Executive Summary
The State of Michigan
Multi-Casualty
Burn Incident Plan
Version #19
Updated November 1, 2013
The Mass Casualty Incident Burn Plan has been developed for Healthcare systems in
Michigan to help expand the ability to provide burn care and to safeguard and prioritize the
utilization of limited resources. The State of Michigan recognizes that no one state has the
ability to meet the increased capacity needs of a significant incident involving large numbers of
burn patients and therefore has worked with their Healthcare Preparedness partners to identify
hospitals willing to train staff in the management of burn patients until a burn center bed
becomes available. These designated hospitals are called Burn Surge Facilities (BSF).
In order to successfully create an operational statewide plan, four basic premises must
be uniformly understood and incorporated into each response plan for the Mass Casualty Burn
Incidents. They include:

Regional Medical Coordination Centers (RMCCs) or Multi-Agency Coordination Centers
(MACs)

Creation of a State Burn Coordinating Center (SBCC)

Maximum utilization of the state’s Burn Centers (there are 6 Burn Centers)

Establishment of Regional Burn Surge Facilities (BSFs)
The 8 Regional Healthcare Coalitions, working with the Michigan Department of
Community Health (MDCH) has identified 11 hospitals to be designated as BSFs. Each region
who has a Burn Center will have at least 1 BSF and the regions without Burn Centers will have
2 designated BSFs. The BSFs will have personnel trained in Advance Burn Lift Support (ABLS),
to include nurses and physicians. They are preferably a Level I or Level II trauma center. They
will function as the initial stabilization/evaluation/transport staging center with support of the
MCC and the CHECC.
The Burn Plan incorporated the utilization of “adjusted environments of care”, through
designated hospitals that will provide stabilization for burn patients, even though these facilities
are not normally associated with providing definitive care to burn patients. The ability to
standardize the care that will be provided in these hospitals that do not provide definitive burn
care has been agreed upon in an effort to safeguard critical resources and, ultimately, improve
outcomes for patients. The plan incorporated the use of burn stages to provide context for the
scope of an incident.

Stage I: State of Michigan burn centers and burn centers in our neighboring state will
manage as many patients who meet the Mass Casualty Burn Center Referral Criteria as
available resources permit. Once it is recognized that the potential for the event to
exceed local recourses exists, then the regional Medical Control Center (RMCC) and the
local Emergency Operations Center (EOC) with the assistance of the State Burn
Coordinating Center (SBCC) should begin to coordinate medical response efforts with
the Community Health Emergency Coordination Center (CHECC) and the State
Emergency Operations Center (SEOC). Burn Surge Facilities will be utilized as needed
Updated November 1, 2013
to briefly care for and house other burn patients pending transfer to burn centers. It is
expected that all burn casualties will be transferred within 24-48 hours to burn centers.

Stage II: State burn centers will manage as many patients as possible given the
resources available for patients meeting the Mass Casualty Burn Center Referral
Criteria. When burn center bed capacity has been exceeded, or transport is not feasible,
Regional BSF’s may be utilized to provide care and to house patients. The SBCC,
CHECC and the SEOC will facilitate the coordination of other burn resources with the
Great Lakes Healthcare Partnership (GLHP) as well as the American Burn Association
(ABA) network of burn centers.

Stage III: State burn centers will provide care for as many patients as the have
resources to support care that meet the Mass Casualty Burn Center Referral Criteria.
When Burn Center bed capacity has been exceeded or transport is not feasible,
Regional BSF’s may be utilized to care for and house patients. The process for the
transfer of patients out of state, utilizing our GLHP will begin, once all in state resources
are exhausted. This process will be coordinated through established incident command
structure.
Given the limited availability of definitive burn care at the national level, it is understood that
even a “relatively minor” incident may indicate a need for accessing resource’s from one or
more of the planning partners to ensure the best possible outcomes for patients. This will be
through the use of non-traditional burn care resources, to provide surge capacity during a multicasualty burn incident (MCBI); the State of Michigan is able to protect those facilities with
definitive burn care capabilities from being overwhelmed through the use of offsite triage and
stabilization. The type of surge capacity planning can maximize the use of critical definitive care
resources.
This type of planning assists the local jurisdictions and Regional Healthcare Coalitions
(HCC) to plan for and provide a uniform coordinated response when the MCI exceeds local
resources. This plan is an adjunct to local preparedness efforts and provides guidance to each
Regional HCC in providing a uniform assessment of their current capacity to care for burn
patients and an assessment of burn surge capabilities. The plan applies to all levels of
government to include the local, regional, state and/or multi-state level. It provides guidance for:

