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Predicting Resource Utilization in Burn Treatment

Disasters have a multitude of causes, ranging from environmental events (earthquakes, volcanoes, forest fires) to man-made incidents (bombs, arson, explosions, gas leaks). As many as 20 to 30% of injuries resulting from a mass casualty event involve burns.1 Burn care is currently concentrated in a relatively small number of highly specialized centers because of the need for high intensity care. As a result, even a “small” burn disaster consisting of 10 to 20 patients can overwhelm local medical systems. As such, planning for burn incidents is a necessary aspect of disaster preparedness for all hospitals. Appropriate planning requires knowledge of injury treatment and an understanding of resource requirements after burn injury. Burn injury treatment is distinguished from other traumatic injuries by its intensity, extent, and duration. Unlike other forms of trauma, burn patients require prolonged hospitalization (approximately 1 day per percent burn) and additional material and personnel support to address both the wounds and the metabolic derangements that accompany burn injury. The supplies needed to care for a burn wound have been the focus of most disaster planning, but burn treatment involves multiple other resources, such as ventilator support, blood products, antimicrobials, and surgical interventions. There is a vast array of literature on initial burn management, but less is known about the resource utilization for the entire hospitalization. Appropriate disaster preparedness planning, as well as military planning, must account for both initial and ongoing resource requirements after the event. Burn centers are likely to be unavailable for months after an incident; hence, preparations need to be made for prolonged hospital care of the burn patient in other locations. The American Burn Association National Burn Repository (NBR), consisting of data from multiple burn centers, contains data on resource utilization after burn injury and may represent the best source of information for preparedness planning. The purpose of this article is to develop and test predictive models for resource utilization after burn injury to better inform disaster preparedness and military planning efforts.