REQUEST FOR PROPOSAL (RFP)
Statewide Burn Surge Table Top Exercise
A. Introduction
The Research and Education Foundation (REF) of the Ohio Hospital Association (OHA), seeks
professional services from parties, hereinafter referred to as Bidder, to perform all necessary
facets toward the design, development and implementation of a statewide burn surge table top
exercise that would evaluate the role of the statewide burn coordination center and evaluate
criteria for burn surge facilities statewide to be use during events when treatment, movement or
evacuation of Ohio burn patients is needed, and/or when there is an influx of burn patients from
other states that may transport to Ohio.
Ohio has a Burn Surge Plan (Appendix C) that has been implemented in varying degrees within
the eight homeland security planning regions. Within these planning regions burn surge facilities
have been identified by the Regional Healthcare Coordinator, the number varying by population
and size of the region. The Plan calls for these surge facilities to be either a Level 2 or Level 3
trauma center, however, in the more rural areas of Ohio the role of surge facility may be an
general acute care facility.
The Bidder will have a working knowledge of the issues faced by hospitals related to burn
capacity and capability. The Bidder must also have a working knowledge of the OHA websites
available to hospitals and healthcare facilities to ensure utilization during a surge event, i.e.
SurgeNet, OHTrac, etc. The Bidder will collaborate with the Ohio Hospital Association, the
Ohio Department of Health, the State Burn Coordinating Center and the regional hospital
coordinators from each of the planning regions across Ohio.
The Bidder will adhere to the U.S. Department of Health and Human Services Office of the
Assistant Secretary for Preparedness and Response (ASPR) FY 2014 Continuation Guidelines
and the Ohio Department of Health (ODH) Grant Administration Policies and Procedures
Manual (GAPP).
Scope of Service
The Bidder shall meet all of the following project requirements:
A. General Requirements of the Bidder
1. Demonstrate in writing their ability to perform all deliverables in
accordance with the contract executed by the parties.
2. Bidder must provide documentation that reflects the depth of
knowledge, experience, and resources necessary to complete projects
such as these.
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3. Bidder must provide at least two references for which they have
successfully provided services on surge management projects that were
similar in nature, size, and scope of this Proposal
4. Demonstrate financial stability, sufficient staffing and training to
administer this project. Bidders must provide documentation that reflects
the depth of knowledge, experience and resources necessary to complete
projects such as this.
5. Demonstrate technical capacity to administer this project.
6. Adhere to all Assistant Secretary for Preparedness and Response
(ASPR) Federal requirements and ODH state requirements for hospital
disaster preparedness grants.
At REF’s sole discretion additional information may be requested of the Bidder.
B. Requirements of the Project (Two weeks after receipt of signed contract)
1. Submit a detailed written work plan that provides specific information to
perform all necessary facets toward the implementation of a statewide
standardized medical surge process.
2. Submit a staffing plan and timeline for completion of deliverables with
work plan.
3. Submit a detailed budget for the entire project.
4. Meet with OHA after receipt of signed contract to review the work plan
and timeline and address questions as needed.
C. Deliverables of the Project

Design, develop and deliver a Table Top Exercise (TE) with After Action Reports (AAR)
and Improvement Plans (IP) for each participating hospital, the Ohio Hospital
Association and the Ohio Department of Health under this Agreement utilizing the
Homeland Security Exercise and Evaluation Program (HSEEP) methodology.

The objectives/capabilities for the TE include Capability 1 – Heatlhcare Preparedness,
Function 6, Capability 6 – Information Sharing, P5, P6, and Capability 10 – Medical
Surge

Conduct an Initial, Mid, and End Planning Meeting and develop an Agenda and Meeting
Minutes for each meeting.

Develop the following documents for the TE: Situational Manual, Power Point
Presentation, Participant Feedback Form, AAR/IP, and Participant Handout.

Develop Exercise Evaluation Guides (EEGs) for each objective/capability.
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
The Contractor shall cooperate and coordinate with the REF, the Ohio Hospital
Association (“OHA”), the Ohio Department of Health, the State Burn Coordinating
Center, and the Regional Healthcare Coordinators in the implementation of the exercises
and in performing related duties under this Agreement.