Uniform triage of burn patients

Categorization of hospital resources

Critical burn surge supplies based on regional population and projected surge capacity
needs

Staff and training readiness for patient care

A communication model for the management of a MCBI
Updated November 1, 2013
The extent of injury seen in burn patients involved in a MCI will vary in degree and criticality
and the extent and intensity of care and resources required will vary significantly. Michigan
utilized the planning assumption of 60% of the ASPR Hospital Preparedness Program (HPP)
benchmark of 50 patients per million population will sustain a 30% Total Body Surface Area
(TBSA) injury (on average).
In the event of a MCBI, each of the eight Emergency Preparedness Regions should plan to
provide initial treatment and stabilization for burn victims triaged as meeting the criteria for a
burn referral to a burn center. Planning projections are based on a population ratio of 50 per
million population. This capacity planning should incorporate the development of non-traditional
burn bed resources to include:

Initial and ongoing training in burn triage

Categorization of injuries

Patient care

Supply caches capable of supporting patient care for at least 72 hours.
During the MCBI the RMCC, SBCC, State Burn Centers and the BSF’s work with the State of
Michigan to coordinate patient care. The RMCC’s will be activated to coordinate the needs of
the Healthcare organization in response to a MCI. The primary functions of the MCC during the
time will be:

Serving as a support to hospitals, local EOC’s, other RMCC’s and the CHECC. The
SEOC is kept informed via the CHECC

Situational awareness of the HCO’s within the HCC

Current availability of regional medical resources

Coordination of requests and receipt of intra- and extra-regional medical resources

Casualty transportation system (CTS)

Serving as the primary mechanism for medical communications to the CHECC
consistent with Regional Operational Guidelines.
The SBCC is the University of Michigan Burn Center who is responsible for assisting the
RMCC’s, CHECC and the SEOC in managing MCBI’s in which the resources of any given
region of the state are exceeded. The SBCC was selected based on the following criteria:

Around-the-clock on call coverage by a burn surgeon and burn disaster response
support team

Telemedicine capabilities
Updated November 1, 2013

Interoperable communications that include Michigan Public Safety Communications
System (800MHz)

ABA verified Burn Center

Michigan Health Alert Network (MIHAN) participation

Ability to serve in the role and continue to care for their patients (under catastrophic
conditions)

Rapid Web-publication capabilities
To further support Michigan’s planning for a Burn Mass Casualty Incident, the SBCC has
duties outside of incident response including:

Assist in the development of training protocols for personnel at designated BSF’s
and Burn Centers

Coordinate the maintenance and updating burn related protocols at the BSF and
Regional HCC

Develop and maintain a process for recording burn casualty reports associated with
a mass casualty incident in which they are activated

Coordinate the rotation and updating of burn supply caches located within each
Regional HCC and central locations within the state

Coordinate the procurement of critical burn surgery supplies, such as skin Allograft
and wound care products and maintain a database of supply sources and contacts.

Working with suppliers outside the state and coordinating supply distribution to other
in-state Burn Centers

Demonstrate proficiency in the utilization MIHAN as well as other web-based
resources to facilitate distribution of documents, protocols and databases needed for
Burn MCI preparedness

Maintain documentation for potential reimbursement

Assist with education, training and exercises as appropriate

Act as a liaison with coordinating burn centers from other states including the GLHP,
on an ongoing basis, in support of inter-state planning activities.
Michigan currently has six Healthcare Facilities with Burn Centers capable that routinely
accept burn referrals and are able to provide definitive care for burn patients, as defined by
the American College of Surgeons in the Resources for Optimal Care of the Injured Patient
2006. These centers continue to serve their primary role during a Burn MCI, but will work in
Updated November 1, 2013
conjunction with the SBCC to manage the flow of burn surge patients to ensure the optimal
use of the state’s definitive burn care capacity.
The Regional BSF’s will be responsible for the initial evaluation and stabilization of burn
patients and preparation for transfer, if necessary, during the initial 72 hours. They have 24hour coverage with ABLS-trained nurses and physicians. Because it is expected that the
BSF’s will need to care for some burn patients during the initial 72 hours they will be able to
receive distance consultation support from the SBCC during this phase. It is expected that
the SBSS will provide on-site burn consultation at the BSF for the secondary triage of burn
casualties after the incident and as appropriate and feasible.
The development of this plan included education of all members of the Regional MCC’s,
selected individuals from the State of Michigan and staff at the BSF’s. Each region received
a cache of supplies to be utilized by the BSF during a surge event and a Website is
available with educational material and “Just in Time” training videos to support the needs of
hospital staff caring for these burn patients.
Updated November 1, 2013