"After The Fire"; The Legacy of College Dormitory Fire Twenty Years Later.

In January of 2000 the team at The Burn Center at Saint Barnabas was confronted with what is to date, the single largest burn mass casualty incident since its doors opened in 1977. Looking back through history at other catastrophes shows that, even in the wake of these "landmark events", the lessons learned remain, so that perhaps all was not in vain. 2, 6, 7, 8, 9, 11, 13, 19 While this fire took place more than twenty years ago, its legacy is still being felt today. The following discussion examines some of the key lessons learned, and underscores the fact that positive change does come from tragedy.

Developing and implementing a plan for large-scale burn disaster response in New Jersey.

For the first time in modern history burn centers must face the reality of having to potentially care for a staggering number of injured patients. Factors such as staffing, patient acuity and bed availability compel medical professionals to regularly examine various aspects of their respective healthcare delivery systems, especially with regards to how these systems should function for mass casualty response. The majority of burn care in New Jersey is provided by one designated burn treatment facility. A planning group was formed to identify additional hospital support systems capable of providing short-term patient care during a disaster. Focus was on three key areas: identifying actual versus potential nonburn center resources, ascertaining the number and level of burn expertise at these facilities, and assessing the capacities of any available resources and personnel. Retrospective review of discharge data highlighted which of the more than seventy New Jersey hospitals besides The Burn Center were treating and releasing burn injures. In a disaster The Burn Center designates these hospitals as Tier Facilities to serve as additional resources until patients may be transferred to other recognized regional and national burn centers. Triage is conducted in accordance with the American Burn Association Benefit-to-Ratio Triage grid, matching patient acuity with each hospital's tier designation. A secondary triage, conducted 24 hours after the initial incident, identifies which patients require transport for more specialized burn care. Twenty-seven burn centers from Maine through Maryland and the District of Columbia, who have joined together as a Consortium, agree to support one another for optimal patient distribution and management in accordance with accepted national standards of care. State Medical Coordination Centers equipped to coordinate and track transport of large numbers of injured personnel are able to facilitate this collaborative, multiagency response throughout the northeast region. Burn centers share many issues common to emergency preparedness. Paramount among them is an ability to provide quality burn care for the greatest number of patients at a time when staff and resources will be severely limited. It is incumbent upon burn centers to explore opportunities extending beyond individual state and regional resources in order for centers to continually maintain this standard of care, particularly in a disaster.