The Consultant covenants that he/she/they will not use for the benefit of him/her/their
self or any other party (other than the REF) or disclose to any other person or
organization any Confidential Information (as hereinafter defined) except as such
disclosure or use is consented to in advance by the REF pursuant to this Agreement or in
writing, which written consent specifically refers to this covenant. This covenant shall
survive the termination of this Agreement. Confidential Information as used herein
means information of commercial value to the REF or OHA members that is created,
discovered, developed, or has otherwise become known to the REF, or in which property
rights have been assigned to or otherwise conveyed to the REF or OHA members,
including, but not limited to, the whole or any part of any technical information, trade
secret, data technique, marketing plan, strategy, forecast, client or supplier list, business
plan, financial information or patient information.
D. Contract Award and Duration
One contract will be awarded contingent upon the availability of funds. The
contract will be awarded to only one Bidder with an award of $35,000.00. The
successful Bidder will be required to contract with the REF of the OHA to
perform the Scope of Services described in this RFP. A contract will be issued,
which shall be in effect commencing on or about February 15, 2014 through June
15, 2014.
B. Submittal Process
A. RFP Questions
1. Persons who have questions concerning the RFP are encouraged to
submit written questions to:
Carol Jacobson, RN
carolj@ohanet.org
Director Emergency Preparedness
Ohio Hospital Association
155 E. Broad Street
Columbus, OH 43215
2. Written questions must be received at one of the above-mentioned
addresses no later than 4 p.m. on January 24, 2014. The above
mentioned parties shall respond to any questions by close of business on
January 27, 2014. Telephone inquiries will not be accepted.
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B. Submittal Information
1. Time Schedule
The following is the projected timetable to be applied to submission,
receipt, and evaluation of proposals:
January 27, 2014
Deadline for Written Questions
4 p.m. Eastern Standard Time
February 8, 2014
Deadline for Proposal
2:00 p.m. Eastern Standard
Time
February 13, 2014
Notification of Vendor Contract Award
2. The Bidder shall submit one (1) original proposal and two (2) complete
copies of the formal proposal. The original proposal should be marked
as such or be readily identifiable as the original. This material must be
received by the REF at this address:
155 E. Broad Street, Suite 301
Columbus, OH 43215
ATTN: Carol Jacobson
3. Packages containing the proposal material shall be sealed and plainly
marked on the outside in the following manner:
STATEWIDE BURN SURGE TABLE TOP EXERCISE
ATTN: Carol Jacobson
4. Late or fax proposals will not be accepted. Envelopes or packages
received after the above date and time will not be accepted. Proposals
will be available for public inspection upon completion of the proposal
review process.
C. Selection Process
A. A selection committee for the REF will review and evaluate all properly
submitted proposals that are received on or before the deadline. The committee
will then rank the proposals according to those that are most advantageous to the
REF, taking into account, but not limited to, the evaluation factors set forth
below:
1. Background and Related Project Experience
2. Performance on Previous Projects
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3. Familiarity with Relevant Local, State, and Federal Standards and
Requirements
4. Understanding of Project
5. Schedule/Staffing
To ensure competitive proposals for the procurement of the professional services
requested, proposals should include the following information and will be
evaluated according to these criteria:
a) Background and Related Project Experience: Provide a
history of the submitting organization, including the
number of employees (identify professional staff and
support staff) and available facilities.
Related project experience, similar to the requested work,
should be included in this section. Specify relevant
experience with governmental entities. Identify the cities,
the dates of service, and the key contacts.
b) Performance on Previous Projects: Provide a summary of
performance for each project relevant to timeliness, actual
performance and any savings or benefits that were provided
to the agency. List any projects similar to the requested
work with other agencies.
c) Location: Provide name and address of submitting
organization and the state in which it is incorporated (if
applicable). This should include the location of the
organizations primary office and the location of the office
available for handling the requested service. This should
also include a discussion on staff accessibility for the
project and the amount of work to be performed.
d) Familiarity with Relevant Local, State and Federal
Standards and Requirements: This should include a
description of the firm’s or individual’s familiarity with all
applicable federal standards and requirements and federal
regulations should be listed in this Section.
e) Current Work Load: Discuss the Bidder’s ability to
complete the project by the June 30, 2012 deadline.
f) Understanding the Project: The Bidder submitting a
proposal shall describe in detail the services to be rendered
to complete the project and perform the tasks listed in
Section II, Scope of Services.
