request for available beds was made to the southern burn center directors, and available beds were identified in North Carolina and Georgia. Given the humanitarian flights going into Atlanta, Georgia, a decision was made to handle the first group of patients between burn centers in North Carolina locations as well as two beds that had opened in Florida. In addition to the request for available beds, a series of emails was used to communicate with burn center directors. Additional messages included attempts to identify the size and scope of burns for those being evacuated and future missions being considered. Throughout the first several weeks of the disaster, information coming from Haiti was scarce and ever changing as they struggled to manage the disaster. Additional barriers to consistent and reliable information from Haiti included the dramatic loss of Haitian infrastructure, the presence of international responders [11,54] with language barriers, and the overwhelming scope of the disaster. By the morning of January 25, information was more reliable but still limited, and the overwhelming numbers of sick and injured continued to complicate triage decisions. As email messages moved throughout the day several were aimed at determining the number of patients, and the nature of their burns. Other concerns included cultural and language support. Many of the patients spoke Haitian Creole, some French, and occasionally spoke either Spanish or English. In summary, information was limited. A chart from one of the messages was redacted and reformatted for this paper as an example found in (Fig. 1).



4


Fig. 1 – This flow diagram represents the decision scheme for the Southern Burn Disaster Plan. In this particular case, the Regional Coordination Center was not involved since the contact was made directly to the coordinator for the Southern Burn Plan who facilitated the movement. The key components of the plan; Activation, Facilitation and Communication all functioned quite well.

5.

Finance – payment, fee for service

The economics of the American Healthcare System are generally considered capitalistic, also known as Fee-forService. Facilities and clinicians routinely deal with a variety of payer sources. Patient payment options for healthcare services include a variety of commercial insurance as well as two federal/state operated programs that focus on either the elderly (Medicare [55]) or the economically disadvantaged (Medicaid [56]). Florida relied on Medicaid as a payer of last resort but costs were quickly adding up. Medicaid includes an optional ‘‘Humanitarian Parole Status under the Cuban/Haitian Entrant program.’’ (Both Florida and North Carolina had opted into this program. Additional details are included in Fig. 3). (Medicaid [56] is a health insurance program where the principle guidelines are established by the US Federal

government with some variances between States. Medicaid is administered by the States (or US Territories) and targets those who have an income indexed based on the poverty line. Medicaid costs are shared by both Federal and State governments with the federal share ranging from 50 to 82% depending on a variety of factors. [57] The Federal share in 2010 for FL was 67.64% and for NC was 74.98 [58].) Burn care for critical injuries is expensive. As an example, a patient with a 50–59% total body surface area (TBSA) of injury (calculated based on the rule of 9 s) will incur average hospital charges of $661,730 ($69,285) [59] (for those who survive). While key factors such as comorbidities, general health, and age can significantly alter these numbers, this is an expensive patient population. The request to care for these burn injured patients on an interstate basis, which triggered activation of the SRBDP, involved only Haitian citizens. This was not a ‘‘(US) National



5

Fig. 2 – Extracted details from an email exchange January 25, 2010 between key members involved in the evacuation of burn injured patients.

Disaster.’’ Since it includes activation of the National Disaster Medical System (NDMS) [60–62], the typical NDMS payment system known as Definitive Medical Care (DefCare) was not available. Thus, Medicaid was the payer source for these patients.

6.

Logistics – transportation resources

The C-130 flight initially landed FLL airport and then flew on to Raleigh, North Carolina (RDU) Airport. The patients were transferred to waiting ambulances for transport to their assigned hospitals. Both airports were NDMS designated and both states had developed transportation resource and asset inventories [63] for disasters such as this. Florida ESF-8 arranged for two advanced life support (ALS) ambulances to transport from the C-130 after it arrived at FLL International Airport to Orlando Regional Medical Center, a drive of approximately 250 mile (400 km). North Carolina ESF-8 and Wake County Emergency Medical Services (EMS) arranged

for four ambulances to manage the transfer from the C-130 after it arrived at RDU International Airport. The ambulances transported patients with burns to the two North Carolina Burn Centers located in Chapel Hill and Winston Salem. The range of patients and nature of injury was clarified once the final patient manifest (Fig. 4) was forwarded from US TRANSCOM to the Florida ESF-8 leads. This included 6 patients with burns who were identified for placement in three US hospitals (burn centers). Their burns were: 45%, 40%, 40%, 25%, 35%, and 25% TBSA respectively.

