Resource Requirements in a Burn Mass Casualty Event
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
4.1. “It Takes a Village…”
- Recruitment from Other Areas/Units: Recruitment of medical staff from other hospital departments or external agencies to temporarily bolster the burn unit’s workforce. However, this strategy will need to be executed with caution as the recruited staff may lack familiarity with the unit or with burn care, potentially resulting in additional inefficiencies. Additionally, this will likely inadvertently put strain on other services from which the staff is recruited [9,20].
- Adjustment of Patient-to-Nurse Ratio: Temporary modification of the patient-to-nurse ratio to accommodate the increased workload while ensuring patient safety and care quality.
- Modify Shifts for Staff: Implement longer shifts for existing staff members to ensure adequate coverage and continuity of care. This needs to be performed with finesse to avoid burnout and fatigue [21]. This will unlikely be feasible long term but may be a stopgap if needed.
4.2. Consumables and Supply Chain Management
4.3. Surge Testing and Disaster Preparedness
4.4. Automation in Inventory Management
4.5. Limitations and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Quantity | Quantity | Quantity | Quantity | ||||
---|---|---|---|---|---|---|---|
Oxygen mask | 4 | Suction tube | 101 | Tracheostomy tube inner cannula | 23 | Toothbrush | 16 |
Tube-kit for high-flow O2 | 1 | Ventilator tube | 11 | Sheet (bed) | 624 | Pillowcase | 1575 |
Faecal tube bag | 52 | Sterile water 1000 mL (for ventilator’s humidifier) | 92,000 | Bacterial filter for ventilator | 87 | High flow nasal cannula | 3 |
Tube between suction ejector and suction container | 30 | Tube to invasive indirect calorimetry | 10 | Nebuliser-kit | 14 | Swivel connector for ventilator tube | 106 |
Nonsterile examination gloves | 34,025 | Water trap to invasive calorimetry | 10 | Finger saturation probe (single use) | 40 | Small container for discarded sharp objects | 16 |
Underlay | 1543 | Inner pillowcase | 328 | Blanket (bed) | 112 | Absorber (to ventilator) | 315 |
Large roll of paper towel | 120 | Diaper | 290 | Patient gown | 40 | Vomit carton | 785 |
Towel small | 750 | Washcloth | 4845 | Cavilon cloths | 562 | Oral care sticks | 1468 |
Disposable Cup | 2097 | Paper bag | 329 | Large plastic bag | 988 | Laundry bag, green | 329 |
Laundry bag | 329 | Bag for trash can | 328 | Thick grey plastic bag | 88 | Plastic bag clear | 656 |
Large container for discarded sharp and contaminated objects | 251 | Surface disinfectant, mL | 206,000 | Hand disinfectant, mL | 72,000 | Chlorhexidine alcohol, mL | 46,750 |
Gauze, pack | 105 | Saline for flushing, mL | 149,320 | Syringe | 3586 | Visitor’s gown | 412 |
Operation-/dressing change gown | 1815 | Apron | 7070 | Bag for suctioning device | 31 | Theatre cap | 1075 |
Surgical mask | 474 | Nonsterile heating blanket (Bair hugger™) | 48 | Blanketrol® mattress | 41 | Hotline® tubing | 44 |
Suction catheter | 521 | ECG electrode | 341 | Hourly UOP bag | 16 | Abdominal pressure measuring tube | 10 |