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g) Staffing and Scheduling: The Bidder shall provide a
detailed project schedule and workflow diagram for all
tasks identified in Section II, Scope of Services. Provide a
list of staff members assigned to this project. Designate a
primary and alternate contact within the organization and
include electronic mail addresses and telephone numbers
(voice and facsimile). Primary and alternate contact must
have past or current hospital experience as it relates to
medical surge management.
h) Cost Summary: Provide a budget detailing the cost,
charges and overhead resulting from each of the tasks
identified in Scope of Service.
i) Willingness to comply with the Copeland “Anti-kick-back
Act” (18 U.S.C. 874)
j) Agreement to comply with the Ohio Department of Health
(ODH) GAPP Manual (available online at
www.odh.ohio.gov) directives that states: “Sub-grantees
may not contract for extra compensation with its employees
to provide services to the program without prior written
authorization of ODH. Consideration will only be given in
the following two situations: 1) a salaried faculty member
of an educational institution when the consultation is across
departmental lines or involves a separate or remote
operation, and the work performed by the consultant is in
addition to his regular departmental load; or 2) a subgrantee employee when the agency’s policies permit such
consulting fee payments to its own employees regardless of
whether federal or state grant funds are involved, when the
work involved is clearly outside the scope of the
employee’s salaried duties. Any request to approve such a
contract must address these issues.
k) Agreement to ensure that all contracts and subcontracts
subject to the Contract Work Hours and Safety Standards
Act (40 U.S.C. 327 etseq.) shall include a provision
requiring the contractor to comply with the applicable
sections of the Act and the Department of Labor’s
supplementing regulations (29 CFR Parts 5 and 1926).
B. Failure by the Bidder submitting a proposal to respond to a specific requirement
may be a basis for elimination for consideration during the comparative
evaluation. The REF reserves the right to accept or reject any or all proposals. The
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REF also reserves the right to elect not to award a contract based on this Request
for Proposal for any reason.
C. List references for all similar projects previously completed using the format
outlined in Appendix B. Provide at least two (2) references for projects
conducted within the last two (2) years that can attest to the Bidder’s
qualifications to do the work requested for this project, especially noting similar
or related projects. Include names of contact persons, telephone numbers, project
objectives, strategy, service rendered, budget, and beginning and completion dates
for each referenced project.
D. Provide a conflict of interest statement indicating that the organization or
organizations, and the individuals assigned to this project do not have, and shall
not have for the duration of the subject contract, any other interests in or business
association with the REF.
E. The REF is not liable for any costs incurred by the Bidder in responding to this
RFP, or for any costs incurred in connection with any discussions or
correspondences required for clarification of any subject contained in this RFP.
Any and all costs incurred in responding to this RFP, including oral interviews,
demonstrations or other related activities shall be the responsibility of the Bidder.
D. Contract
A. If a contract is awarded, the successful Bidder shall enter into a Professional Service
Agreement with the REF. The contract entered into between the successful Bidder,
the REF shall be similar to other standard agreements for professional services
involving the FY13/14 grant award from the Ohio Department of Health with the
REF.
B. The REF reserves the right to amend or withdraw the RFP any time prior to the
award of a contract. The Bidder may withdraw a response to the RFP any time prior
to the award of a contract.
C. All products that result from the proposed contractual agreement will be the sole
property of the U.S. Department of Health Resource and Human Services
Administration (HRSA) National Bioterrorism Hospital Preparedness Program.
D. All bids will be considered firm and in the event a contract ensues as a result of this
solicitation, the Bidder selected will be required to fulfill the contractual obligations
at the amount quoted in the cost proposal.
E. Pursuant to Section 149.43 of the Ohio Revised Code, the proposal may be
considered a public record and be released upon request.
F. The REF does reserve the right not to award a contract under this RFP.
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G. Other Considerations
A. Public Records: The REF will treat any documents submitted with the proposal
as a public document unless informed in writing by Bidder that it considers the
document to contain trade secrets under Ohio laws. The REF may require
additional information in support of such a claim.
B. Background Information regarding the REF is available on the OHA web site:
www.ohanet.org
C. Appendices and References Documents
Appendix A: Reference List Forms
Appendix B: Surge Capacity Status 2006-2007
Appendix C: Burn Surge Plan
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Appendix A
REQUEST FOR PROPOSAL (RFP)
Implementation of Statewide Medical Surge Management Process
(Duplicate form as necessary)
Reference List
List at least three (3) references that most closely reflect similar scope of work projects within
the past two (2) years.
