Across the United States (US), there are approximately 2,000 burn beds in 133 burn centers, only 72 of which are verified by the American Burn Association (ABA). As such, many areas in the US are hundreds of miles from the closest burn center. Eight states do not have a burn center, and another 11 do not have an ABA-verified center. Further, the average center has 15 beds, and, on average, there are 90 available beds across the US. Therefore, in addition to patient care complexities, the broader infrastructure for burn patients is severely limited. These constraints suggest the burn healthcare system is particularly vulnerable to disasters, where the needs will exceed the resources available.

A literature review was conducted of available burn mass casualty incident (BMCI) plans from stakeholders in each level of a response. These response partners included prehospital agencies, hospitals (those with and without trauma center designations), emergency management agencies (local, state, and federal), healthcare coalitions, public health (district, state, and federal), regional coordinating burn centers, and the ABA.

The amalgamation of the BMCI plans yields a tripartite infrastructure not unfamiliar to emergency management professionals. The burn care agencies integrate into a response, similar to the way in which public health integrates into the emergency management infrastructure. The local to state to federal escalation of assets is reflected by an escalation from the local burn center to the regional coordinating burn center to the ABA. However, gaps remain in the communication between response partners. Few plans, particularly at the local level, reflect the integration of the burn system response.

The burn healthcare infrastructure in the US is constrained and therefore is particularly vulnerable to a BMCI. Emergency responders should preemptively examine their plans and systems to specifically integrate the burn care and response infrastructure.