Doppler gel 20 mL | 584 | Positioning boot | 4 | Probe unit for tube feeding | 158 | Blanketrol®-unit, number of uses | 30 |
Hotline® unit, number of uses | 41 | Bair hugger™ unit, number of uses | 59 | Suction ejector | 8 | O2 flow measuring device | 8 |
Suction canister | 8 | Ventilator | 8 | Hillrom Bed | 8 | Equipment table | 8 |
Bed trolley | 8 | Computer/Metavision (PDMS) | 8 | Vitals monitor | 8 | Cable for invasive blood pressure measurement | 16 |
Cable to temp-probe | 8 | Cable for saturation measurement | 8 | Base cable for saturation measurement | 8 | Cuff to sphygmomanometer | 8 |
Reusable cable for arterial line | 8 | Tube feeding pump | 8 | Scale | 8 | Ceiling hoist | 8 |
Patient-table (OR) | 8 | Heat humidifier | 8 | Syringe pump | 40 | Infusion pump | 24 |
O2-tube and connector | 9 | Health care assistant (HCA) | 330 | Health care assistant hour | 2640 | Nurse (RN) | 42 |
RN hour | 336 | ICU RN | 288 | ICU RN hour | 2304 | Anaesthesia nurse | 2 |
Anaesthesia nurse hour | 3 | Intensivist | 112 | Intensivist hour | 116 | Plastic surgeon | 262 |
Plastic surgery hour | 409.6 | Corridor HCA- | 328 | Corridor HCA hour | 265.52 | Physiotherapist | 32 |
Physiotherapist hour | 49 | Occupational therapist | 32 | Occupational therapist hour | 44 | Social worker | 7 |
Social worker hour | 5 | Dietitian | 25 | Dietitian hour | 19.5 | Administrator | 79 |
Administrator hour | 7.26 | Work clothes white blouse/trousers | 1500 | Orthosis | 11 | Cotton/”fluff” | 131 |
Bandage | 382 | Central line | 11 | Arterial line | 16 | Peripheral line | 20 |
Dialysis line | 2 | Endotracheal tube | 7 | Tracheostomy tube | 4 | Urinary catheter | 7 |
Towel | 211 | Intraosseous needle | 2 | Faecal tube | 5 | Pigtail drain | 1 |
Small sterile drape | 9 | Needle | 1449 | Dish | 10 | Bowl | 317 |
Scalpel | 42 | Label | 1865 | Sterile gauze | 376 | Small cotton wool | 1389 |
Tegaderm™ | 36 | Theatre drape 140 × 150 cm | 10 | Transfer cannula | 196 | Flo-switch used for arterial line in A. Femoris | 3 |
Suture | 54 | Theatre glove | 706 | Xylocaine 10 mg/mL ampule | 34 | Saline, mL, infusion/injection | 87,854 |
Blood pressure set | 42 | Tube lock to dialysis tube | 5 | Kit of instruments for wound care (bowl, 2 scissors, 2 forceps…) | 122 | Needle holder | 11 |
Scissor sterile | 12 | Sterile forceps | 4 | Syringe glycerine gel | 4 | Theatre sheet | 324 |
Suction tube 12 cm tapered | 2 | Tube holder, Velcro | 65 | Marker (pen) | 6 | Cotton band for trach | 27 |
Trach gauze | 27 | Ziploc bag | 47 | Suction and diathermy bag (OR) | 73 | Steri-strip | 2 |
Peripheral/central line dressing | 85 | Cotton band for gastric/duodenal band | 89 | Cotton band for endotracheal tube | 62 | 3-way connector iv tube | 210 |
Injection membrane (Bionector) | 68 | Adapter for blood sampling | 223 | Paraffin gauze (Jelonet) roll | 411 | Dermanet® Roll | 44 |
Surgical staple | 369 | Theatre gauze | 1898 | Polyurethane dressing | 156 | Surgifix net, 2 m | 93 |
Net hat | 8 | Tubifast® | 10 | Flamazine, mL | 40 | Acetic acid, mL | 2500 |
