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Burns
Topic Collection
January 13, 2025

Topic Collection: Burns

Many types of critical incidents (in addition to house and other structure fires) can lead to burn injuries, and not every healthcare facility is able to provide adequate care to burn patients. The resources in this Topic Collection will help healthcare facility staff plan for burn casualties as a result of structural fires, blasts, wildfires, or chemical burns caused by terrorist attacks or hazardous materials incidents. Select articles provide a review of emergency burn care (including care of patients that may have to remain at non-burn centers while awaiting transfer), but this collection is not a comprehensive review of burn care. Select articles that were published more than 10 years ago are also included, as they were deemed "classics" and/or still offer helpful information/planning considerations/templates. Please note that they may contain old fluid resuscitation recommendations or mention oxandrolone (which has been withdrawn by the U.S. Food and Drug Administration). This Topic Collection was refreshed in January 2025. 

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

American Burn Association. (n.d.). Advanced Burn Life Support Live. (Accessed 12/30/2024.)
This online training course (fee required) prepares clinicians to assess burn injuries and make treatment decisions for the first 24 hours following a disaster. This does not provide full ABLS certification which requires attendance at hands-on training offered by burn centers.
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American Burn Association. (2018). Disaster Response. American Burn Association.
This webpage includes links to various resources designed to help manage burn patients in a mass casualty event. This page is updated regularly and currently includes links to resources such as disaster plans, guidelines for providing care in austere conditions.
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ASPR TRACIE. (2020). Healthcare Coalition Burn Surge Annex Template.
The 2019-2023 HPP Funding Opportunity Announcement (FOA) requires Healthcare Coalitions (HCCs) to develop a coalition-level burn annex to their base medical surge/trauma mass casualty response plan. This burn-focused operational annex template can be tailored by coalitions to complement their response plans.
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ASPR TRACIE. (2021). Step-by-Step Guide to Implementing the Coalition Burn Surge Annex TTX Template (PDF).
Healthcare coalitions can use this guide to enhance operational area awareness and capability in order to effectively address the needs of burn victims as part of a whole community emergency response framework. It can also be utilized to satisfy Funding Opportunity Announcement (FOA) requirements for the Hospital Preparedness Program (HPP) Cooperative Agreement.
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ASPR TRACIE. (2023). Mass Burn Event Overview. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides guidance for healthcare coalitions, burn centers, state public health preparedness professionals, healthcare entities, and other stakeholders planning for a burn mass casualty incident.
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ASPR TRACIE. (2024). Burn Mass Casualty Incidents: Triage, Assessment, and Treatment Considerations.
Burn Mass Casualty Incidents (BMCI) are infrequent but can quickly overwhelm local resources and exceed the capacity of the closest burn center to provide care. Patients will need to be cared for initially at non-burn facilities that may be called on to render immediate critical interventions and prolonged care until transfer to a burn center is deemed necessary and possible. This ASPR TRACIE tip sheet offers an initial approach to burn injury evaluation and resuscitation at hospitals that do not normally provide burn care.
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ASPR TRACIE. (2025). Issue 20: Preparing for and Responding to Mass Casualty Burn Incidents.
The articles in this issue can help our stakeholders address challenges associated with planning for and responding to mass casualty burn incidents (MCBIs). One article focuses on the lessons learned since the 2003 Rhode Island Station nightclub fire. Another article highlights ASPR’s National Disaster Medical System’s Disaster Mortuary Operational Response Team’s response to the wildfires that ravaged Maui in 2023. We highlight the role of the national Burn Watch Board in highlighting burn bed availability across the Nation, and we feature an article on how ASPR’s Biomedical Advanced Research and Development Authority (BARDA) is working to research and develop treatments for injuries sustained in an MCBI.
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Endorf, F.W., and Dries, D.J. (2011). Burn Resuscitation. Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine. 11;19:69.
The authors discuss how under-resuscitation has become rare with the use of weight- and injury-based formulas, and that over resuscitation is now a concern that may contribute to death and poor outcomes in adult and pediatric patients. They provide practice-based recommendations that use the 2008 American Burn Association consensus statement as a starting point, with noted modifications based on their clinical experience.
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Herndon, D. et al. (2017). Total Burn Care. (5th edition is available in print and as an e-book.)
This book provides a comprehensive discussion on the management of burn patients from initial presentation to rehabilitation, with an emphasis on an integrated team approach to meet the clinical, social, and physical needs of burn patients.
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Horner, C.W., Crighton, E., and Dziewulski, P. (2012). 30 Years of Burn Disasters within the UK: Guidance for UK Emergency Preparedness. (Abstract only.) Burns. 38(4):578-84.
This article reviews 37 disasters from 1980-2009 that occurred in the UK; only 3 disasters included had more than 5 patients with greater than 10% body surface burned. Findings may be used for surge staff and bed planning and pre-hospital care, as well as to inform exercise planning.
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Jeschke, M.G., et al. (2012). Handbook of Burns Volume 1: Acute Burn Care. (Book available for purchase.)
This book discusses the initial presentation of a burn patient, and describes in detail all aspects of acute burn care.
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Kearns, R., Bettencourt, A., Hickerson, W., et al. (2020). Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline. Journal of Burn Care & Research. 41(4): 770–779.
A committee of experts from the American Burn Association created triage tables for conventional, contingency, crisis, and catastrophic burn care, included in this article. (Readers may need to click on the PDF version of the article to fully access the tables.)
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Kraft, R., Herndon, D.N., Al-Mousawi, A.M., et al. (2012). Burn Size and Survival Probability in Pediatric Patients in Modern Burn Care: A Prospective Observational Cohort Study. Lancet. 379(9820):1013-21.
This article describes a single center, observational cohort study of 952 pediatric burn patients with burns covering at least 30% of their bodies to identify burn size(s) associated with morbidity and mortality. The authors recommend that pediatric patients with burns over more than 60% of their bodies should be transferred immediately to a burn center for care. While dated, these recommendations are still worth including in hospital burn plans.
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Newman, A. (2024). Extreme Weather and Healthcare – Are you Ready for a Burn Disaster?
This article provides an overview of North American burn disaster regions and related organizations and highlights the importance of planning and exercising for burn mass casualty incidents, emphasizing the role of telehealth and burn triage.
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Rowan, M., Cancio, L., Elster, E., et al. (2015). Burn Wound Healing and Treatment: Review and Advancements. Critical Care. 19(1): 243.
This (dated but relevant) review article focuses on burn wound pathophysiology and treatment, and discusses inflammation; resuscitation; wound coverage and grafting; and wound healing.
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University of Michigan State Burn Coordinating Center. (2022). Emergency Burn Triage and Management.
This website offers a wealth of burn care information as well as free just-in-time training modules for hospital staff on the management of burn patients.
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Western Regional Burn Disaster Consortium. (2024). Burn Injury Poster.
This poster guides healthcare providers through a primary and secondary survey of burn injuries and includes burn wound evaluation variables and photos. Steps for responding during a mass casualty burn incident are also included.
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Burn Care Considerations and Research

Aguirrezabala, J., Aguilera-Sáez, J., Illa-Boixaderas, M., et al. (2022). Response of a Single European Burn Center to Centelles Mass Casualty Burn Disaster: Enzymatic Debridement Utility. International Journal of Burns and Trauma. 12(6):224-231.
The authors describe the response to a mass casualty burn incident (MCBI) in Barcelona, Spain, where seven patients qualified for enzymatic debridement. Patients with deep burn injuries to the face and/or lesions with a higher risk of developing complications (e.g., compartment syndrome) were prioritized for treatment. The authors share their treatment protocol, photos of patients and their progress, and strategies for overcoming challenges associated with patient transfer and lack of materials. The lessons learned can inform MCBI planning and response in U.S. hospitals.
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* American Burn Association. (2018). Disaster Response. American Burn Association.