Name of Organization: __________________________________________________
Address: _____________________________________________________________
_______________________________________________________________
Telephone: _________________________________
Project Name: _________________________________________________________
Contact: __________________________ Title: ______________________________
Service Dates: _________________________________________________________
Project Manager:______________________________________________________
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Appendix B
Ohio Hospital Association
Disaster Preparedness Program
SURGE CAPACITY STATUS
Surge capacity is a health care system’s ability to rapidly expand beyond normal services to meet
the increased demand for qualified personnel, medical care, and public health in the event of
bioterrorism or other large-scale public health emergencies or disasters.
HRSA Critical Benchmark #2-1: Surge Capacity: Beds
Establish a system that allows the triage, treatment and initial stabilization of 500 adult and
pediatric patients per 1,000,000 awardee jurisdiction (1:2000), above the current daily staffed
bed capacity, with acute illnesses or trauma requiring hospitalization from a chemical, biological,
radiological, nuclear or explosive (CBRN&E) incident.
HRSA expects that the ration of 1:2000 (500 adult and pediatric patients’ per1 million
populations) will be used to determine the number of adults and pediatric patients a state must
prepare for. Designing healthcare delivery system to care for thousands or even hundreds of
thousands of patients or victims when the current healthcare system is overwhelmed poses an
overwhelming task for any state. The intent of critical benchmark #2.1 is to provide a framework
for developing a unified (Public Health, RMRS, MMRS, local jurisdictions) comprehensive
system of response that meets the needs of a region or state, to provide the most good for the
greatest number of people while using limited resources and integrates easily into the Federal
Response Plan.
The issue of surge for Ohio hospitals will be approached utilizing a 3 Step System as a means of
determining additional bed capacity. In the event additional beds are needed for a disaster, it is
anticipated that Step 1 would be to utilize staffed beds within the hospital itself through
cancellation of elective procedures, early discharges and utilization of 100% of normally staffed
beds. Step 2 would be to identify capacity above Step 1. Surge can be created by utilizing all
available health care facilities care areas (i.e. all licensed beds, outpatient areas, converted
patient care areas, activation of MOUs, and/or opening of identified alternative care sites). Step
3 identifies capacity created by local jurisdictional plans that include Alternate Care Centers and
activation of regional, state and federal resources, i.e. space and/or equipment at large sites such
as auditoriums and possibly local hotels/motels.
Hospitals are aware that as they develop their bed surge they will also have to determine what
equipment and supplies they would need to stock these beds/areas. For example, if a hospitals
disaster plan currently identifies the county fairgrounds as its alternative site, where are the beds,
staff and needed equipment coming from?
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All regions have regional Memorandum of Understanding between hospitals and other health
care facilities to assist with resources, to include personnel and beds during a disaster. Six of the
seven-bioterrorism planning regions have a trauma diversion system in place that is being
evaluated for use during a disaster (Cincinnati, Dayton, Akron, Cleveland, Central Ohio, and
Toledo). Two of the bioterrorism planning regions have bed and resource tracking capabilities
(GDAHA Bed Tracking System) utilized during disasters (Cincinnati, Dayton,). OHA will enter
into a contract with GDAHA to provide bed and resource tracking capabilities to all remaining
regions. OHA, ODH and the state EOC will have full access to this resource.
As a result of planning since 2003, the 173 Ohio HRSA funded hospitals can create 2,780
additional beds by implementing Step 1 and 5,009 beds by implementing Step 2. However, these
numbers are flexible and completely dependent upon the daily census and staffing capability of
each hospital. Based on documented reports and projections the 7,789 bed identified would not
be sufficient to care for the victims of a mass casualty or a biological event. Although there are
triage processes in place in hospitals, these processes are for individual or low volume incidents
and not designed for the large volume produced by a mass casualty or biological event. To begin
to alleviate some of the burden for hospitals during these events it will become necessary for
other health partners to develop alternative care centers or facilities to assist with triaging of
patients and directing them to locations where appropriate care can be provided.
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Appendix C
Burn Surge Plan
The State of Ohio Template for Hospital Management of
Burn Patients Resulting from a Mass Casualty Incident
Introduction
This plan is designed to assist local jurisdictions in planning for and providing a uniform
coordinated response in the event of a mass casualty burn incident once the burn centers and
burn surge facilities have exceeded their resources and ability to coordinate an ongoing medical
response. Because all disasters are considered to be local by nature, this plan is designed as an
adjunct to local preparedness efforts. This plan defines what constitutes a multi-casualty burn
incident. It also provides guidance to each Homeland Security Planning Region toward a uniform
assessment of their current capacity to care for burn patients and their burn surge capabilities
(see Appendix 1).