7.

January 25 2010 23:21L

While reports throughout the day continued to indicate an arrival of 19:35L, it was apparent that was not going to happen. At 23:21L, a message estimated the FLL arrival was going to be 02:00L January 26. Another particular aspect to the note included the manifest of 30 patients and 20 attendants on board. Prior communications did not indicate the patients with



6


Fig. 3 – Guidance distributed by Florida ESF-8, frequently asked questions.



Fig. 3. (Continued ).


7


8


Fig. 4 – De-identified patient and attendant manifest for this mission. This was all of the patient information that was available to those involved in triage and patient distribution. Two patients were transported to Orlando, Florida (US) three to Chapel Hill, North Carolina (US) and one to Winston Salem, North Carolina (US).

burns would be accompanied by attendants (family members). We later learned that that companion animals (such as dogs and goats) had also been included on other flights. The 23:21L message confirmed FLL resources to be used included three critical care transport teams, seven basic life support (BLS) and seven advanced life support (ALS) ambulances to meet the C-130. The aircraft would then be refueled at FLL and continue on to RDU. The flight manifest for this mission was updated to reflect the four patients bound for North Carolina, as well as one attendant (Fig. 4). At RDU, an incident management team (IMT) was scheduled to be in place by 05:00L to await the C-130 which had an updated estimated arrival time of 06:00L.

8.

January 26 2010 05:00L

As crews and equipment began to assemble in the staging area at RDU to include RDU operations, and Wake County EMS, the

state representatives learned the C-130 was still at FLL. Command at RDU released resources with a return scheduled for 08:00L.

9.

January 26 2010 07:17L

The next message arrived at 07:00L. A further complication to the transfer included the hours-on-duty limits for flight crews. Thus, the ‘‘front-end crew’’ and another C-130 were brought into FLL to transfer the patients onto RDU. By 08:00L all ambulance resources had assembled, with a briefing conducted at 08:45L [64]. The aircraft landed at 09:00L. The final patient was moved to an ambulance by 09:21L [64]. All ambulances were escorted off the tarmac at 09:26L and departed for their final destinations. There were 14 EMS and critical care transport staff; 8 from Raleigh Fire Department and 6 involved in incident management. The operation was completed at 10:15L.



10.

Care of the patients

Each of the patients had burns in varying stages of healing. Many had complications, given the time that had passed since the earthquake and the time of arrival at US Burn Centers. In one case a patient was carried by his wife, more than 12 mile (20 km) from the location where he was burned, to an international field hospital. There he was initially treated and referred to the USNS Comfort hospital ship for critical care [65]. After patients arrived at the three burn centers care proceeded in a more typical manner for delayed medical treatment [65–67]. Differences included language barriers, a lack of familiarity with technology, and the loss of personal support such as family. For patients who had lived in Haiti all of their lives, the technology and surroundings were difficult to comprehend. Patients spoke Haitian Creole or French, but understood little if any English [67]. All of the patients recovered from their injuries, and were referred to HHS for final disposition [68]. Local public health worked with local non-governmental organizations (NGOs) to aid in providing temporary lodging for family attendants who accompanied the patients. Five of the six Haitian patients, chose to return to Haiti where they reunited with family and friends. Orlando has a large Haitian community. Both of the patients treated in Orlando received significant non-financial support from the local Haitian community. They assisted with communication and spiritual needs during the course of the hospitalization. They also assisted with housing and transportation to follow-up visits for the first year after discharge from the hospital. One of the patients assimilated into the local Haitian community.

11.

Future flights

January 28th, a message was distributed announcing no further flights were being scheduled at that point (Fig. 4). The next several days were used to reevaluate what had been done and what still needed to be done. Much of the ‘‘emergent’’ aspect of the disaster was passing. Financial pressures were mounting, particularly for Florida, who was having to cover the state portion of Medicaid costs, which were significantly higher than budgeted (The message came from TRANSCOM but followed notification by Florida they would not accept additional patients until a payment source beyond Medicaid could be used). February 1st, another message was distributed that included guidelines for future patient evacuations (Fig. 2). A resumption of flights began but by that point, there were few remaining patients with critical or specialty care needs resulting from the earthquake. Many of the additional flights include either repatriated Americans or those who met humanitarian refugee status. With the surge of responders, equipment, and supplies to Haiti and those injured being managed, treated and released, transferred, or having died, the surge equilibrium [69] was finally being reached. The with surge equilibrium achieved, this all but eliminated the need for future flights.