This webpage includes links to various resources designed to help manage burn patients in a mass casualty event. This page is updated regularly and currently includes links to resources such as disaster plans, guidelines for providing care in austere conditions.
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American Burn Association. (2023). Annual Burn Injury Summary Report.
This infographic highlights data on inpatient burn care provided at burn centers between 2018 and 2022. It includes information on causes, regional data, patient demographics, surge admission events, and mortality data. A more recent report is available for a fee.
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* American Burn Association. (2023). Burn Mass Casualty Incident: Who are our Federal Partners? How Can they Assist with Patient Care?
Speakers in this webinar discussed the Maui wildfires and the Western Region Burn Disaster Consortium and related federal initiatives available through the Administration for Strategic Preparedness and Response.
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ASPR TRACIE. (2023). Mass Burn Event Overview. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides guidance for healthcare coalitions, burn centers, state public health preparedness professionals, healthcare entities, and other stakeholders planning for a burn mass casualty incident.
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ASPR TRACIE. (2025). Burn and Blast Medical Countermeasures Program: The Federal Perspective.
The mission of ASPR’s Biomedical Advanced Research and Development Authority (BARDA) is to develop medical countermeasures (MCM) that address the public health and medical consequences of chemical, biological, radiological, and nuclear (CBRN) accidents, incidents and attacks, pandemic influenza, and emerging infectious diseases. In this article from Issue 20 of the ASPR TRACIE Exchange, Dr. Narayan Iyer, BARDA’s CBRN Burn and Blast Medical Countermeasures Program Director, shares more about BARDA’s research and development into treatments for injuries sustained in a mass casualty burn incident (MCBI).
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Avni, T., Levcovich, A., Ad-El, D.D., et al. (2010). Prophylactic Antibiotics for Burns Patients: Systematic Review and Meta-Analysis. British Medical Journal. 340:c241.
The authors performed a review and meta-analysis of studies that looked at the use of systemic antibiotics in burn patients. They found a benefit in all-cause mortality at 100 days to prophylactic antibiotics, but note the poor quality of the research to that point in time, so only recommend perioperative use of antibiotics. While the article is dated, experts continue to agree that prophylaxis is not recommended.
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Azzopardi, E.A., Azzopardi, E., Camilleri, L., et al. (2014). Gram Negative Wound Infection in Hospitalised Adult Burn Patients--Systematic Review and Metanalysis. PLoS One. 9(4):e95042.
The authors found that Gram-negative infections are the most common in burn wounds, and that bacterial species do not differ across institutions, as has been assumed in the past. While the article is dated, these infections continue to be the most common in burn wounds.
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Boyle, T., Ludy, S., Meguerdichian, D., et al. (2023). Feasibility and Acceptability of a Model Disaster Teleconsultation System for Regional Disaster Health Response. Telemedicine Journal and e-Health. 4;29(4):625–632.
The authors studied the feasibility of a partnership between the Region 1 Regional Disaster Health Response System and the American Burn Association, who developed a model regional disaster teleconsultation system. Using simulated disasters, the authors found high acceptance for the model, but participating physicians expressed the need for more reliable technology and improved audiovisual quality.
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Chestovich, P., Saroukhanoff, R., Moujaes, S., et al. (2023). Temperature Profiles of Sunlight-Exposed Surfaces in a Desert Climate: Determining the Risk for Pavement Burns. Journal of Burn Care & Research. 44(2):438-445.
Compared to traditional burns, pavement burns are associated with increased length of hospital stay, higher total hospital costs, and a higher likelihood of operative management. The authors measured the temperature of different surfaces exposed to sunlight, to better understand the risk of burn injury due to hot pavement in desert climates. They found that surfaces in sunlight were 36-56 degrees Fahrenheit hotter than the same materials in the shade. These findings can be incorporated into hospital burn surge plans as heat domes and other extreme heat incidents increase across the U.S.
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Daher, R., Gause, E., Stewart, B., et al. (2023). Preparing for a Burn Disaster in Brazil: Geospatial Modelling to Inform a Coordinated Response. Burns. 49(5):1201-1208.
The authors mapped and classified burn beds in Brazil to understand the geographic challenges associated with getting burn injury care in a mass casualty burn incident (MCBI). They identified healthcare facilities in Brazil which could increase their capacity in the event of an MCBI to ensure at-risk community members had access to care. Healthcare emergency managers in the U.S. may choose to use similar analytical tools when planning for mass burn incidents.
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Datta, P., Chowdhury, S., Aravindan, A., et al. (2022). Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice. Cureus. 14(11):e31550.
This comprehensive review provides guidance for the care of burn victims, including fluid resuscitation (note these do not reflect the 2023 guidelines), nutrition, organ support, and wound care. The review includes rationales for existing guidelines and background on pathophysiology of burn injury.
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Davydow, D.S., Katon, W.J., Zatzick, D.F. (2009). Psychiatric Morbidity and Functional Impairments in Survivors of Burns, Traumatic Injuries, and ICU Stays for Other Critical Illnesses: A Review of the Literature. International Review of Psychiatry. 21(6):531-8.
The authors discuss the prevalence of post traumatic stress disorder, depression, and functional impairments in patients suffering burns, severe trauma, and ICU stays for critical illnesses. They also discuss risk factors for these conditions; interventions to improve outcomes; and future research directions.
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* Feng, J., Chien, J., Kao, K., et al. (2018). Predictors of Early Onset Multiple Organ Dysfunction in Major Burn Patients with Ventilator Support: Experience from A Mass Casualty Explosion. cientific Reports (8(1): 10939.
Records from 88 patients injured at a mass casualty color dust explosion were examined to determine variables associated with early onset multiple organ dysfunction syndrome (MODS). The most common organ failure was hematologic (68.6%); respiratory failure was listed second (48.9%). Patients with early MODS were more likely to have prolonged ventilator dependence and longer stays in the intensive care unit.
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Garcia Garcia, J., Gonzalez Chavez, A., and Orozco Grados, J. (2022). Topical Antimicrobial Agents for the Prevention of Burn-Wound Infection. What Do International Guidelines Recommend? A Systematic Review. World Journal of Plastic Surgery. 11(3):3-12.
This systematic review of clinical practice guidelines found heterogeneity in the existing guidelines for topical antimicrobial agents to prevent burn-wound infection, but no ideal topical treatment for specific settings/clinical scenarios. Most guidelines recommended dressings which incorporated silver compounds. The authors encourage the development of more consistent recommendations.
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Hamblin, M. (2020). Novel Pharmacotherapy for Burn Wounds: What Are the Advancements. Expert Opinion on Pharmacotherapy. 20(3):305-321.
Pharmacotherapy after burn injury can treat metabolic problems, hyperglycemia, catabolism, and glucogenesis. Personalized medicine may improve burn treatment by targeting stem cells and improving tissue regeneration. Sections 5 and 7 of this article cover the importance of nutrition and agents to treat burn progression.
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Herndon, D. et al. (2017). Total Burn Care. (5th edition is available in print and as an e-book.)
This book provides a comprehensive discussion on the management of burn patients from initial presentation to rehabilitation, with an emphasis on an integrated team approach to meet the clinical, social, and physical needs of burn patients.
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Hughes, A., Almeland, S., Leclerc, T., et al. (2021). Recommendations for Burns Care in Mass Casualty Incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020. Burns. 47(2):349-370.
The authors summarize 22 recommendations to enhance burn mass casualty incident (BMCI) response, providing a framework for national and international teams of burn specialists and to support health facilities. They conclude that there is a need for EMT burn specialist teams, standardized care in BMCIs, and advancing healthcare system capability globally.
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Jeng, J., Gibran, N., and Peck, M. (2014). Burn Care in Disaster and other Austere Settings. (Abstract only.) Surgical Clinics of North America. 94(4):893-907.
