Emergency department organisation for disasters : A review of emergency department disaster plans in public hospitals of Singapore

Disaster management plans of emergency departments (EDs) in four major public hospitals were reviewed. A comparison was made between these plans, and they were analyzed to gain an understanding of the differing objectives and doctrines behind the practices. These were summarized into five major management concepts, which are considered to be critical to the success of a disaster plan: 1)staff mobilization systems (cascading vs batch mobilization); 2)staff deployment systems; 3)team organization (surgeons vs residents); 4)area management (the role of the area manager); 5)casualty volume management (accommodation vs expansion vs extension concepts). the concepts derived should serve as a useful guide to the development of an ED disaster plan and potentially influence how new ED facilities could be planned(AU)

Anatomy of a burns disaster : The Miri Bank explosion

A bank explosion in a neighbouring country over 1000 km away resulted in ten badly burned victims being airlifted to the Burns Centre, Singapore General Hospital (BCSGH) for treatment. The severely injured included patients with 90, 80, 74, 66, 45, 33 and 31 per cent burns. Nine had respiratory burns (four severe, one moderate, four mild). One patient died, thus, the mortality rate for the six most severely injured was 16.7 per cent. This differs from predicted mortality rates of 78 per cent according to McCoy or 54 per cent according to Thompson, Herndon et al. The factors contributing to this result were the small size of the disaster, the use of an established Burns Mass Disaster plan and an individual management policy that incorporates carefully monitored fluid resuscitation, recognition of respiratory burns with early treatment by intubation thuspre empting complications, early surgery and a multidisciplinary approach to complications such as infection and renal failure. The average length of stay was 43 (range 5-122 days). The cost of the hospitalisation of the ten casualties was $ 312,317.00 (AU)