12.

9

Costs and payment for services

After several weeks of ongoing discussions, HHS eventually activated NDMS Federal Coordinating Centers (FCC) [70] (in Atlanta and Tampa) to facilitate the movement of the remaining patient evacuations to NDMS partner hospitals. This also provided a mechanism, apart from Medicaid, for these hospitals to seek reimbursement for the care rendered to those patients based on the NDMS DefCare payment standards. By early 2011, Congress approved an arrangement labeled as the Haiti Earthquake Medical Reimbursement Program (HEMR) [71] to fund the NDMS missions. This also included refunding the states that had expended Medicaid funds to cover the costs associated with the patients based on NDMS DefCare standards.

13.

Conclusion

Earthquakes are likely natural disasters for much of the world. Haiti is one of the more impoverished nations of the international community. This disaster tested the international community’s capacity to reach out and help however it could. From their neighbor in the Dominican Republic to China, Korea, Japan, Qatar, Israel, Iceland, Great Britain, Germany, Canada, France, Chile, Columbia and Shri Lankan, relief workers all came to help. The largest international presence however, came from its northern neighbor, the United States. The focus of this paper was one particular flight for one particular group of burn injured patients testing international and interstate processes that heretofore had never moved beyond the theoretical. There are thousands of stories from Haiti that include triumph and heartbreak from the earthquake. There were, however, lessons learned that offer both hope and concern when the next disaster strikes. These lessons learned include a process to move critical patients with burns which are difficult to manage under ideal circumstances. Moving international patients into the US southern regional burn centers after an international disaster was not envisioned at the time the SRBDP was developed. Yet, the process generally worked well to move six critical burns from a hospital ship, to a field hospital, to a C-130 and distributed to three member hospitals. More likely the process worked based on an observation General Eisenhower once made; ‘‘plans are nothing, planning is everything!’’ The process included many phone calls and messages between people in various states and burn centers who have worked together before, trained together and trust one another. Despite knowing it involved a relatively small group of patients, this was a difficult process with multiple challenges. If future threat or hazard analyses suggests there is a need to move many more patients, this process must be exercised, refined and streamlined. In the aftermath of a disaster, the solution in Haiti was common to that of other disasters; continue to care for the patients until the patient needs created by the disasters are met. Those with the greatest needs who had a reasonable opportunity to survive their injury became the ones identified for



10


transfer. The international nature of the disaster was difficult to negotiate for US civilian disaster responder systems. Those systems are designed for interstate operations. International matters are outside of how they were designed. Responders to Haiti came from around the globe, with many struggling merely to find a location to land their airplane and set up their field hospital or stage their rescue team. The catastrophic infrastructure loss made a difficult task almost impossible. The USNS Comfort, a massive hospital ship, could not dock, and thus, all patients had to be airlifted to and from the ship, tying up valuable resources and further crowding an airspace that was difficult to manage. Yet, through it all, normalcy did emerge at some point. While no two disasters are identical, lessons learned have applicability to future disasters. From the movement of burn-injured patients to the value of plans and planning to include transportation resources and surge capacity, all of the efforts of the past 10 years colluded to minimize the misery and maximize successful outcomes for this horrific disaster.

[2]

[3]

[4]

[5]

[6]

Grants and funding [7]

This work is supported in part by the US DHHS/ASPR Hospital Preparedness Program Grant CDC-RFA-TP12-1201 through the North Carolina Office of Emergency Medical Services Contract 00027162. We would also like to acknowledge the support of our educational programs through FEMA Grant EMW-2011-FP01131.

Acknowledgements Details were either provided or confirmed by a variety of representatives from the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Those who either provided input or confirmed information include Dr. Monique Howard, Mr. Joseph Lamana, Mr. David Dolinsky, Dr. Lewis Rubinson, Mr. Gregg Lord and RADM Clare Helminiak. In addition to the co-authors involved in the work, others who contributed to creation of the SRBDP include Dr. Alan Dimick, Dr. Michael Peck, Dr. David Barillo and Mr. Joe Acker. While not a co-author of the plan, it should also that Dr. David Mozingo played a critical role as well in the burn disaster efforts for Florida as well as the southeast. Key members of the Florida ESF-8 coordination team included Sharon Cohen, Jeanne Eckes, Kelly Keys and Steve Thorton. Receipt of the patients was coordinated at RDU by Wake County EMS, Carolina Air Care, Wake Forest Baptist Air Care, and NCOEMS On scene coordination at RDU included Joseph Zalkin and Jonathon Olsen, both of Wake County EMS, and Jeff Peterson from NCOEMS.