This article (while dated) appears in a special issue dedicated to burns and discusses considerations for managing burn patients in conditions with limited resources, such as using oral hydration for resuscitation. The authors maintain that all plans should include procedures for resuscitation, airway management, wound care, and pain management, and should be tested their limits on a regular basis.
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Jeschke, M.G., Shahrokhi, S., Finnerty, C.C. et al. (ABA Organization and Delivery of Burn Care Committee.). (2018). Wound Coverage Technologies in Burn Care: Established Techniques. Journal of Burn Care Research. 39(3):313-318..
The authors review established techniques in burn care. They include discussion of care for partial thickness and full thickness burns, synthetic and biosynthetic membranes, amnion biological covering, skin grafting, dermal analogues, and keratinocyte coverage.
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Kearns, R., Flores, C., Arledge, F., et al. (2023). Development of Prepositioned Burn Care-Specific Disaster Resources for a Burn Mass Casualty Incident. (Abstract only.) Journal of Burn Care & Research. 44(6):1428-1433.
The authors used quarterly regional healthcare coalition meetings as “focus groups” to help understand how to prepare emergency responders and local hospitals for burn mass casualty incidents (BMCIs). Participants noted the relationship between the lack of burn patients and related wound dressings. Group consensus led to the creation of a storage kit and supply caches designed to support a BMCI response.
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Klein, M.B., Goverman, J., Hayden, D.L., et al. (2015). Benchmarking Outcomes in the Critically Injured Burn Patient. Annals of Surgery. 259(5):833-41.
The authors followed 300 adults and 241 children from 6 burn centers with TBSA =20% through hospitalization using a single, uniform protocol, and collected data to compare to existing benchmarks (burn size, age, and inhalation injury). The authors contend that the results and improvements in burn injury care form the basis for new (at the time) outcome benchmarks.
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Liu, X., Chi, Y., Wu, Y., et al. (2024). Research Progress and Considerations on Oral Rehydration Therapy for the Prevention and Treatment of Severe Burn Shock: A Narrative Review. (Abstract only.) Burns.
The authors reviewed the literature to understand how oral rehydration therapy (ORT) should be employed as part of burn injury care, since it can be rapidly deployed and is less invasive than IV fluids. They provide provisional guidelines for ORT (timing, rate, and composition of the therapy), emphasizing the need for close monitoring for complications like diarrhea and vomiting.
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Naeini, F., Zeraattalab-Motlagh, S., Rahimlou, M., et al. (2024). Nutritional Interventions in Patients with Burn Injury: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomised Clinical Trials. (Abstract only.) The British Journal of Nutrition. 132(10):1317-1324.
The authors conducted a literature review on the impact of nutritional interventions on burn patients and found that some interventions (e.g., early enteral nutrition, glutamine) could reduce overall mortality, length of hospital stay, and sepsis risk.
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Newman, A. (2024). Extreme Weather and Healthcare – Are you Ready for a Burn Disaster?
This article provides an overview of North American burn disaster regions and related organizations and highlights the importance of planning and exercising for burn mass casualty incidents, emphasizing the role of telehealth and burn triage.
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Norouzkhani, N., Arani, R., Mehrabi, H., et al. (2022). Effect of Virtual Reality-Based Interventions on Pain During Wound Care in Burn Patients; a Systematic Review and Meta-Analysis. Archives of Academic Emergency Medicine. 10(1):e84.
This systematic meta-analysis examined how virtual reality (VR) technology improved pain experienced by 1,293 burn patients. Overall, 22 interventions significantly reduced pain, 7 did not affect pain, and one increased it. The authors recommend providing VR devices to burn wards for patients to reduce pain particularly during bandage changes and other wound care treatments.
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Orban, C., and Tomescu, D. (2013). The Importance of Early Diagnosis of Sepsis in Severe Burned Patients: Outcomes of 100 Patients. Chirurgia. 108(3):385-8.
The authors examined causes of sepsis in 100 burn patients and found that the most common causes were from multi-drug resistant Gram-positive (58%) and Gram-negative (26%) organisms; this confirmed earlier study findings. The article (while dated, findings are still relevant) discusses effective antibiotics to combat these organisms, and highlights the variability in pharmacokinetics in burn patients, and the corresponding need for dose adjustments of these antibiotics.
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Phua, Y., Miller, J. and Wong, S. (2010). Total Care Requirements of Burn Patients: Implications for a Disaster Management Plan. (Abstract only) Journal of Burn Care and Research. 31(6): 935-41.
The authors reviewed patient data from 2006-2009 to better understand their operative and ward-based needs. They found that they could use a formula based on burn surface area, mean depth, and burn type to predict total operating theater time, and that operative time required was greatest during the first week (nursing and related health hours remained relatively constant). While dated, these planning considerations remain relevant.
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Rowan, M., Cancio, L., Elster, E., et al. (2015). Burn Wound Healing and Treatment: Review and Advancements. Critical Care. 19(1): 243.
This (dated but relevant) review article focuses on burn wound pathophysiology and treatment, and discusses inflammation; resuscitation; wound coverage and grafting; and wound healing.
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Shahrokhi, S., Arno, A., Jeschke, M.G. (2014). The Use of Dermal Substitutes in Burn Surgery: Acute Phase. Wound Repair and Regeneration. 22(1):14-22.
This slightly dated article discusses dermal substitutes and their use as scaffolds that promote tissue regeneration and wound healing. Currently available products are reviewed in detail.
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U.S. Army Medical Department Center and School Health Readiness Center of Excellence (2018). Emergency War Surgery: Burns.
This online book chapter provides an overview of the initial management of burns, including escharotomy.
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* Won, P., Craig, J., Choe, D., et al. (2023). Blood Glucose Control in the Burn Intensive Care Unit: A Narrative Review of Literature. (Abstract only.) Burns. 49(8):1788-1795.
The authors note that there are conflicting guidelines for glucose control in burn patients in intensive care. Their review found that intensive glucose control increased the risk of hypoglycemia, but it also led to a decrease in infections. The authors conclude that controlling glucose levels should be tailored to the burn patient’s comorbidities.
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Zhang, P., Zou, B., Liou, Y. (2021). The Pathogenesis and Diagnosis of Sepsis Post Burn Injury. Burns Trauma.
The authors examine the etiology of factors like multiple organ dysfunction syndrome, hypovolemia, immune response, inflammation and metabolic changes that can lead to sepsis in burn injury. They also discuss biomarkers of sepsis after these injuries. Figures 3 and 4 illustrate the pathogenic events and host response to infection in burn patients who contract sepsis.
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Clinical Care

American Burn Association. (2022). Guidelines for Burn Patient Referral.
Healthcare providers can use the information on this webpage related to burn severity and percentage of body surface area involved to determine when a patient needs to be transferred to a burn center.
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ASPR TRACIE. (2024). Burn Mass Casualty Incidents: Triage, Assessment, and Treatment Considerations.
Burn Mass Casualty Incidents (BMCI) are infrequent but can quickly overwhelm local resources and exceed the capacity of the closest burn center to provide care. Patients will need to be cared for initially at non-burn facilities that may be called on to render immediate critical interventions and prolonged care until transfer to a burn center is deemed necessary and possible. This ASPR TRACIE tip sheet offers an initial approach to burn injury evaluation and resuscitation at hospitals that do not normally provide burn care.
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Jayawardena, A., Lowery, A., Wooten, C., et al. (2019). Early Surgical Management of Thermal Airway Injury: A Case Series. (Abstract only.) Journal of Burn Care and Research. 40(2):189-195.
The authors discuss three cases of burns to the airway and found that in all cases the thermal injury was subsequently superseded by the immune response and scarring. The article discusses antibiotic use in two patients and the use of skin graft in the third.
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Jeschke, M., van Barr, M., Choudhry, M., et al. (2020). Burn Injury. Nature Review Disease Primers. 6(1):11.
Because burn injuries can cause immune, inflammatory, and metabolic response they are associated with morbidity and mortality. They can also impact quality of life and mental health, making them challenging to treat. The authors provide overview of burn diagnosis, screening, care, and management.