This model is designed to be implemented at the State and/or intra-regional level. It provides
guidance for the uniform triage of burn patients, categorization of hospital resources, a list of
critical burn surge supplies based on regional population and projected surge capacity needs,
identification of staff and training readiness for patient care, and a communication model for the
management of a multi-casualty burn incident.
Authority
Authority for the development and implementation of this plan comes from The Pandemic and
All-Hazards Preparedness Act of 2006 (Public Law 109-417), amended section 319C-2, of the
Public Health Service (PHS) Act. This Act authorizes the Secretary of Health and Human
Services (HHS) to award competitive grants or cooperative agreements to eligible entities to
enable such entities to improve surge capacity and enhance community and hospital
preparedness for public health emergencies.
Under Section 319C-1 of the Public Health Service Act, the U.S. Department of Health and
Human Services Health Resource and Service Administration established the National
Bioterrorism Hospital Preparedness Program. This Program provides federal guidelines under
Critical Benchmark #2-9, requiring that states plan for the provision of care to burn patients
based on a population ratio of 50 per million populations. In the case of each state, this presents
as a tangible quantitative target. However, the paucity of detail with regard to what constitutes a
“burn patient” is a significant limitation in the construct of any plan.
Planning Assumptions
The foundation for burn surge planning in Ohio relies on a number of qualitative assumptions
that are significant factors in the formation of this plan:
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-
All burn patients’ injuries are not equal
Federal assets may not be readily available
Reliance on FEMA Region partners to assist in a response should they be requested
Burn surge patients may need to be transferred out of the state as well as within the state
Allocation of Scarce Resources
The first of these assumptions is the recognition that all burn patients’ injuries are not equivalent,
and as such the extent and intensity of care and resources required will vary significantly. This
nuance is critical in assessing existing burn capacity and subsequently establishing enough
resources to expand that capacity to meet the burn surge threshold set for any given state. In
Ohio, the assumption is that 60% of the mandated 50 patients per million population will sustain
30% or greater total body surface area (TBSA) burns and/or will require mechanical ventilation.
The second assumption is that help will not readily be available in terms of federal assets.
Regions must first rely on themselves and develop partnerships with surrounding states (to
include FEMA Region 5 states), in order to sustain the needs of burn surge patients for 72-120
hours. Within that timeframe regions must be prepared to provide care for the first 72 hours
without outside assistance. Between 72-120 hours, the assumption is that resources from the
surrounding states---specifically FEMA Region 5--- and federal assistance will begin to become
available.
The third assumption is that the surrounding states and FEMA Region 5 states will adopt a
similar organizational approach. This is extremely important as Ohio works under the
assumption that, depending upon the incident site location, the surge patient may be transferred
out of state or redistributed within the state. While there exists consistency in the standards of
care provided to burn patients, it is critical that the surrounding states and FEMA Region 5 states
adopt response structures capable of interfacing in order to provide a coordinated response in a
timely fashion. Absent that coordination, Ohio may not be able to rely on intra-regional support
capable of mitigating critical care issues between 72-120 hours post incident.
The fourth assumption is that sufficient resources may not be available to sustain the needs of
burn patients in the event of a mass casualty incident. The American Burn Association (ABA)
Triage Table (Appendix 2) and or appropriate current ABA guideless can help guide resources
when in short supply.
Critical Operational Concepts
In the event of a mass casualty burn incident, each of the established Ohio Homeland Security
Planning Regions should plan to provide initial treatment and stabilization for burn victims
triaged as meeting the criteria for a burn referral to a regional burn coordinating center. Planning
projections should be based on a population ratio of 50 casualties per million, or a minimum of
25 patients. This capacity planning should incorporate the development of non-traditional “burn
bed” resources to include initial and ongoing training in triage methodology, categorization of
injuries, patient care, and supply caches capable of supporting patient care for 72-120 hours. In
order to successfully create an operational statewide and/or intra-regional plan, three basic
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premises must be uniformly understood and incorporated into each region’s response plans for
mass-casualty burn incidents. The three basic concepts of operational importance are:
-
The creation of a Regional Medical Coordination Center (RMCC)
The creation of a Regional Burn Coordinating Center (RBCC)
The establishment of Regional Burn Surge Facilities (RBSFs)
These defined resources provide a basis for a universal understanding that enhances each
region’s ability to coordinate the care and movement of burn patients during a mass casualty
burn incident.