[8]

[9]

[10]

[11]

[12]

[13]

[14] [15]

[16]

references [17] [1] US Geological Service. Earthquakes with 50,000 or More Deaths. Earthquake Hazards Program; 2013, http://

earthquake.usgs.gov/earthquakes/world/ most_destructive.php [accessed 20.04.13]. Yang C, Wang HY, Zhong HJ, Zhou L, Jiang DM, Du DY, et al. The epidemiological analyses of trauma patients in Chongqing teaching hospitals following the Wenchuan earthquake. Injury 2009;40(May (5)):488–92. Qiu J, Liu GD, Wang SX, Zhang XZ, Zhang L, Li Y, et al. Analysis of injuries and treatment of 3,401 inpatients in 2008 Wenchuan earthquake – based on Chinese Trauma Databank. Chinese Journal of Traumatology Zhonghua chuang shang za zhi/Chinese Medical Association 2010;13(October (5)):297–303. Nakamori Y, Tanaka H, Oda J, Kuwagata Y, Matsuoka T, Yoshioka T. Burn injuries in the 1995 Hanshin-Awaji earthquake. Burns: Journal of the International Society for Burn Injuries 1997;23(June (4)):319–22. Dursun R, Karadas S, Gormeli G, Isik Y, Cakir C, Gormeli CA. Analysis of burn cases observed after the 2011 Van earthquake. Ulusal travma ve acil cerrahi dergisi Turkish Journal of Trauma & Emergency Surgery: TJTES 2013;19(May (3)):251–5. Bai XD, Liu XH. Retrospective analysis: the earthquakeinjured patients in Barakott of Pakistan. Chinese Journal of Traumatology Zhonghua chuang shang za zhi/Chinese Medical Association 2009;12(April (2)):122–4. Albornoz C, Villegas J, Sylvester M, Pena V, Bravo I. Analysis of the burns profile and the admission rate of severely burned adult patient to the National Burn Center of Chile after the 2010 earthquake. Burns: Journal of the International Society for Burn Injuries 2011;37(June (4)):678– 81. Ad-El DD, Engelhard D, Beer Y, Dudkevitz I, Benedeck P. Earthquake related scald injuries – experience from the IDF field hospital in Duzce, Turkey. Burns: Journal of the International Society for Burn Injuries 2001;27(June (4)):401– 3. Peek-Asa C, Kraus JF, Bourque LB, Vimalachandra D, Yu J, Abrams J. Fatal and hospitalized injuries resulting from the 1994 Northridge earthquake. International Journal of Epidemiology 1998;27(June (3)):459–65. Hughes CD, Nash KA, Alkire BC, McClain CD, Hagander LE, Smithers CJ, et al. The impact of natural disaster on pediatric surgical delivery: a review of Haiti six months before and after the 2010 earthquake. Journal of Health Care for the Poor and Underserved 2012;23(May (2)):523–33. Kreiss Y, Merin O, Peleg K, Levy G, Vinker S, Sagi R, et al. Early disaster response in Haiti: the Israeli field hospital experience. Annals of Internal Medicine 2010;153(July (1)):45–8. Centers for Disease Control and Prevention. CDC Responds to the Haiti Earthquake; 2010, http://emergency.cdc.gov/ disasters/earthquakes/haiti/Updates/030510.asp [accessed 20.04.13]. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Medicine and Public Health Preparedness 2009;3(June (2 Suppl.)):S59–67. National Response Framework; 2008, www.fema.gov/pdf/ emergency/nrf/nrf-core.pdf [accessed 07.12.12]. National Response Framework. Emergency Support Function 8; 2008, http://www.fema.gov/pdf/emergency/nrf/ nrf-esf-08.pdf [accessed 07.12.12]. Barillo DJ, Dimick AR, Cairns BA, Hardin WD, Acker 3rd JE, Peck MD. The Southern Region burn disaster plan. Journal of Burn Care & Research 2006;27(September–October (5)):589–95. Kearns R, Holmes 4th J, Cairns B. Burn disaster preparedness and the southern region of the United States. Southern Medical Journal 2013;106(January (1)):69–73.