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Journal of Burn Care & Research. (2024). Practice Guidelines Collection. Oxford Academic.
This webpage links to guidelines for the management of thermal injuries endorsed by the American Burn Association. The recommendations provide best practices on frostbite, caring for critically ill burn patients, pain management, radiation and chemical injuries, and other considerations for clinical care of burn patients (e.g., fluid resuscitation, airway management, skin substitutes and grafts, and occupational and physical therapy).
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Kaddoura, I., Abu-Sittah, G., Ibrahim, A., et al. (2017). Burn Injury: Review of Pathophysiology and Therapeutic Modalities in Major Burns. American Burn Fire Disasters. 30(2):95-102.
Burns are a common form of injury around the world. This paper describes the pathophysiology and treatment of burn injuries, with a focus on metabolic, hemodynamics, cardiac, renal, hepatic, gastro-intestinal, immunologic, endocrine responses. Note that oxandrolone, while mentioned in the article, is no longer used due to an FDA withdrawal.
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* Kearns, R., Bettencourt, A., Hickerson, W., et al. (2020). Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline. Journal of Burn Care & Research. 41(4): 770–779.
A committee of experts from the American Burn Association created triage tables for conventional, contingency, crisis, and catastrophic burn care, included in this article. (Readers may need to click on the PDF version of the article to fully access the tables.)
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Liu, H., Zhang, F., and Lineaweaver, W. (2017). History and Advancement of Burn Treatments. Annals of Plastic Surgery. 78(2):52-58.
This review examines the history, present, and future of burn care treatments. The therapeutics associated with burn care examined here include fluid resuscitation, burn wound excision, dressings, antimicrobials, skin grafts, and skin substitutes.
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Moore, R., Popowicz, P., and Burns, B. (2024). Rule of Nines. StatPearls.
The Rule of Nines is a tool which can assist healthcare providers to understand what percentage of a burn patient’s total body surface area (TBSA) is affected by second- and third-degree burns. The article includes details on how to use the tool and considerations for treating obese or pediatric patients.
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Nielson, C., Duethman, N., Howard, J., et al. (2017). Burns: Pathophysiology of Systemic Complications and Current Management. Journal of Burn Care and Research. 38(1):e469-e481.
The authors translate advancements in the understanding of burn injury at the cellular level into treatment guidance for clinicians. The study focused on cellular mechanisms of burn injury, systemic effects on organs, treatment, and potential future therapeutics.
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Romanowski, K.S., Carson, J., Pape, K., et al. (2020). American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature a Compilation of Expert Opinion and Next Steps. Journal of Burn Care and Research. 41(6):1129-1151.
The authors reviewed the literature from 1968-2018 and brought together experts to discuss treatment of pain after burn injury. The group noted gaps in the current knowledge and research questions for future studies. They also created 20 guidelines on pain assessment, pharmacologic and nonpharmacologic treatments, and anesthesia.
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Roy, S., Mukherjee, P., Kundu, S., et al. (2024). Microbial Infections in Burn Patients. Acute and Critical Care. 39(2):214-225.
Microbial infections, including drug resistant infections, can occur after burn injury. This article includes background on epidemiology, etiology, and common pathogens seen in burn injury infections. It covers the most common pathogens observed, including bacteria, fungal and viral infections.
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Schaefer, T. and Nunez Lopez, O. (2023). Burn Resuscitation and Management. StatPearls.
The authors cover how to treat burn injury sites and systemic reactions which can lead to burn shock. The article includes information on when fluid resuscitation is warranted in adults and children, contraindications, techniques, and other clinical considerations for fluid resuscitation.
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Western Region Burn Disaster Consortium. (2022). Burn Injury Guidelines for Care.
This document can help guide clinical care for single or multiple burn patients. It includes sections on adult and pediatric burn patients, wound care, physical therapy, radiation injury, mental health, and providing patient care during a burn mass casualty incident.
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Wibbenmeyer, L., Lacey, A., Endorf, F., et al. (2024). American Burn Association Clinical Practice Guidelines on the Treatment of Severe Frostbite. Journal of Burn Care & Research. 45(3):541-556.
This clinical practice guideline, endorsed by the American Burn Association, provides information on best practices for treatment of severe frostbite. After a multidisciplinary committee reviewed the literature, they recommended rewarming the affected tissue in a water bath and treating with thrombolytics to minimize the need for amputation. There were several other clinical care recommendations for which there is limited existing evidence.
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* Won, P., Craig, J., Choe, D., et al. (2023). Blood Glucose Control in the Burn Intensive Care Unit: A Narrative Review of Literature. (Abstract only.) Burns. 49(8):1788-1795.
The authors note that there are conflicting guidelines for glucose control in burn patients in intensive care. Their review found that intensive glucose control increased the risk of hypoglycemia, but it also led to a decrease in infections. The authors conclude that controlling glucose levels should be tailored to the burn patient’s comorbidities.
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Young, A., Graves, C., Kowalske, K., et al. (2017). Guideline for Burn Care Under Austere Conditions. Journal of Burn Care & Research. 38(2):e497-e509.
The authors provide guidelines for burn care and pain management in resource-limited settings, whether a rural setting or during a mass casualty burn incident that leads to a lack of supplies. They address how pain, nutrition, rehabilitation, pediatric issues, and palliative care can be managed in these austere settings.
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Education and Training

American Burn Association. (n.d.). Training Brochure: Advanced Burn Life Support. (Accessed 1/9/2025.)
This brochure outlines two training courses (fee required) that prepare clinicians and emergency personnel to assess burn injuries and make treatment decisions for the first 24 hours following a burn disaster. Course options include live, didactic lectures with hands-on simulations or an online, self-paced learning program.
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American Burn Association. (2020). Just-in-Time Training Summary Sheet: Patient Care Priorities for the First 24 hours in Burn Mass Casualty for Non-Burn Physicians.
Healthcare providers can use the information in this document to provide burn patient care (e.g., triage, decontamination for radiation exposure, airway care, circulation, and wound care) just after a mass casualty burn incident, in an austere environment.
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* ASPR TRACIE. (2021). Step-by-Step Guide to Implementing the Coalition Burn Surge Annex TTX Template (PDF).
Healthcare coalitions can use this guide to enhance operational area awareness and capability in order to effectively address the needs of burn victims as part of a whole community emergency response framework. It can also be utilized to satisfy Funding Opportunity Announcement (FOA) requirements for the Hospital Preparedness Program (HPP) Cooperative Agreement.
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* ASPR TRACIE. (2021). Using the ASPR TRACIE Burn Surge Templates to Enhance an HCC (PPT).
Annette Newman, MS, RN, CCRN, Community Outreach/Burn Disaster Coordinator and Western Region Burn Disaster Consortium Coordinator shares how a healthcare coalition used ASPR TRACIE burn surge templates during actual incidents and exercise templates to help with the planning process.
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* County of Los Angeles, Department of Health Services, Emergency Medical Services Agency, Disaster Services. (2024). Burn Resource Manual.
This manual both defines the role of a Burn Resource Center (BRC) and provides guidelines for the use of BRCs during a burn disaster in Los Angeles County. A burn care plan, appendices, and training resources make up this manual that may also serve as a model for other locales when developing burn bed surge plans.
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Cross, J. and Kazzi, Z. (2009). Responding to Victims with Burn Injuries in Disaster Events. (Free registration required.) Alabama Department of Public Health.
This 90-minute webcast provides participants with information to enhance their expertise in burn care.
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Emergency Management Institute. (2021). V-0001 – Virtual Tabletop Exercise Series (VTTX) Public Health Burn Mass Casualty Incident. Federal Emergency Management Agency.
The exercise focuses on a public health emergency from the result of a Burn Mass Casualty Incident (MCI). Participants will address the limited availability of hospital beds, transportation, and logistics during the exercise.
