On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion from the explosion led to structural failure in multiple locations and breached additional natural gas, electrical, and ammonia lines that ran overhead in the 1-story concrete industrial plant. Intent is the major difference between this type of accident and a terrorist using an incendiary device to terrorize a targeted population. But while this disaster lacked intent, the response, rescue, and outcomes were improved as a result of bioterrorism preparedness. This article discusses how bioterrorism hospital preparedness planning, with an all-hazards approach, became the basis for coordinated burn surge disaster preparedness. This real-world disaster challenged a variety of systems, hospitals, and healthcare providers to work efficiently and effectively to manage multiple survivors. Burn-injured patients served as a focus for this work. We describe the response, rescue, and resuscitation provided by first responders and first receivers as well as efforts made to develop burn care capabilities and surge capacity. A t 11:27 a.m. on June 9, 2009, the first of many 911 calls began flooding the emergency communications center. The calls for help described an explosion at an industrial plant in Garner, North Carolina, a town in Wake County near Raleigh. Approximately 300 employees had reported for work that morning. By the end of the day, 3 were dead and 68 injured (another patient would succumb to his injuries months later).An investigation concluded that the explosion resulted from a gas leak. Once the gas leak found an ignition source, DOI: 10.1089DOI: 10. /bsp.2013 the ensuing conflagration and explosion sent a shock wave through the concrete building, causing exterior walls to collapse, crushing cars parked next to the building, and blowing large holes in the ceiling. As these walls and ceiling sections collapsed, they ripped open additional supply lines of gas and ammonia and exposed electrical lines in multiple sections of the building, culminating in a horrific and deadly scene.and Bioterrorism: Biodefense Strategy, Practice, and Science Volume 12, Number 1, 2014 ª Mary Ann Liebert, Inc.The subsequent investigation concluded there had been no purposeful intent, and terrorism was ruled out. Nevertheless, one method of terrorizing a population is to purposefully explode an incendiary device to injure, mutilate, and kill people and to destroy buildings and infrastructure. 1 While this disaster lacked purposeful intent, the response, rescue, and outcomes reflected many of the efforts of the past decade in which terrorism and b...

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In 2005, the American Burn Association published burn disaster guidelines. This work recognized that local and state assets are the most important resources in the initial 24- to 48-hour management of a burn disaster. Historical experiences suggest there is ample opportunity to improve local and state preparedness for a major burn disaster. This review will focus on the basics of developing a burn surge disaster plan for a mass casualty event. In the event of a disaster, burn centers must recognize their place in the context of local and state disaster plan activation. Planning for a burn center takes on three forms; institutional/intrafacility, interfacility/intrastate, and interstate/regional. Priorities for a burn disaster plan include: coordination, communication, triage, plan activation (trigger point), surge, and regional capacity. Capacity and capability of the plan should be modeled and exercised to determine limitations and identify breaking points. When there is more than one burn center in a given state or jurisdiction, close coordination and communication between the burn centers are essential for a successful response. Burn surge mass casualty planning at the facility and specialty planning levels, including a state burn surge disaster plan, must have interface points with governmental plans. Local, state, and federal governmental agencies have key roles and responsibilities in a burn mass casualty disaster. This work will include a framework and critical concepts any burn disaster planning effort should consider when developing future plans.

Function 1: Develop recovery processes for the healthcare delivery system 12 P1. Healthcare recovery planning 12 P2. Assessment of healthcare delivery recovery needs post disaster 13 P3. Healthcare organization recovery assistance and participation 13 Function 2: Assist healthcare organizations to implement Continuity of Operations (COOP) 13 P1. COOP planning assistance for healthcare organizations 14 P2. Healthcare organization COOP implementation assistance 14 P3. Healthcare organization recovery assistance 15 CAPABILITY 3: Emergency Operations Coordination 16 Function 1: Healthcare organization multi-agency representation and coordination with emergency operations 16 P1. Healthcare organization multi-agency coordination during response 16 P2. Healthcare organization and emergency operations decision coordination 17 Function 2: Assess and notify stakeholders of healthcare delivery status 17 P1. Healthcare organization resource needs assessment 17 P2. Incident information sharing 17 P3. Community notification of healthcare delivery status 18 Function 3: Support healthcare response efforts through coordination of resources 18 P1. Identify available healthcare resources 18 P2. Resource management implementation 18 P3. Public health resource support to healthcare organizations 19 P4. Managing and resupplying resource caches 19 E1. Inventory management system 19 Function 4: Demobilize and evaluate healthcare operations 19 Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness v CONTENTS P4. Healthcare information sharing with the public 26 E1. Healthcare information systems 26 P5. Bed tracking 26 E2. Bed tracking system 27 S1. Bed tracking system training 27 P6. Patient tracking 27 E3. Patient tracking system 27 P7. Patient record tracking 28 Function 2: Develop, refine, and sustain redundant, interoperable communication systems 28 P1. Interoperable communications plans 28 E1. Interoperable communication system 29 S1. Communication training 29 CAPABILITY 10: Medical Surge 30 Function 1: The Healthcare Coalition assists with the coordination of the healthcare organization response during incidents that require medical surge 30 P1. Healthcare Coalition preparedness activities 31 P2. Multi-agency coordination during response 31 Function 2: Coordinate integrated healthcare surge operations with pre-hospital Emergency Medical Services (EMS) operations 31 P1. Healthcare organization coordination with EMS during response 32 P2. Coordinated disaster protocols for triage, transport, documentation, CBRNE 32 S1. Training on local EMS disaster triage methodologies 32 S2. Coordinated CBRNE training 33 Function 3: Assist healthcare organizations with surge capacity and capability 33 P1. Medical surge planning 33 P2. Medical surge emergency operations coordination 34 P3. Assist healthcare organizations maximize surge capacity 34 P4. Assist healthcare organizations maximize surge capability 36 P5. Medical surge information sharing 37 P6. Healthcare organization patient transport assistance 37 P7....

This article will review the use of temporary hospitals to augment the healthcare system as one solution for dealing with a surge of patients related to war, pandemic disease outbreaks, or natural disaster. The experiences highlighted in this article are those of North Carolina (NC) over the past 150 years, with a special focus on the need following the September 11, 2001 (9/11) attacks. It will also discuss the development of a temporary hospital system from concept to deployment, highlight recent developments, emphasize the need to learn from past experiences, and offer potential solutions for assuring program sustainability. Historically, when a particular situation called for a temporary hospital, one was created, but it was usually specific for the event and then dismantled. As with the case with many historical events, the details of the 9/11 attacks will fade into memory, and there is a concern that the impetus which created the current temporary hospital program may fade, as well. By developing a broader and more comprehensive approach to disaster responses through all-hazards preparedness, it is reasonable to learn from these past experiences, improve the understanding of current threats, and develop a long-term strategy to sustain these resources for future disaster medical needs.