JBUR 6195 No. of Pages 22 b u r n s x x x ( 2 0 2 0 ) x x x Àx x x Available online at www.sciencedirect.com ScienceDirect jo urnal homepage: www.elsevier.com/locate/burns Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020 a,b,c d,e g,h Amy Hughes , Stian Kreken Almeland , Thomas Leclerc , i j k l,m,n Takayuki Ogura , Minoru Hayashi , Jody-Ann Mills , Ian Norton , a,f,n, Tom Potokar * a Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK b Humanitarian and Conflict Response Institute (HCRI), University of Manchester, UK c Cambridge Hospital NHS Foundation Trust (Addenbrookes), Paediatric ICU Department, UK d Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway e Faculty of Medicine, University of Bergen, Norway f Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK g Burn Centre, Percy Military Teaching Hospital, Clamart, France h Val-de-Grâce Military Medical Academy, Paris, France i Japanese Society for Burn Injuries, The Disaster Network Committee j Japanese society for burn injuries, The Academic Committee k Rehabilitation Programme, Department of NCD, World Health Organization, Geneva, Switzerland l World Health Organization (2013-2019), Emergency Medical Team Initiative Lead, Geneva m Respond Global, Queensland, Australia n Co-Chair World Health Organization EMT Technical Working Group on Burns, Geneva a r t i c l e i n f o a b s t r a c t Article history: Health and logistical needs in emergencies have been well recognised. The last 7 years has Accepted 2 July 2020 witnessed improved professionalisation and standardisation of care for disaster affected Available online xxx communities À led in part by the World Health Organisation Emergency Medical Team (EMT) initiative. Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn Keywords: management benefits from specialist skills, expert knowledge, and timely availability of Burns specialist resources. With burn MCIs occurring globally, and wide variance in existing burn Mass casualty incidents care capacity, the need to strengthen burn care capability is evident. Although some high- Emergency medical teams (EMTs) income countries have well-established disaster management plans, including burn specific Recommendations plans, many do not À the majority of countries where burn mass casualty events occur are * Corresponding author at: Co Chair WHO-EMT Technical Working Group on Burns; Centre for Global Burn Injury Policy & Research; Swansea University; Wales; UK. E-mail addresses: [email protected] (A. Hughes), [email protected] (S.K. Almeland), [email protected] (T. Leclerc), [email protected] (T. Ogura), [email protected] (M. Hayashi), [email protected] (J.-A. Mills), [email protected] (I. Norton), [email protected] (T. Potokar). https://doi.org/10.1016/j.burns.2020.07.001 0305-4179/© 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: A. Hughes, et al., Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020, Burns (2020), https://doi.org/10.1016/j.burns.2020.07.001 JBUR 6195 No. of Pages 22 2 b u r n s x x x ( 2 0 2 0 ) x x x Àx x x without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters. Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to: 1) review literature on burn care in MCIs; and 2) define and agree on recommendations for burn care in MCIs. The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs. © 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY- NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1.2. International technical working group on burns 1. Introduction (TWGB) Health and logistical needs in emergencies have been well In accordance with the processes used to create minimum recognised [1]. The last seven years has witnessed an standards of care amongst the emerging EMT specialist teams, improving professionalization and standardisation of care a number of global burn and EMT experts were invited to for disaster affected communities À a change which has participate in a succession of Technical Working Group on been brought about in part by the World Health Organiza- burns consensus meetings (TWGB). All EMT working groups tion Emergency Medical Team (WHO EMT) initiative [2]. are convened by WHO under the auspices of the Strategic Since its origin in 2013, this initiative has provided a Advisory Group (SAG) of the EMT Initiative. This SAG assists platform for the evolution and development of specialist the WHO EMT secretariat to identify gaps and priorities for EMTs, strengthening specific health and logistical response work and is made up of representatives from Ministries of in emergencies. National capacity strengthening has been a Health. Opinions from each of the 6 regions, as well as UN and focus, with particular resources targeted to building representatives from Non Government Organisations (NGOs) National EMT specialist teams. The initiative supports and the Red Cross and Red Crescent movement, are and encourages trained and appropriately skilled teams represented. of national and international personnel to deliver a co- The TWGB was given terms of reference and a time bound ordinated approach to targeted health needs whilst adher- period to complete its work of two years. Experts came from a ing to minimum standards of care. The evolving nature, and range of countries and geographic regions, were gender changing definition, of humanitarian emergencies has balanced, and represented national health authorities, aca- highlighted the need for a widened scope of practice for demic institutions, professional bodies, NGOs and the Red EMTs. In addition to EMT’s influential role in outbreaks, Cross Red Crescent movement, WHO and militaries. conflict and chronic complex disasters, smaller scale but The aims of this work were: high impact emergencies have also brought to attention a 1) Review the literature on burn injuries and management need for specialist EMTs able to target specific health in MCIs; and needs [3,4]. 2) define and achieve agreement amongst the EMT and MCIs resulting in burn injuries present some unique global burns community on recommendations for burn care in challenges [5,6]. Accounting for at least 200,000 deaths MCIs. annually, burn injuries and the resultant morbidity, mortality, The resulting recommendations are meant to provide a and disability rank high as a global public health problem [7,8]. framework to guide national and international specialist burn With high prevalence in low and middle-income countries, teams and health facilities to ensure delivery of safe, non-fatal burns are among the leading causes of Disability appropriate, and relevant care to burn patients in the context Adjusted Life Years (DALY) lost [9]. Burn management of those of a mass casualty. injured requires specialist skills, expert knowledge, and timely A three-staged approach was undertaken: availability of specialist resources. Lack of immediate (on- scene) patient care and the consequences of poor early 1 A comprehensive literature search was performed using a decision-making in patient management can impact signifi- number of search terms. In addition, relevant cited papers cantly on patient outcome and capability of health facilities to from citation lists were sourced . deliver good burns care [10]. MCIs with multiple burn injured 2 A series of TWGB consensus meetings were held to patients have demonstrated the extensive demands placed on facilitate discussion and consensus building. In total four health care workers and local health facilities and the TWGB meetings were held over an 18 month period . resultant high morbidity and mortality rates. With burn MCIs 3 A two-phase survey was conducted detailing each of the occurring globally, and the wide variance in existing burn care proposed draft recommendationsand circulated to the EMT capacity in different parts of the world, the need to strengthen and wider burns community for feedback. The results of burn care capability is evident. the survey can be found at https://interburns.org/survey. Please cite this article in press as: A. Hughes, et al., Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020, Burns (2020), https://doi.org/10.1016/j.burns.2020.07.001 JBUR 6195 No. of Pages 22 b u r n s x x x ( 2 0 2 0 ) x x x Àx x x 3 1.3. TWGB consensus process protracted clinical journey for the patient, commonly resulting in long-term health consequences affecting functioning, Step 1 quality of life and mental health. Burn patients also risk being Members of the TWGB undertook a comprehensive litera- stigmatised by communities [7,11] ture search. Evidence was collated from both published and Table 1 captures some of the most recent global MCIs ‘grey’ literature. In addition, guidelines and technical docu- resulting in burn injuries [12À19]. The end column highlights ments across the humanitarian sector were consulted. the constraints and challenges identified during the MCI Step 2 response and from which anecdotal evidence was considered Burn experts from a variety of contexts, and with significant when evolving the recommendations presented in this paper.