[18] Barillo DJ, Wolf S. Planning for burn disasters: lessons learned from one hundred years of history. Journal of Burn Care & Research 2006;27(September–October (5)): 622–34. [19] Cavallini M, Papagni MF, Baruffaldi Preis FW. Fire disasters in the twentieth century. Annals of Burns and Fire Disasters 2007;20(June (2)):101–3. [20] Peleg K, Reuveni H, Stein M. Earthquake disasters – lessons to be learned. The Israel Medical Association Journal: IMAJ 2002;4(May (5)):361–5. [21] Wachtel TL, Cowan ML, Reardon JD. Developing a regional and national burn disaster response. The Journal of Burn Care & Rehabilitation 1989;10(November–December (6)):561–7. [22] Mackie DP, Hoekstra MJ. The Bijlmermeer plane disaster: an account of the rescue operation with special reference to burn casualties. Annals of the Mediterranean Burn Club 1993;VI:44–5. [23] Cassuto J, Tarnow P. The discotheque fire in Gothenburg 1998. A tragedy among teenagers. Burns: Journal of the International Society for Burn Injuries 2003;29(August (5)):405–16. [24] Brandsjo K, Hedelin A, Lundin T, Lundalv J, Swedish Disaster Medicine Study O. KAMEDO Report No. 75: fire catastrophe in Gothenburg 29–30 October 1998. Prehospital and Disaster Medicine 2005;20(July–August (4)):258–61. [25] Tarnow P, Gewalli F, Cassuto J. Fire disaster in Gothenburg 1998 – surgical treatment of burns. Burns: Journal of the International Society for Burn Injuries 2003;29(August (5)):417–21. [26] Tarnow P, Cassuto J. Disaster planning – lessons learned from the fire disaster in Gothenburg. Lakartidningen 2005;102(January (4)):206–9. 212–213. [27] Gewalli F, Fogdestam I. Triage and initial treatment of burns in the Gothenburg fire disaster 1998. On-call plastic surgeons’ experiences and lessons learned. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 2003;37(3):134–9. [28] van Harten SM, Welling L, Perez RS, Patka P, Kreis RW. Management of multiple burn casualties from the Volendam disaster in the emergency departments of general hospitals. European Journal of Emergency Medicine 2005;12(December (6)):270–4. [29] Welling L, van Harten SM, Patka P, Bierens JJ, Boers M, Luitse JS, et al. The cafe fire on New Year’s Eve in Volendam, the Netherlands: description of events. Burns: Journal of the International Society for Burn Injuries 2005;31(August (5)):548–54. [30] van Harten SM, Bierens JJ, Welling L, Patka P, Kreis RW, Boers M. The Volendam fire: lessons learned from disaster research. Prehospital and Disaster Medicine 2006;21(September–October (5)):303–9. [31] Welling L, Boers M, Mackie DP, Patka P, Bierens JJ, Luitse JS, et al. A consensus process on management of major burns accidents: lessons learned from the cafe fire in Volendam, The Netherlands. Journal of Health Organization and Management 2006;20(2–3):243–52. [32] Welling L, van Harten SM, Henny CP, Mackie DP, Ubbink DT, Kreis RW, et al. Reliability of the primary triage process after the Volendam fire disaster. The Journal of Emergency Medicine 2008;35(August (2)):181–7. [33] McFee RB, Leikin JB, Kiernan K. Preparing for an era of weapons of mass destruction (WMD) – are we there yet? Why we should all be concerned. Part II. Veterinary and Human Toxicology 2004;46(December (6)):347–51. [34] Murphy JK. After 9/11: priority focus areas for bioterrorism preparedness in hospitals. Journal of Healthcare Management/American College of Healthcare Executives 2004;49(July–August (4)):227–35.