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* Kearns, R.D., Myers, B., Cairns, C.B., et al. (2014). Hospital Bioterrorism Planning and Burn Surge. Biosecurity Bioterrorism. 12(1):20-8.
This article discusses how using an all-hazards approach to bioterrorism response planning helped to prepare hospitals in the Raleigh/Durham, NC area to care for casualties from a plant explosion in June 2009. The rescue, response, and resuscitation of survivors by first responders and first receivers, as well as efforts to develop burn surge, are described.
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University of Michigan State Burn Coordinating Center. (2022). Emergency Burn Triage and Management.
This website offers a wealth of burn care information as well as free just-in-time training modules for hospital staff on the management of burn patients.
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* Western Region Burn Disaster Consortium. (2021). Burn Surge Tabletop Exercise Template.
This template includes an exercise overview, objectives and aligned capabilities, roles and responsibilities, logistics, schedule, and communications plan. (Select materials apply only to exercise planners, controllers, and evaluators.)
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Event-Specific Lessons Learned

* American Burn Association. (2023). Burn Mass Casualty Incident: Who are our Federal Partners? How Can they Assist with Patient Care?
Speakers in this webinar discussed the Maui wildfires and the Western Region Burn Disaster Consortium and related federal initiatives available through the Administration for Strategic Preparedness and Response.
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* ASPR TRACIE. (2021). Using the ASPR TRACIE Burn Surge Templates to Enhance an HCC (PPT).
Annette Newman, MS, RN, CCRN, Community Outreach/Burn Disaster Coordinator and Western Region Burn Disaster Consortium Coordinator shares how a healthcare coalition used ASPR TRACIE burn surge templates during actual incidents and exercise templates to help with the planning process.
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ASPR TRACIE. (2025). Injuries Sustained and Lessons Learned from the 2003 Station Nightclub Fire.
The 2003 Station nightclub fire—one of the deadliest in American history— resulted in over 200 injuries and 100 deaths. At the time, Dr. Colleen Ryan was serving as the co-director of the Sumner Redstone Burn Center at Massachusetts General Hospital, where she provided care to numerous burn patients after this mass casualty burn incident (MCBI). We interviewed Dr. Ryan (currently a Professor of Surgery at Harvard Medical School, and Staff Surgeon at both Sumner Redstone Burn Center and Shriners Children’s-Boston) to learn more about the incident and the progress that has been made in the MCBI and burn injury fields since 2003 for Issue 20 of the ASPR TRACIE Exchange.
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ASPR TRACIE. (2025). Issue 20: Preparing for and Responding to Mass Casualty Burn Incidents.
The articles in this issue can help our stakeholders address challenges associated with planning for and responding to mass casualty burn incidents (MCBIs). One article focuses on the lessons learned since the 2003 Rhode Island Station nightclub fire. Another article highlights ASPR’s National Disaster Medical System’s Disaster Mortuary Operational Response Team’s response to the wildfires that ravaged Maui in 2023. We highlight the role of the national Burn Watch Board in highlighting burn bed availability across the Nation, and we feature an article on how ASPR’s Biomedical Advanced Research and Development Authority (BARDA) is working to research and develop treatments for injuries sustained in an MCBI.
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Cairns, B.A., Stiffler, A., Price, F. et al. (2005). Managing a Combined Burn Trauma Disaster in the Post-9/11 World: Lessons Learned From the 2003 West Pharmaceutical Plant Explosion. (Abstract only.) The Journal of Burn Care and Rehabilitation. 26(2):144-50.
The authors share lessons learned from a January 2003 chemical plant fire and describe the challenges associated with managing patients with combined burn and trauma injuries. While dated, solid recommendations for disaster planning are included.
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Chen, H., Wu, K., Yeh, C., et al. (2019). Management of Major Burns in 37 Casualties of a Colored Powder Explosion: Experience of the Linkou Burn Center in Taiwan. (Abstract only.) Annals of Plastic Surgery. 82(5):512-519.
Using data for 37 patients with burns over more than 20% total burn surface area, the authors describe patient treatment at a burn center after a mass casualty burn incident. Nearly 100 debridement and 88 skin grafts were performed; patients received an average of 5.6 surgeries. The mean hospital stay was 62 (+/- 32) days, and two mortalities ensued (one related to cardiac insult, the other due to sepsis).
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Chien-Hao Lin, Chih-Hao Lin, Chih-Yi Tai, et al. (2019). Challenges of Burn Mass Casualty Incidents in the Prehospital Setting: Lessons From the Formosa Fun Coast Park Color Party. (Abstract only.) Prehospital Emergency Care. 23(1): 44-48.
A review of the prehospital treatment of patients of a mass casualty burn incident revealed the need to improve field triage protocols (e.g., by adding signs of inhalation injury). Additional findings included the benefit of using regional emergency medical services to ensure equitable patient loading.
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Chim, H, Yew, W.S., and Song, C. (2007). Managing Burn Victims of Suicide Bombing Attacks: Outcomes, Lessons Learnt, and Changes Made from Three Attacks in Indonesia. Critical Care. 11(1):R15.
The authors reviewed medical charts of victims of three separate terrorist bombings to identify lessons learned and develop a burn disaster response plan for future events. Considerations for simultaneous blast injuries in the management of bombing casualties are included.
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Chuang, S., Chang, K., Woods, D., et al. (2019). Beyond Surge: Coping with Mass Burn Casualty in the Closest Hospital to the Formosa Fun Coast Dust Explosion. (Abstract only.) Burns. 445(4): 964-973.
The authors combined data from medical records with information gleaned from interviews with healthcare providers who responded to the incident to understand how the hospital adapted to patient surge and bottlenecks. Providers treated 44 patients with an average total burn surface area of 51.3%; 20 were intubated. Shortages in clinicians, space, and equipment ensued, and the authors described three primary adaptive strategies that bolstered the response.
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Dacey, M. (2003). Tragedy and Response—The Rhode Island Nightclub Fire. (First 100 words only.) New England Journal of Medicine. 349:1990-1992.
This article provides a graphic account with excellent learning points from the vantage of an emergency department physician caring for multiple victims in the aftermath of the Station Nightclub fire in Rhode Island.
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* Feng, J., Chien, J., Kao, K., et al. (2018). Predictors of Early Onset Multiple Organ Dysfunction in Major Burn Patients with Ventilator Support: Experience from A Mass Casualty Explosion. cientific Reports (8(1): 10939.
Records from 88 patients injured at a mass casualty color dust explosion were examined to determine variables associated with early onset multiple organ dysfunction syndrome (MODS). The most common organ failure was hematologic (68.6%); respiratory failure was listed second (48.9%). Patients with early MODS were more likely to have prolonged ventilator dependence and longer stays in the intensive care unit.
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Kao, H., Loh, C., Kou, H., et al. (2018). Optimizing Mass Casualty Burns Intensive Care Organization and Treatment Using Evidence-Based Outcome Predictors. (Abstract only.) Burns. 44(5): 1077-1082.
Of the 52 burn injury patients who required intensive care after a mass casualty incident, 44,2% received escharotomies; patients had a mean of nearly 15 days on mechanical ventilation; and each patient received an average of two grafting procedures. The authors emphasize the need to incorporate these findings into hospital preparedness plans.
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* Kearns, R.D., Myers, B., Cairns, C.B., et al. (2014). Hospital Bioterrorism Planning and Burn Surge. Biosecurity Bioterrorism. 12(1):20-8.
This article discusses how using an all-hazards approach to bioterrorism response planning helped to prepare hospitals in the Raleigh/Durham, NC area to care for casualties from a plant explosion in June 2009. The rescue, response, and resuscitation of survivors by first responders and first receivers, as well as efforts to develop burn surge, are described.
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Mahoney, E., Harrington, D., Biffl, W., et al. (2005). Lessons Learned from a Nightclub Fire: Institutional Disaster Preparedness. Annals of Plastic Surgery. 67(5):460-3.
