Document Type

Master's Culminating Experience

Publication Date



Natural and manmade disasters have occurred throughout the decades, within the United States and around the globe. Increased incidence and awareness of terrorist attacks have caused the US to re-evaluate its safety and preparedness efforts to prevent such events from happening and to develop an adequate response plan if such unfortunate events do occur. Therefore, the purpose of this research is to (1) review and discuss the American Burn Association’s (ABA) paradigm for emergency planning in burn disasters, (2) give recommendation about the National Response Framework (NRF) guidelines on “all hazards” response as they pertains to burns, and (3) give recommendations on how the US can maintain an ample supply of allograft tissue for emergency situations that result in burn victims.

A literature review was completed, and a best practices approach for the above issues was created. Recommendations were given to strengthen both ABA’s response plane and the NRF guidelines for burn casualties. Also, opportunities to achieve better outcomes for burn victims by promoting and starting an allograft tissue reserve were recommended. The ABA’s emergency response plan for events that produce mass burn casualties was reviewed. Primary and secondary triaging of burn victims to burn centers is the model used for this organization, yet the ABA’s plan was not congruent with other federal and regional response plans. Differences in these plans centered around triage protocols for treatment on scene as opposed to triage and evacuation to burn centers. Recommendations were given to improve the ABA’s emergency response plan by incorporating other plans and maintaining congruency to accommodate local responses. Furthermore, recommendations for the NRF were constructed by using criteria from the ABA. The NRF provides guidelines for all aspects of government including local, tribal, state, and federal levels by describing how to respond to emergencies for all hazards. Even though this framework provides incident command structure, organization, and alternate resources and organizations, the framework only depicts a broad representation of response actions and does not give detail or awareness to more specific or critical circumstances. If emphasis from the NRF were placed on both local and state awareness of the complexities of mass burn management in emergency situations, better outcomes would be produced. By using the ABA’s response model and guidance from the NRF, regions could create efficient response plans with resources already sustained by their area if federal assistance were unable to reach the emergency in time.

The US simply does not have enough allograft tissue available to respond to an emergent event involving mass burn casualties. Although autografts are the preferred method of grafting, other temporary and permanent skin alternatives were reviewed for advantages and disadvantages. Skin on skin is the graft of choice, whether the procedure is an autograft (the person’s own skin) or allograft (skin from a cadaver); as this has been shown to produce the best results versus other alternatives. When burned individuals are unable to provide autografts due to the severity of their burns, cadaveric allograft skin can be used to decrease pain, prevent infection, promote skin growth, and act as a temporary barrier. Proper cryopreservation of allograft tissues preserves these tissues up to five years, with no decrease in viability. Recommendations have been given for the United States Food and Drug Administration (FDA) to regulate a strategic stock of cryopreserved allografts for emergency situations, and for the American Association of Tissue Banking (AATB) to establish and maintain this allograft tissue reserve. Achieving both of these recommendations would allow monitoring inventory using strict storage guidelines and circulating inventory to ensure use before its five year expiration. Further research needs to be completed on these issues to provide additional support and significance. If the recommendations provided were implemented, our nation could save more lives in disasters involving mass burn injuries.