11

[35] Cairns BA, Stiffler A, Price F, Peck MD, Meyer AA. Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion. The Journal of Burn Care & Rehabilitation 2005;26(March–April (2)):144–50. [36] Feeney JM, Goldberg R, Blumenthal JA, Wallack MK. September 11, 2001, revisited: a review of the data. Archives of Surgery (Chicago III: 1960) 2005;140(November (11)):1068– 73. [37] Jordan MH, Hollowed KA, Turner DG, Wang DS, Jeng JC. The Pentagon attack of September 11, 2001: a burn center’s experience. The Journal of Burn Care & Rehabilitation 2005;26(March–April (2)):109–16. [38] Niska RW, Burt CW. Bioterrorism and mass casualty preparedness in hospitals: United States, 2003. Advanced Data from Vital and Health Statistics US Centers for Disease Control 2005;391:1–14. [39] Yurt RW, Bessey PQ, Bauer GJ, Dembicki R, Laznick H, Alden N, et al. A regional burn center’s response to a disaster: September 11, 2001, and the days beyond. The Journal of Burn Care & Rehabilitation 2005;26(March–April (2)):117–24. [40] Jeng JC, Hollowed K, Owen CT, Rizzo AG, Royce T, Sava J, et al. Contemplating the Pentagon attack after five years of space and time: unheard voices from the ramparts of our burn center. Journal of Burn Care & Research 2006;27(September–October (5)):612–21. [41] Yurt RW, Bessey PQ, Alden NE, Meisels D, Delaney JJ, Rabbitts A, et al. Burn-injured patients in a disaster: September 11th revisited. Journal of Burn Care & Research 2006;27(September–October (5)):635–41. [42] Gamelli RL, Purdue GF, Greenhalgh DG, Yurt RW, Kagan RJ, Kealey P, et al. Disaster management and the ABA Plan. Journal of Burn Care & Rehabilitation 2005;26(March–April (2)):102–6. [43] Kearns RD, Cairns BA, Hickerson WL, Holmes 4th JH. ABA southern region burn disaster plan: ‘‘The process of creating and experience with the ABA southern region burn disaster plan’’. Journal of Burn Care & Research 2013. [44] Eastern Regional Burn Disaster Consortium. The Eastern Regional Burn Disaster Consortium brings together twentyseven burn centers from Maine through Washington, DC who have joined together to assist one another in event of a burn mass casualty incident; 2012, Available at: http:// www.burndisasterconsortium.com/ [accessed 30.12.12]. [45] Kearns RD, Holmes IVJ, Cairns B. Southeastern burn surge capabilities during the 2009 Presidential inauguration. Journal of Burn Care & Research 2010;31(2):1. [46] Kearns RD, Holmes IV JH, Maggin J, Cairns BA. An industrial plant explosion and the effectiveness of a 21st century burn disaster plan. Journal of Burn Care & Research 2011;32(2):1. [47] Stuart JJ, Johnson DC. Air force disaster response: Haiti experience. Journal of Surgical Orthopaedic Advances 2011;20(1):62–6. Spring. [48] Walk RM, Donahue TF, Sharpe RP, Safford SD. Three phases of disaster relief in Haiti – pediatric surgical care on board the United States Naval Ship Comfort. Journal of Pediatric Surgery 2011;46(October (10)):1978–84. [49] Kearns RD, Holmes IV JH, Cairns BA. The 2010 Haitian earthquake and the Southern burn disaster plan. Journal of Burn Care & Research 2011;32(March (2)):1. [50] Lezama NG, Riddles LM, Pollan WA, Profenna LC. Disaster aeromedical evacuation. Military Medicine 2011;176(October (10)):1128–32. [51] Pivnick S. Keesler medical teams aid Haiti relief efforts Air Education and Training Command; 2010, http:// www.aetc.af.mil/news/story.asp?id=123190220 [accessed 20.04.13]. [52] USAF. C-130 Factsheet; 2011, http://www.af.mil/ information/factsheets/factsheet.asp?fsID=92.



12


[53] Bridges E, Evers K. Wartime critical care air transport. Military Medicine 2009;174(April (4)):370–5. [54] Sarani B, Mehta S, Ashburn M, Nakashima K, Gupta R, Dombroski D, et al. The academic medical centre and nongovernmental organisation partnership following a natural disaster. Disasters 2012;36(October (4)): 609–16. [55] Medicare; 2013, http://www.medicare.gov/ [accessed 20.05.13]. [56] Medicaid; 2013, http://www.medicaid.gov/ [accessed 20.05.13]. [57] Medicaid Finance and Reimbursement; 2013, http:// www.medicaid.gov/Medicaid-CHIP-Program-Information/ By-Topics/Financing-and-Reimbursement/Financing-andReimbursement.html [accessed 01.10.13]. [58] Federal Medical Assistance Percentage for Medicaid and Multiplier. State Health Facts; 2012, http://kff.org/medicaid/ state-indicator/federal-matching-rate-and-multiplier/ [accessed 01.11.13]. [59] American Burn Association. 2012 National Burn Repository, Report of Data from 2001–2011; 2012, http:// www.ameriburn.org/2011NBRAnnualReport.pdf [accessed 01.09.13]. [60] National Disaster Medical System, Serving the Federal Response with Disaster Medical Services; 2010, http:// ndms.fhpr.osd.mil/ [accessed 07.12.12]. [61] Yeskey K. The Key Role of NDMS in Disaster Response 2010; Statement by Kevin Yeskey M.D. on The Key Role of NDMS in Disaster Response before the Committee on Homeland Security and Governmental Affairs, for the United States Senate; 2012, Available at: http://www.hhs.gov/asl/testify/ 2010/07/t20100722a.html [accessed 07.12.12].