The authors share their experiences treating burn patients from the Station nightclub fire, including converting the trauma floor of Rhode Island Hospital into a 21-bed burn intensive care unit and 34-bed acute burn ward.
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(2025). Managing Disaster Mortuary Services after the Maui Wildfires.
When fires ravaged Maui and took the lives of 102 people, personnel from ASPR’s Office of the National Disaster Medical Systems (NDMS) Disaster Mortuary Operational Response Teams (DMORT) were deployed to support the decedent management aspects of the disaster. The experienced mortuary specialists on the team, along with regional response staff, assisted across the state with victim identification and respectfully processing human remains. ASPR TRACIE met with Robert Vigil, Deputy Team Commander, DMORT Region 9 (who spent three weeks in Maui and subsequently won the NDMS Director Jack W. Beall 2024 Responder of the Year Award) and Josh Gore, Supply Management Officer/Logistics Section Chief with the Logistics Response Assistance Team (who spent nearly four weeks there) to learn more about the logistics work that contributed to this award-winning response for Issue 20 of the ASPR TRACIE Exchange.
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Smolle, C., Cambiaso-Daniel, J., Forbes, A., et al. (2017). Recent Trends in Burn Epidemiology Worldwide: A Systematic Review. Burns. 43(2):249-257.
This paper examines the epidemiology of burns, including their higher prevalence in lower socioeconomic populations and in less developed communities. The authors explain, however, that advances in social development and burn care mean that burn injuries are causing less morbidity and mortality, especially in highly developed countries.
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Sole Brito, C. (2024). Hot Spots: Reflecting on the Summer of 2023.
The author provides a snapshot of burns and heat-related illness in the summer of 2023 accompanied by links to related ASPR TRACIE resources that can help readers prepare for warmer weather and wildfires.
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Steinert, A. and Mendelson, J. (2024). 538 Lessons Learned: Helping Non-Burn Facilities Prepare for Burn Mass Casualty Disasters. (Abstract only.) Journal of Burn Care & Research. 45(Suppl 1):137.
An Oregon burn center updated the state’s burn mass casualty plan, focusing on caring for patients beyond the first 96 hours. The authors then conducted several tabletop exercises to familiarize EMS and healthcare facilities in both urban and rural settings with the plan. The exercises revealed similar issues across rural and urban regions, including “difficulty establishing control at the scene and the initial responding hospital, insufficient decontamination supplies, traffic and delays in transporting patients… and lack of staffing.”
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Trinh, N., Nadler, D., Shie, V., et al. (2014). Psychological Sequelae of the Station Nightclub Fire: Comparing Survivors with and Without Physical Injuries Using a Mixed-Methods Analysis. PloS One. 9(12).
This survey of 104 Station nightclub fire survivors found that all experienced significant negative mental health effects, regardless of injury status. The authors break down these results and note the positive aspects as well (e.g., respondents feeling as though they had a second chance at life, meeting a helpful support group).
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Weissman, O., Israeli, H., Rosengard, H., et al. (2013). Examining Disaster Planning Models for Large Scale Burn Incidents--A Theoretical Plane Crash into a High Rise Building. (Abstract only.) Burns. 39(8):1571-6.
The authors use outcome data from the El-Al cargo Aircraft crash near the Amsterdam Schiphol Airport in 1992; the World Trade Center attacks in New York; and the attack against the Pentagon in Washington, DC on 9/11/01 to develop recommendations for managing burn mass casualty incidents.
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Yang, C. and Shih, C. (2016). A Coordinated Emergency Response: A Color Dust Explosion at a 2015 Concert in Taiwan. American Journal of Public Health. 106(9):1582–1585.
An explosion of color powder forced “color play” concert attendees to flee; 499 victims were transported to 34 hospitals within six hours (and cared for by 1235 first responders) in nearly 300 emergency vehicles from agencies across five cities and counties. The authors highlight cross-departmental coordination and mobilization, long-term case management, and lessons learned (e.g., how the unified command system and teams carried out a successful response, managing already crowded emergency departments and patient transfer, and the equitable distribution of scarce supplies in high demand).
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Yeong, E., O'Boyle, C., Huang, H., et al. (2018). Response of a Local Hospital to a Burn Disaster: Contributory Factors Leading to Zero Mortality Outcomes. (Abstract only.) Burns. 44(5): 1083-1090.
The authors describe characteristics and treatment of burn injuries following a mass casualty burn incident; 42% of patients were intubated on the day they were admitted, with 71% having confirmed inhalation injuries and mean intubation time of 17 days. Nearly all patients received grafting, and the mean hospital stay was 1.5 days per percent burn. The authors highlight facility expansion, staff recruitment, and clear treatment strategies for burn patients as factors that contributed to a successful response.
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Pediatric Considerations

Branski, L.K., Norbury, W.B., Herndon, D.N., et al. (2010). Measurement of Body Composition in Burned Children: Is there a Gold Standard? Journal of Parenteral and Enteral Nutrition. 34(1):55-63.
This prospective study of 279 pediatric patients with burns covering 40% of total body surface area compared 2 measurement methods for body composition: whole body potassium counting (K count); and dual x-ray absorptiometry (DEXA). The authors concluded that DEXA scans be used (with a correction factor, as needed) because they are less stressful for the patient, in addition to being more affordable than K counts.
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Jeschke, M.G., Gauglitz, G.G., Kulp, G.A., et al. (2012). Long-Term Persistance of the Pathophysiologic Response to Severe Burn Injury. PLoS One. 6(7):e21245.
This cohort study was conducted from 1998-2008, and enrolled 997 pediatric burn patients and a matched control group to measure hypermetabolic and inflammatory changes for 36 months post-burn. The authors found that alterations persisted for far longer than originally thought, and that severely burned pediatric patients require treatment for a longer period of time. While dated, these findings are still worth considering in hospital burn plans.
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Jeschke, M.G., Kulp, G.A., Kraft, R., et al. (2010). Intensive Insulin Therapy in Severely Burned Pediatric Patients: A Prospective Randomized Trial. American Journal of Respiratory and Critical Care Medicine. 182(3):351-9.
This prospective randomized study of 239 severely burned pediatric patients with burns over greater than 30% of their bodies showed that intensive insulin therapy decreased mortality in the treatment group vs. the control group. Insulin was shown to improve organ function, and to decrease catabolism, insulin resistance, sepsis, and infection.
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Joffe, M. (2024). Moderate and Severe Thermal Burns in Children: Emergency Management. UpToDate.
This webpage contains current information on the recommended treatment for burn injuries. It covers clinical care of the burn wound, systemic and metabolic responses, prehospital care, evaluation, physical examination, and other clinical information.
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Kraft, R., Herndon, D.N., Al-Mousawi, A.M., et al. (2012). Burn Size and Survival Probability in Pediatric Patients in Modern Burn Care: A Prospective Observational Cohort Study. Lancet. 379(9820):1013-21.
This article describes a single center, observational cohort study of 952 pediatric burn patients with burns covering at least 30% of their bodies to identify burn size(s) associated with morbidity and mortality. The authors recommend that pediatric patients with burns over more than 60% of their bodies should be transferred immediately to a burn center for care. While dated, these recommendations are still worth including in hospital burn plans.
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Kraft, R., Herndon, D.N., Finnerty, C.C., et al. (2014). Occurrence of Multiorgan Dysfunction in Pediatric Burn Patients: Incidence and Clinical Outcome. Annals of Surgery. 259(2):381-7.
This prospective study of 821 pediatric burn patients with burns over greater than 30% of their bodies at a single burn center categorized patients as having single- organ failure, multi-organ failure, and no organ failure, and related impact on clinical outcomes. The authors found that patients with liver and renal failure had the worst outcomes, while those with cardiac and pulmonary organ failures had good prognoses. Patients with three or more organ failures were generally fatal cases. While dated, these considerations are still worth including in hospital burn plans.