Regional Medical Coordination Center
A Regional Medical Coordination Center (RMCC) will be identified within each region. These
Centers are the organization/agency that currently coordinates the emergency preparedness
initiatives for hospitals (i.e. Central Ohio Trauma System for Central Region, Ohio Hospital
Association for SE Region, etc.). These Centers may be opened when emergency medical care is
needed in response to a mass casualty incident. The RMCC functions as an extension of the
regional model of preparedness and assists the incident management structure with medicallyrelated decisions and resource allocations. The basic concept of RMCC operation must remain
consistent, even though regional variations may exist based on resources and assets available.
RMCC staff must have access to and be trained in the use of communication and alerting
devices/system utilized by responding agencies within Ohio (for example MARCS radio,
SurgeNet, OHTrac, OPHCS. The primary function of the RMCC is to assist the scene incident
command with a detailed understanding of:
-
The current availability of regional medical resources
The current availability of regional medical personnel
Triage and destination protocols for adult and pediatric casualties
The availability of state and/or federal medical resources
The coordination of requests and receipt of extra-regional medical resources
The need to serve as an interface between hospitals, Homeland Security Regions, RBCC,
RBSF, and the State Emergency Operations Center (SEOC)
The need to transport pediatric burn surge patients to RBCCs that care for children
Regional Burn Coordinating Center
Ohio currently has hospitals which have been identified by the American College of Surgeons
(ACS) as best able to accept burn referrals and provide definitive care for burn patients, as
defined in the ACS Resources for Optimal Care of the Injured Patient: 2006, Committee on
Trauma Care. Contact information for these facilities can be found at www.ameriburn.org or in
Appendix 3. These “burn centers” will work in conjunction with the Regional Medical
Coordination Center (RMCC) to manage the flow of burn surge patients and to ensure the
optimal use of Ohio’s definitive burn care capacity. Each Homeland Security planning region
will identify a healthcare facility to act as the Regional Burn Coordinating Center (RBCC). In
the SE region coverage will be provided by The Ohio State University Burn Center and
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Nationwide Children’s Hospital. The RBCCs are responsible for assisting the RMCCs and the
State Emergency Operations Center (SEOC) in managing the mass casualty burn incident in
which the resources of any given region are exceeded.
The RBCC has the following capabilities:
- Around-the-clock on-call coverage by a burn surgeon and burn disaster response support
team.
- Telemedicine capabilities
- ABAverification as a burn center, or commensurate capabilities
- Access to communication and reporting systems utilized in Ohio (Surgenet, OHTrac,
OPHCS, MARCS)
- A process for recording burn casualty reports from any mass casualty incident
During a Burn Mass Casualty Incident, the RBCC will:
- Notify and coordinate with the American Burn Association to identify burn centers
outside of Ohio that are capable of receiving patients
- Activate Regional Burn Surge Facilities (RBSF) as needed in conjunction with the
RMCC and SEOC
- Lead the triage of all burn patients to the regional RBSF, and, if necessary, to other
region’s RMCC and/or RBSFs
- Support RBSF’s in the care of burn casualties during the initial 72 hours following the
initial incident
- Provide nurses and surgeons to assist in the secondary triage of burn casualties at the
RBSF as needed. This may require assistance from RBCC’s outside of the affected area.
- Coordinate the triage, transfer, and tracking of burn casualties to out-of-state- burn
centers after the initial 72 hours if necessary.
To support Ohio’s preparation to respond to a Burn Mass Casualty Incident, the RBCCs will:
- Assist in the development or writing of training protocols for personnel at designated
RBSFs and other RBCCs
- Provide guidance and recommendations on the rotation and updating of regional burn
supply caches for the initial response
- Provide guidance and recommendations on procurement of critical burn surgery supplies
(skin allograft, wound care products) for their region
- Serve as a resource for current database of supply sources and contacts
- Participate in a web-based resource database to facilitate distribution of documents and
protocols needed for burn mass casualty incident preparedness
- Act as a liaison with burn centers from other states and RBSFs on an ongoing basis for
the Regional Response Plan and to appropriate state agencies
Regional Burn Surge Facilities
Regional Burn Surge Facilities (RBSFs) are hospitals that will care for burn patients given that
designated RBCCs may initially be overwhelmed and transportation limited. Each region will
initially identify Level 2 and Level 3 trauma centers as RBSFs. If additional burn beds are
15
needed, regions should reach out to other hospitals within their region. The goal is a multilateral
increase in short-term capabilities across the regions, surrounding states and FEMA Region 5.