[62] Franco C, Toner E, Waldhorn R, Inglesby TV, O’Toole T. The national disaster medical system: past, present, and suggestions for the future. Biosecurity and Bioterrorism: Biodefense Strategy Practice and Science 2007;5(December (4)):319–25. [63] Kearns RD, Hubble MW, Holmes 4th JH, Cairns BA. Disaster planning: transportation resources and considerations for managing a burn disaster. Journal of Burn Care & Research 2013;1. [64] University of North Carolina Medical Center News Team. Haitian patients arrive at UNC Health Care [online video]. YouTube; 2010 [26.01.10]. [65] University of North Carolina Medical Center News Team. Jan. 27 Haiti Burn Patient press conference [online video]. YouTube; 2010 [27.01.10]. [66] University of North Carolina Medical Center News Team. Haitian patients arrive at UNC-Press Conference [online video]. YouTube; 2010 [27.01.10]. [67] University of North Carolina Medical Center News Team. Feb. 12 Haiti Burn Patient Press Conference [online video]. YouTube; 2010 [26.01.10]. [68] University of North Carolina Medical Center News Team. A new life begins for Haitian earthquake survivor [online video]. YouTube; 2010 [09.06.10]. [69] Kearns RD, Conlon KM, Valenta AL, Holmes IV JH, Cairns CB, Johnson 2nd DL, et al. Disaster planning: the basics of creating a burn mass casualty disaster plan for a burn center. Journal of Burn Care & Research 2013;13. [70] Federal Coordinating Center Guide; 2006, http:// fhp.osd.mil/ndms/docs/fccGuide.pdf [accessed 07.12.12]. [71] Haiti Earthquake Medical Reimbursement Program; 2011, http://haiti.apprio.com/ [accessed 20.04.13].


Trust via disasters: the case of Chile's 2010 earthquake.

Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake.

The Technical Efficiency of Earthquake Medical Rapid Response Teams Following Disasters: The Case of the 2010 Yushu Earthquake in China.

Burn therapist contributions to the American Burn Association and the Journal of Burn Care and Research: a 45th anniversary review.

Haitian and international responders' and decision-makers' perspectives regarding disability and the response to the 2010 Haiti earthquake.

Assessment of the health status in Brazilian burn victims five to seven months after hospital discharge.

Psychometric properties of the Creole Haitian version of the Resilience Scale amongst child and adolescent survivors of the 2010 earthquake.

Suicidal burns in Samarkand burn centers and their consequences.

Corrigendum: Examining the Correlation between Objective Injury Parameters, Personality Traits and Adjustment Measures among Burn Victims.

Burn rehabilitation: our unanswered challenge. The 1992 presidential address to the American Burn Association.

The 'cigarette burn' sign.

Rating the burn scar.

Mental health training experiences among Haitian healthcare workers post-earthquake 2010.

The elderly burn patient.

Project Medishare's Historic Haitian Earthquake Response.

Burn Care of the Elderly.

A comparison of burn related injuries following the natural disaster Super Storm Hurricane Sandy to the National Burn Repository of the American Burn Association.

The management of electrical burn.

[The immunopathophysiology of burn trauma].

Preface: organizational aspects of burn care in The Netherlands and some aspects of future burn care.

The role of a dedicated staff psychiatrist in modern burn centers.

Comment on: burn care experts and burn expertise.

The stone that mourns its victims: Haiti still recovering from its injuries and traumas 5 years after the 2010 earthquake.

Outpatient presentations to burn centers: data from the Burns Registry of Australia and New Zealand outpatient pilot project.