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Landolt, M.A., Buehlmann, C., Maag, T., Schiestl, C. (2009). Brief Report: Quality of Life is Impaired in Pediatric Burn Survivors with Posttraumatic Stress Disorder. Journal of Pediatric Psychology. 34(1):14-21.
The authors interviewed 43 pediatric burn patients at an average of 4.4 years post-burn and found that 8 of them had post-traumatic stress disorder (PTSD); PTSD was also negatively correlated with patients’ health-related quality of life.
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Rivero, H.G., Lee, J.O., Herndon, D.N., et al. (2011). The Role of Acute Pancreatitis in Pediatric Burn Patients. Burns. 37(1):82-5.
The authors looked at autopsy reports of 78 burned children for reported evidence of pancreatic inflammation, and fat/parenchymal necrosis. The incidence of pancreatitis was found to be low, but its negative effects on mortality were found to be high. The authors advocate for increased monitoring and management of pancreatitis in burned children; these findings remain valid years later.
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Rosanova, M.T., Stamboulian, D., and Lede, R. (2014). Risk Factors for Mortality in Burn Children. (Abstract only.) Brazilian Journal of Infectious Disease. (2):144-9.
The authors reviewed clinical data for 100 pediatric patients ranging from 31.5 months to 204 months old to determine risk factors for mortality; burn sizes and depths were variable among the study population. They identified age less than or equal to 4 years; Garces index score 4; colistin use in documented multiresistant infections; mechanical ventilation; and graft requirement as independent variables related with mortality.
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Ryan, C.M., Antoon, A., Fagan, S.P., et al. (2011). Considerations for Preparedness for a Pediatric Burn Disaster. (Abstract only.) Journal of Burn Care Research. 32(5):e165-6.
This “Letter to the Editor” outlines considerations (still relevant years later) that must be included in the development of pediatric burn plans, such as addressing mental health and family reunification needs; specialized equipment/size of equipment; and modifications of triage and care protocols to suit pediatric patients.
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Tompkins, R.G. (2012). Survival of Children with Burn Injuries. Lancet. 379(9820):983-4.
This (dated, but still relevant) article discusses improvements in survival from burn injuries and briefly summarizes key advances that have led to decreased mortality from burns for both children and adults.
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Williams, F.N., Branski, L.K., Jeschke, M.G., and Herndon, D.N. (2011). What, How, and How Much Should Patients with Burns be Fed? Surgical Clinics of North America. 91(3):609-.
This review focuses on nutritional support to decrease post-burn hyper-metabolism and insulin resistance. The authors recommend enteral delivery of high-protein, high carbohydrate feedings and drugs to promote anabolism, in addition to thermoregulation and early excision and grafting of wounds. This resource remains informative, though somewhat dated; note that oxandrolone has been withdrawn by the FDA.
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Williams, F.N., Herndon, D.N., Hawkins, H.K., et al. (2009). The Leading Causes of Death after Burn Injury in a Single Pediatric Burn Center. Critical Care. 13(6):R183.
The authors reviewed autopsy reports for 144 pediatric burn patients admitted to their burn center from 1989-2009. The leading cause of death over the 20-year period was sepsis (47% overall; 54% for 1999-2009), followed by respiratory failure (29%), anoxic brain injury (16%), and shock (8%). Multi-drug resistant bacteria are believed to account for the increase in sepsis over time time (this finding remains valid years later).
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Plans, Tools, and Templates

Albanese, J., Burich, D., Smith, D., et al. (2015). Clinical Guidelines for Responding to Chemical, Biological, Radiological, Nuclear and Trauma/Burn Mass Casualty Incidents: Quick Reference Guides for Emergency Department Staff. (Abstract only.) Journal of Business Continuity and Emergency Planning. 8(2):122-133.
This paper describes clinical guidelines for hospitals to treat patients during chemical, biological, radiological, or other incidents leading to a mass casualty event in which many people must be treated for burns. While slightly dated, these guidelines can help hospitals prepare for such incidents.
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* American Burn Association. (2018). Disaster Response. American Burn Association.
This webpage includes links to various resources designed to help manage burn patients in a mass casualty event. This page is updated regularly and currently includes links to resources such as disaster plans, guidelines for providing care in austere conditions.
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ASPR TRACIE. (2020). Healthcare Coalition Burn Surge Annex Template.
The 2019-2023 HPP Funding Opportunity Announcement (FOA) requires Healthcare Coalitions (HCCs) to develop a coalition-level burn annex to their base medical surge/trauma mass casualty response plan. This burn-focused operational annex template can be tailored by coalitions to complement their response plans.
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* ASPR TRACIE. (2021). Step-by-Step Guide to Implementing the Coalition Burn Surge Annex TTX Template (PDF).
Healthcare coalitions can use this guide to enhance operational area awareness and capability in order to effectively address the needs of burn victims as part of a whole community emergency response framework. It can also be utilized to satisfy Funding Opportunity Announcement (FOA) requirements for the Hospital Preparedness Program (HPP) Cooperative Agreement.
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ASPR TRACIE. (2022). Disaster Available Supplies in Hospitals (DASH) Tool.
Disaster Available Supplies in Hospitals (DASH) is an interactive tool that can help hospital emergency planners and supply chain staff estimate supplies that may need to be immediately available during various mass casualty incidents and infectious disease emergencies based on hospital characteristics. Comprised of four modules (pharmacy, burn, trauma, and personal protective equipment), DASH recommends average par levels for specific supplies that acute care hospitals may need to have on hand to respond to a disaster in their community until resupplied. Recommendations are based on user inputs about the size of the hospital, risks in the community, regional role/designation of the hospital, and other factors.
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ASPR TRACIE. (2024). Medical Operations Coordination Centers Toolkit (Third Edition).
This Medical Operations Coordination Centers Toolkit, updated in 2024 to include burn and pediatric annexes, offers considerations that can help state, local, tribal, and territorial governments; cooperative entities such as health care coalitions or trauma/emergency medical services regions; and health care systems ensure optimal balancing of patients across health care facilities and systems.
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ASPR TRACIE. (2025). The Big Picture: Using the Nevada Hospital Association’s Burn Watch Board to Understand Capacity.
Tracking the number of hospital beds available at any given time is a daunting task, and burn beds are no exception. ASPR TRACIE met with Dr. Christopher Lake, who has worked at the Nevada Hospital Association for more than a decade, developing programs that can help healthcare facilities better prepare for and respond to disasters. He provided a tour of the Burn Watch Board—launched just prior to the wildfires that devastated Maui and now used by more than 350 users per day—describing its features and future for an article in Issue 20 of the ASPR TRACIE Exchange.
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* County of Los Angeles, Department of Health Services, Emergency Medical Services Agency, Disaster Services. (2024). Burn Resource Manual.
This manual both defines the role of a Burn Resource Center (BRC) and provides guidelines for the use of BRCs during a burn disaster in Los Angeles County. A burn care plan, appendices, and training resources make up this manual that may also serve as a model for other locales when developing burn bed surge plans.
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Illinois Department of Public Health. (2016). Burn Surge Annex.
This plan supports the Illinois Department of Public Health Emergency Support Function-8 (ESF-8) Plan, by providing a functional annex for all stakeholders involved in an emergency response within the state of Illinois and/or adjacent states in order to provide appropriate burn medical care to patients in Illinois during a burn mass casualty incident (MCI). It guides the state level response and provides local medical services guidance on the care of burn patients, including patient movement, recommendations for care, and resource allocation during a burn MCI that overwhelms the local health care system.
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* Kearns, R., Bettencourt, A., Hickerson, W., et al. (2020). Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline. Journal of Burn Care & Research. 41(4): 770–779.
A committee of experts from the American Burn Association created triage tables for conventional, contingency, crisis, and catastrophic burn care, included in this article. (Readers may need to click on the PDF version of the article to fully access the tables.)