Sulfamylon, mL | 850 | Vaseline, mL | 1240 | Intrasite conformable gauze | 8 | Superabsorbent dressings DryMax | 159 |
NPWT-device, number of uses | 1 | Black NPWT sponge | 2 | NPWT canister | 2 | Separately packed NPWT cover plastic | 2 |
Shower plastic | 1 | Showerhead | 1 | Large towel | 3 | Light handle | 27 |
EZ-DERM (xenograft, pig skin, used previously) | 1 | Forceps | 1 | Needle holder | 1 | Nexobrid 5 g | 10 |
Sterile spatula | 6 | Scissors | 3 | Bacterial culture swab | 51 | Skin biopsy punch | 1 |
X-ray | 15 | CT | 5 | Other | 7 | Fiberbronchoscope device, times used | 13 |
Lubricant | 13 | Anti-fog sponge | 13 | Sterile cone tube connector | 13 | Bite block | 13 |
Glidescope device, times used | 2 | Handle sterile (OR) | 2 | Ultrasound device, times used | 5 | Sock | 5 |
Monitor protective cover | 5 | Sterile ultrasound gel 20 g | 5 | Diathermy device, times used | 25 | Escharotomy | 6 |
Monopolar Diathermy handle | 44 | Smoke evacuator device (to diathermy), times used | 25 | Pre-filter smoke evacuator | 33 | Neutral electrode diathermy | 33 |
Transport ventilator tube | 16 | Infectious disease consultation | 39 | Ophthalmologist | 17 | ENT consultation | 10 |
General surgery consultation | 19 | Vascular consultation | 3 | Psych consultation | 4 | Ortho consultation | 8 |
Tube T Syringe pump | 293 | Infusion line | 198 | IV stopper | 1300 | Medicine cups | 816 |
Lid to medicine cup | 816 | Mixing adapter for closed inject/infusion cannula/needle | 43 | Mixing adapter for closed iv port | 43 | Mixing connector neck 20 and 13 mm | 181 |
Inf anidulafungin (Ecalta™) | 700 | Albumin 200 mg/mL, mL | 1200 | Albumin 50 mg/mL, mL | 6031 | Ciprofloxacin (Ciproxin) | 7200 |
Dexmedetomidin (Dexdor) 8 µg/mL, µg | 54,973 | Fentanyl 50 µg/mL, µg | 30,179 | Furosemide 10 mg/mL, mL | 1586 | Gentamicin Inf | 2320 |
Glucose 25 mg/mL, mL | 20,844.6 | Buffered glucose 50 mg/mL, mL | 16,174 | Glucose 50 mg/mL, mL | 13,045 | Inf glucose carrier #1 50 mg/mL Inf | 1450 |
Inf glucose carrier #2 50 mg/mL Inf | 961 | Humulin regular (Insulin)1 E/mL Inf | 1507.5 | Imipenem (Tienam) Inf | 330.9 | Potassium 1 Mmol/mL Inf, Mmol | 1741.1 |
Ketamine 10 mg/mL Inf, Mg | 49,736 | Clonidine (Catapresan) 15 µg/mL Inf | 19,139 | Midazolam (Dormicum) Inf, Mg | 1934 | Morfin 1 mg/mL Inf, mg | 4706.5 |
Noradrenalin 0.1 mg/mL Inf. Mg | 1491 | Nutriflex Lipid Plus SVA Inf, mL | 42,476 | Inf oxycodone 1 mg/mL Inf | 2475 | Propofol 20 mg/mL Inf. mg | 202,467 |
Inf remifentanil Inf, 100 µg/mL | 34,678 | Ringer acetate Inf | 597,253 | Inf tranexamic acid (Cyklokapron) gram | 7.8 | Inf tribonat Inf | 1400 |
Acetazolamide (Diamox) Inj | 3000 | Calciumchloride Inj, Mmol | 4.5 | Cefotaxim (Claforan) Inj | 155 | Dalteparin (Fragmin) Sc. IU | 622,500 |
Efedrin Inj | 150 | Esomeprazol 8 mg/mL Inj | 1240 | Inj Fenylefrin Inj | 1.3 | Inj Fentanyl Inj | 2150 |
Haloperidol (Haldol) 1 mg/mL Inj | 4 | Hydrocortisone (Solu-Cortef) Inj | 1850 | Potassium citrate Inj | 60 | Lidocaine 10 mg/mL with adrenaline 5 µg/mL Inj, mg | 425 |
