Four experienced burn care providers participated as advisors in two mass casualty exercises in an area where access to a bum center is severely limited. The role of the advisors, lessons learned, and recommendations for future exercises will be presented.

Prior to the exercises, advisors provided a Justin-Time lecture orienting hospital workers to prehospital triage, emergent burn care, and burn center transfers. Exercise 1 consisted of a simulated train derailment with hazardous materials spill and involved 150 victims; many with burn injuries and associated trauma. An advisor was assigned to each car to provide guidance to victims and feedback to exercise evaluators on prehospital triage, victim management, and transfer decisions. Exercise two involved a terrorist attack at an oil refinery in a small community; 140 victims were moulaged, triaged, and transported to the hospital. A burn advisor was assigned to each of the following areas of the hospital: initial triage area, intensive care unit (ICU) for immediate/critical victims, rehabilitation area for patients triaged into delayed or minor injury categories, and the state Disaster Medical Assistance Team (DMAT) treatment area.

Overall, victims with injuries other than burns were more accurately triaged at the scene, assessed at the hospital, and managed. Although the state has provided burn courses to 150 nurses, physicians, and paramedics over the previous three years, there is a significant need for further burn training.

The presence of experienced burn advisors provided the opportunity for healthcare providers to receive training, ask questions during the exercise, and receive feedback following the exercise.