During a Burn Mass Casualty Incident, the RBSF’s will:
-
-
Conduct the initial evaluation and stabilization of burn patients and preparation for
transfer as possible and necessary during the initial 72 hours (either all periods or no
periods after phrases in this section). In a Burn Stage 1 incident, the goal is for all burn
casualties to be transferred within 72 hours to a regional burn center or to burn center
outside of Ohio.
RBSFs function as the initial stabilization/evaluation/transport staging center with
support of the RMCC.
RBSFs will do secondary triage, resuscitation and escharotomies.
RBSFs will be provided with an “Education Kit” to assist with treatment.
Mass Casualty Burn Incident
For the purpose of this plan, qualitative factors that may cause a local jurisdiction to declare a
mass-casualty incident include but are not limited to:
- Inhalation injuries
- Size of the burn area
- Number of victims with more than 40% of burn area
- Presence of other trauma-related injuries which compound the intensity of care and
resources required for ongoing patient care
Mass casualty burn incidents are grouped into three separate and distinct “Burn Stage Levels.”
Each level is based on an analysis of existing burn resources in existence within each planning
region, or based on the enhancement of resources as described within this plan:
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Mass Casualty
Burn Stage
(BS)
Burn Stage I
Definition
Any event in which 10-24 patients:
- Have ≥30% TBSA burn or need
mechanical ventilation
- Meet Mass Casualty Burn Center
Referral Criteria (see page 14)
- Qualitative or quantitative nature of
injuries exceed region’s capacity to
provide effective care
Plan
-
-
Burn Stage II
Any event in which 25-100 patients:
- Have ≥30% TBSA burns or need
mechanical ventilation
- Qualitative nature of injuries exceeds
defined capacity of the region.
-
-
Burn Stage III
Any event in which > 100 patients (or the
potential to have > 100 patients exists)
- Have ≥30% TBSA burns or need
mechanical ventilation
- Qualitative nature of injuries exceeds
defined capacity of the state
-
-
-
RBCCs will manage as many
patients as resources permit who
meet Mass Casualty Burn Center
Referral Criteria.
RBSFs will be utilized as needed to
house all other patients.
If existing burn center resources are
exhausted, patients will be referred
utilizing process outlined in Burn
Stage II.
Alert surrounding state burn centers
closest to incident.
Assure all plans within Stage I are
completed
Local and state EOCs and RMCC
begin to coordinate medical
response efforts
RMCC will manage as many
patients as resources permit who
meet Mass Casualty Burn Center
Referral Criteria
Assure all plans within Stage II are
completed
RMCC and RBCCs will facilitate
coordination of other burn resources
with surrounding states and FEMA
Region 5 partners and the national
ABA network of burn centers.
RBCCs will manage as many
patients as resources permit who
meet Mass Casualty Burn Center
Referral Criteria
If ABA/FEMA Region 5 or
surrounding states burn centers are
unavailable or transport is not
feasible, RBSFs will be utilized to
house patients.
During a Burn Surge Incident, RBCCs will manage as many patients as available resources
permit, meeting the Mass Casualty Burn Center Referral Criteria. RBSFs will be utilized as
needed to house other burn patients. If the existing burn center resources are exhausted, patients
will be referred utilizing the process outlined in Burn Stage II.
17
Once it is recognized that the potential for the event to exceed local resources exists, the local
Emergency Operations Center (EOC) and the RMCC with the assistance of the RBCC should
begin to coordinate medical response efforts with the State EOC. During a BS II incident,
RBCCs will manage as many patients as possible given the resources available for patients
meeting the Mass Casualty Burn Center Referral Criteria. When RBCCs’ bed capacity has been
exceeded and/or transport is not feasible, RBSFs may be utilized to provide care and to house
patients.
During a BS III incident, RBCCs will manage as many patients as resources are available that
meet the Mass Casualty Burn Center Referral Criteria. When RBCCs’ bed capacity has been
exceeded and/or transport is not feasible, RBSFs may be utilized to care for and house patients,
and the process for the coordination of patient movement utilizing surrounding state and/or
FEMA Regional 5 partners will begin.
Patient Transport
One of the most critical elements of any healthcare response plan for mass casualty incidents is
the underlying assumption for readily-available transport for patients to facilities that are able to
provide optimal care based on the nature of patient injuries. The potentially catastrophic results
of a failure in meeting that assumption necessitates that redundancies are built into patient
transport plans.