Lidocaine Inj, mg | 435 | Meropenem (Meronem) Inj, gram | 96 | Metoklopramid 5 mg/mL Inj mg | 639 | Metoprolol Inj | 5 |
Neurobion (B-Vitamin) Inj Im | 3 | Inj Piperacillin (Tazocin) Inj | 288,000 | Inj Ranitidin (Zantac) 2.5 mg/mL Inj | 12,050 | Inj Rokuronium (Esmeron) Inj, mg | 1425 |
Inj Tetanus booster Inj, dose | 2 | Inj Tobramycin (Nebcina) Inj | 1320 | Inj Trimetoprim Och Sulfametoxazol, mg | 5520 | ||
T(ablet) Beviplex Comp T | 193 | T Flunitrazepam T | 2 | T Hydroxicin (Atarax) T | 326 | T Ibuprofen T | 10,800 |
T Melatonin (Circadin) T | 11 | T Mitt Val Sport Multivitamin T | 55 | T Mirtazapin T | 60 | T Ondansetron T | 16 |
T Oxazepam (Sobril) T | 72.5 | T Oxandrolon T | 102.5 | T Paracetamol mg | 279,500 | T Propanolol (Inderal) T | 1220 |
Inj Ranitidin (Zantac) 150 mg. | 3750 | T Spironolakton T | 1525 | T Trimetoprim/Sulfa (Eusaprim Forte) T | 1440 | T Zopliklon T | 170 |
ET (effervescent tablet) Ascorbic acid Vit-C ET | 189 | Oral potassium citrate (Kajos) oral mixture | 60 | Oral Klometiazol (Heminevrin) oral mixture, mg | 600 | Oral Laktulos oral mixture | 417,900 |
Oral Movicol granulate oral | 14.3 | Naloxon 1 mg/mL oral mixture | 603,000 | ET Zinksulfat (Solvezink) ET | 8235 | Acetylcystein Inh, mg | 21,800 |
Ipratropiumbromid + Salbutamol, mg | 45.5 | Lidocaine Gel, urethra | 7 | Chloramfenikol eye ointment, Application | 10 | Occulentum Simplex eye ointment 5 g/tube | 33 |
Erythrocyte-conc, mL | 37,200 | Plasma, mL | 27,280 | Platelet, mL | 10,467 | Transfusion line | 244 |
Enteral nutrition, mL | 69,035 | Blood gas syringe | 766 | Test tube, gold/yellow | 32 | Test tube, mint green | 141 |
Test tube light blue/black | 106 | Test tube, purple 5 mL | 150 | Test tube, purple 7 mL | 6 | Test tube, red | 28 |
Test tube pink | 8 | VacuTainer holder | 182 | Butterfly blue/green | 2 | Kit for lower bronchial microbial culture, trach | 13 |
Culture tub black (MRSA) | 14 | Culture tube without additives | 5 | Faeces culture tube | 5 | Nasopharynx culture tube | 3 |
Blood culture flask aerobic | 44 | Blood culture flask anaerobic | 444 | Blood culture holder | 42 | Urine culture tube | 18 |
VacuTainer holder urine | 5 | Surgery | 28 | Anaesthesia time hour | 114.26 | Operating time hour | 74.5 |
Theatre HCA | 53 | Theatre HCA hour | 261.4 | Theatre RN | 53 | Theatre RN hour | 265.53 |
Plastic surgeon | 94 | Anaesthesia HCA | 28 | Anaesthesia HCA hour | 152.4 | ||
Anaesthesia RN | 42 | Anaesthesia RN hour | 226.7 | Anaesthetist | 27 | Anaesthetist hour | 111.2 |
Theatre clothes | 362 | Nonsterile anaesthesia gown | 200 | Donor skin cm2 | 55,680 | ||
Coa-Comp device, times used | 5 | Bipolar diathermy cable and forceps | 38 | Fluid filter smoke evacuator (diathermy) | 27 | Dermatome device, times used | 6 |
Dermatome blade | 17 | Mesher device, times used | 5 | Mesher plate | 29 | Watson blade | 50 |
Weck knife | 49 | U-alcohol 70%, 1000 mL bottle | 2250 | Amputation | 3 | Torniquet device, times used | 12 |
Tourniquet cuff | 14 | Meek mesh device, times used | 2 | Meek mesh spray glue | 2 | Meek mesh plates | 40 |