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Kearns, R.D., Cairns, B.A., Hickerson, W.L., and Holmes, J.H. 4th. (2014). ABA Southern Region Burn Disaster Plan: The Process of Creating and Experience with the ABA Southern Region Burn Disaster Plan. (Abstract only.) Journal of Burn Care Research. 35(1):e43-8.
This article (while dated, still relevant) discusses the creation of the ABA Southern Region Burn disaster plan developed in 2006 in response to a regional disaster and has been refined through exercises, modeling, and actual events. The authors emphasize the need to build relationships and collaborations in the pre-event setting to ensure the success of any emergency plan, and include information on elements that should be included in all burn plans.
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Kearns, R.D., Conlon, K.M., Valenta, A.L., et al. (2014). Disaster Planning: The Basics of Creating a Burn Mass Casualty Disaster Plan for a Burn Center. (Abstract only.) Journal of Burn Care Research.  35(1):e1-e13.
This article discusses the place of burn centers within the overall local and state disaster response plans, and provides guidance on the priorities for a burn surge plan, which are: coordination, communication, triage, plan activation (trigger point), surge, and regional capacity. The authors advocate for regular plan exercising and emphasize the need for coordination with governmental authorities and other burn centers in the area, recommendations that remain relevant though the article is dated.
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Kearns, R.D., Holmes, J.H. 4th, Alson, R.L., Cairns, B.A.. (2014). Disaster Planning: The Past, Present, and Future Concepts and Principles of Managing a Surge of Burn Injured Patients for those Involved in Hospital Facility Planning and Preparedness. (Abstract only.) Journal of Burn Care Research. 35(1):e33-42.
The authors reviewed published plans, academic works, findings from actual disasters, and reports on disaster modeling to develop surge plan recommendations and a checklist for non-burn center hospitals to use before they are able to transfer burn patients. They focus on staff, supplies, and space, considerations that remain relevant a decade later.
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Kearns, R.D., Hubble, M.W., Holmes, J.H. 4th, and Cairns, B.A. (2014). Disaster Planning: Transportation Resources and Considerations for Managing a Burn Disaster. (Abstract only.) Journal of Burn Care Research. 35(1):e21-32.
The authors review resources for transporting patients, ranging from public to private ambulances and military and governmental vehicles. The authors also emphasize the need for emergency medical planners to know availability, capability, and how to access all potential resources for transporting patients in a mass casualty incident, considerations that remain relevant a decade later.
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Kearns, R.D., Hubble, M.W., Lord, G.C., et al. (2015). Disaster Planning: Financing a Burn Disaster, Where Do You Turn and What Are Your Options When Your Hospital Has Been Impacted by a Burn Disaster in the United States? (Abstract only.) Journal of Burn Care Research. 37(4): 197-206.
This article (while dated, still relevant) discusses the significant care costs for burn patients and provides guidance to hospitals for identifying sources to support care for a large number of burn casualties at their facility.
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Kearns, R.D., Marcozzi, D.E., Barry, N., et al. (2017). Disaster Preparedness and Response for the Burn Mass Casualty Incident in the Twenty-first Century. Clinics in Plastic Surgery. 44(3):441-449.
The authors outline planning and preparedness for a burn mass casualty incident. Planners should consider resources available and preparing to adapt space for rapid triage and discharge after an incident.
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Michigan State Burn Coordinating Center (2018). State of Michigan Burn Mass Casualty Incident (BMCI) Surge Plan.
This document can help emergency managers in Michigan prepare to respond to mass burn casualty incidents, including at sites which do not typically treat burn patients. It can also be tailored by planners in other states.
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Minnesota Department of Health (2019). Minnesota Burn Surge Plan.
This plan lays out how the Minnesota Department of Health would coordinate care for a surge of burn injury patients. It can also be tailored by planners in other states.
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U.S. Department of Health and Human Services, Radiation Emergency Medical Management. (2025). Burn Triage and Treatment: Thermal Injuries.
This website provides information on caring for patients with thermal injuries resulting from a radiation event/nuclear detonation, including treatment of burns under mass casualty conditions. It also provides information on national burn bed capacity, and includes algorithms and tools, such as a dose estimator and “scarce resources triage tool.”
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University of Utah Healthcare. (2024). UofU Health MedPic.
Healthcare providers can use the application to send HIPAA compliant images to University of Utah health teams specializing in burns, plastic surgery, and dermatology for evaluation. This can help determine whether burn patients can be treated in place or need to be transferred for more specialized care.
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Western Region Burn Disaster Consortium. (2021). Burn Mass Casualty Operations Plan.
This plan can serve as a template for healthcare coalitions, burn centers, state public health preparedness professionals, healthcare entities, and other stakeholders planning for a burn mass casualty incident. It identifies the necessary experts and specialized resources and includes information on patient transport, patient tracking and job action sheets, and other tools and processes to ensure a smooth response.
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* Western Region Burn Disaster Consortium. (2021). Burn Surge Tabletop Exercise Template.
This template includes an exercise overview, objectives and aligned capabilities, roles and responsibilities, logistics, schedule, and communications plan. (Select materials apply only to exercise planners, controllers, and evaluators.)
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Western Region Burn Disaster Consortium and Partners. (2022). Burn Surge Planning Toolkit (Version 2).
The document includes both the updated Western Region Burn Disaster Consortium's Burn Mass Casualty Incident Concept of Operations Plan and Healthcare Coalition Burn Surge Annex Template. Updates include new algorithms and flowcharts; links to related resources are also provided.
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Western Region Burn Disaster Consortium and Partners. (2024). Burn Buddy Badge.
Healthcare providers can carry this small, printable reference card to help them perform triage and care on a burn patient.
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Western Regional Burn Disaster Consortium. (2024). Burn Injury Poster.
This poster guides healthcare providers through a primary and secondary survey of burn injuries and includes burn wound evaluation variables and photos. Steps for responding during a mass casualty burn incident are also included.
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Agencies and Organizations

American Burn Association.
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American Burn Association. Disaster Response.
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U.S. Department of Health & Human Services: Burn Triage and Treatment - Thermal Injuries.
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University of Michigan Trauma Burn Center.
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University of Utah Burn Center.
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This ASPR TRACIE Topic Collection comprehensively reviewed in January 2025 by the following subject matter experts (listed alphabetically):

Franco Aveau, MA, Project Officer, Administration for Strategic Preparedness and Response (ASPR), Biomedical Advanced Research & Development Authority; John Hick, MD, Hennepin Healthcare and ASPR TRACIE; Mark P. Jarrett, MD, MBA, MS, Sr. Vice President & Chief Quality Officer, Associate Chief Medical Officer, North Shore-LIJ Health System; Annette Newman, MS, RN, CCRN, Disaster Preparedness Consultant, Utah Hospital Association, Western Region Burn Disaster Coordinator, American Burn Association, State Coordinator, Western Regional Alliance for Pediatric Emergency Management (WRAP-EM); Judy L. Placek, MSN, APRN, FNP-BC, CBRN, Burn Specialty Team Lead, Region 7 Disaster Health Response Ecosystem Team, Nebraska Medicine, Omaha, Nebraska.  

It was refreshed in February 2022 and reviewed in July and August 2015 by Richard Besserman, MD, Operations Executive, Center for Emergency Management and Homeland Security, and Arizona State University; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark P. Jarrett, MD, MBA, MS, Sr. Vice President & Chief Quality Officer, Associate Chief Medical Officer, North Shore-LIJ Health System, and Professor of Medicine, Hofstra – North Shore LIJ School of Medicine; and James C. Jeng, MD, FACS, Associate Professor of Surgery, Mount Sinai Medical System (New York, NY), Chairman, American Burn Association Ad Hoc Disaster Committee, and Chairman, International Society for Burn Injuries Committee on Disaster Preparedness.

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