Supply Caches
Recommendations regarding the purchase and stockpiling of burn supplies for the treatment of
burn patients in the mass casualty environment should be based on:
-
The process for allocation of scarce resources will be provided during surge and crises
situations
There will be limited availability of essential supplies and bed space in burn centers
There will be constraints on human resources
There will be a need for short term care to be managed by medical staff not traditionally
trained in specialized burn wound care
Management of existing resources given discussion of short shelf life of urn supplies
In an effort to mitigate some effects of a surge of burn patients on any given facility, patient
treatment recommendations are based on providing only initial patient care. The care should be
focused on initial management including:
-
Airway, Breathing, Circulation (ABCs)
Fluid resuscitation
Pain Management
Wound care priorities which are to minimize patient pain, overuse of supplies, and time
demands on health care staff until definitive burn care is available (either periods or no
periods in this section)
APPENDIX 1
18
ABA Burn Unit Referral Criteria
Note: It is expected that patients meeting the following criteria will be transferred to intra and
inter state burn centers within 72 hours following the mass casualty event. Depending upon
the level of the incident, however, regional BSFs will have to care for those patients until
transfer is arranged.
BURN UNIT REFERRAL CRITERIA
-
-
Partial thickness burns greater than 10% total body surface area (TBSA)
Burns that involve the face, hands, feet, genitalia, perineum, or major joints
Third-degree burns in any age group
Electrical burns, including lightning injury
Chemical burns
Inhalation injury
Burn injury in patients with preexisting medical disorders that could complicate
management, prolong recovery, or affect mortality
Any patients with burns and concomitant trauma (such as fractures) in which the burn
injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma
poses the greater immediate risk, the patient may be initially stabilized in a trauma
center before being transferred to a burn unit. Physician judgment will be necessary in
such situations and should be in concert with the regional medical control plan and
triage protocols
Burned children in hospitals without qualified personnel or equipment for the care of
children
Burn injury in patients who will require special social, emotional, or long-term
rehabilitative intervention
Excerpted from Guidelines for the Operations of Burn Centers (pp 79), Resources for Optimal Care of the
Injured Patient: 2006, Committee on Trauma, American College of Surgeons.
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APPENDIX 2
Triage Decision Table
APPENDIX 3
Burn Care Facilities in Ohio
20
APPENDIX 3
Ohio’s Burn Centers
Burn Center
Location
Children’s
Hospital
Medical Center
of Akron
Contact
Person
David
Andrews, MD
Medical
Director
Contact
Information
330-434-5341
Number
of Beds
12
Patient Care
Designation
Pediatric and
Adult
14
Pediatric and
Adult
10
Adult
12
Pediatric and
Adult
19
Adult
10
Adult
330-543-8226
Akron
MetroHealth
Medical Center
Miami Valley
Hospital
Nationwide
Children’s
Hospital
The Ohio State
University
Medial Center
St. Vincent
Medical Center
Cleveland
Dayton
Columbus
Columbus
Toledo
Nurse
Manager
Christine
Sadie, RN
Charles
Yowler, MD
Medical
Director
Nurse
Manager
Lynne Yurko,
RN
Travis Perry,
MD
Medical
Director
Nurse
Manager
Melora
Waltman, RN
Or
Team Leader
Gail E.
Besner, MD
Medical
Director
Nurse
Clinician
Sheila Giles,
RN
Sidney Miller,
MD
Medical
Director
Nurse
Manager
Kimberly
Brown, RN
Michael A.
Yanik, MD
Medical
216-778-5627
216-778-4076
937-208-8494
937-208-8494
614-722-3900
614-722-6327
614-293-5710
614-293-8445
419-251-4741
21
Director
The University
Hospitals
Shriner’s
Children’s Burn
Hospital
Cincinnati
Cincinnati
Clinical Nurse
Kimberly
Burkholder,
RN
Kevin Bailey,
MD
Medical
Director
419-251-4734
Nurse Manger
J. Denise
Youngman,
RN
513-584-0543
Richard
Kagan, MD
Medical
Director
513-872-6202
513-558-4361
9
Adult
30
Pediatric
513-872-6257
Nurse
Manager
Angela AllenJackson, RN
A complete listing and contact information for the Ohio Certified Burn Centers can also be found at
www.ameriburn.org.
Revised: 8/31/10
22
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