Versajet, times used | 6 | Versajet handle | 7 | Theatre table, times used | 28 | Theatre table sheet. Absorbing, unsterile | 28 |
Transfer sheet Flexislide | 28 | Sterile air–heat blanket | 24 | Spray device for Tissue glue, times used | 2 | Sprayset Tissue glue | 4 |
Pack of excision instruments | 28 | Theatre towel glue border 75 × 100 (90) cm, 4 pieces/wound and access | 84 | Absorption towel M glue, 4 pieces | 120 | Theatre tape 9 × 49 cm, 5 St | 150 |
Needle box | 30 | Scalpel blade no. 10 | 26 | Scalpel blade no. 22 | 26 | Bandage support 12 cm, 5 pieces, sterile | 150 |
Bandage support 10 cm, 5 pieces | 159 | Ziploc bag 25 × 46 cm, pieces | 43 | Assist table bag 79 × 145 cm, 2 pieces | 60 | Intrasite conformable | 1 |
Infusion pump TIVA | 29 | Infusion fluid warmer | 7 | Infusion line for fluid warmer | 8 | Liquid heater device | 3 |
Anaesthesia machine | 28 | Absorber | 28 | Anaesthesia tube | 28 | Spirometry tube | 28 |
Daily cleaning patient room cleaner 30 min/day | 56 | Daily cleaning patient room staff 30 min/day | 56 | Cleaning time OR | 10 | ||
Long cleaning cloth | 800 | Thick cleaning cloth | 96 | Perform 1 pack (for cleaning) | 32 | ||
Outflow bag | 72 | Dialysis fluid | 840,000 | Citrate 1500 | 22,500 | Chalk 1500 | 22,500 |
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Simulated Patient | Gender | Age | TBSA (%) |
---|---|---|---|
1 | Female | 33 | 56.5 |
2 | Male | 35 | 86 |
3 | Male | 37 | 50 |
4 | Male | 25 | 41 |
5 | Male | 71 | 52 |
6 | Female | 30 | 25 |
7 | Female | 47 | 67.5 |
8 | Female | 68 | 25 |
Health Professional | Number of Hours |
---|---|
ICU/ward nurse | 5546 |
Plastic Surgeon | 410 |
Intensivist | 116 |
Physiotherapist | 49 |
Occupational therapist | 44 |
Dietician | 19.5 |
Anaesthetist | 111 |
Theatre nurse | 909 |
Social worker | 5 |
PPE | Fluids | ||
Gloves (pairs) | 17,012 | Saline | 88 L |
Disposable aprons | 7070 | Ringer acetate | 597 L |
Surgical gowns | 1815 | RBC | 37.2 L or 124 units |
Plasma | 27.3 L or 137 units | ||
Disinfectants | Medication | ||
Surface | 206 L | Propofol | 205,602 mg or 10 L |
Hand hygiene | 72 L | Morphine | 4663 mg |
Dressings | Noradrenaline | 1491 mg | |
Paraffin rolls (15 cm × 2 m) | 411 | Ketamine | 49,736 mg |
Gauze | 1898 | Paracetamol | 279,500 mg |
Bandages | 382 | Syringes | 3711 |
Surgical Staples | 369 | ||
Operation | |||
Number of operations | 28 | ||
Operation time * | 74.5 h | ||
Allograft | 55,680 cm2 |
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Share and Cite
Wong, W.L.; Carlsson, K.; Lindblad, M.; Sjökvist, O.; Huss, F. Resource Requirements in a Burn Mass Casualty Event. Eur. Burn J. 2024, 5, 228-237. https://doi.org/10.3390/ebj5030022
Wong WL, Carlsson K, Lindblad M, Sjökvist O, Huss F. Resource Requirements in a Burn Mass Casualty Event. European Burn Journal. 2024; 5(3):228-237. https://doi.org/10.3390/ebj5030022
Chicago/Turabian StyleWong, Wei Lun, Kristina Carlsson, Marie Lindblad, Olivia Sjökvist, and Fredrik Huss. 2024. "Resource Requirements in a Burn Mass Casualty Event" European Burn Journal 5, no. 3: 228-237. https://doi.org/10.3390/ebj5030022