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‘Lessons learned’: A comparative case study analysis of an emergency department response to two burns disasters

Authors

  • Mark Little,

    Corresponding author
    • Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Jim Cooper,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Monica Gope,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Kelly A Hahn,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Cem Kibar,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • David McCoubrie,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Conrad Ng,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Annie Robinson,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Jessamine Soderstrom,

    1. Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.
  • Muriel Leclercq

    1. Disaster Preparedness and Management Unit, West Australian Department of Health, Perth, Western Australia, Australia
    Search for more papers by this author
    • Mark Little, MBBS, FACEM, MPH&TM, DTM&H, IDHA, Emergency Physician & Clinical Toxicologist; Jim Cooper, MBBCh, FACEM, Emergency Physician; Monica Gope, MBBS, FACEM, Emergency Physician; Kelly A Hahn, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse Specialist; Cem Kibar, MBChB, FACEM, DipAeroRT(Dist), Emergency Physician & Staff Specialist, RFDS Western Operations; David McCoubrie, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Conrad Ng, MBBS, FACEM, Emergency Physician; Annie Robinson, RN, BSc (Nurs), PostGradCert (Emergency), Clinical Nurse; Jessamine Soderstrom, MBBS, FACEM, Emergency Physician & Clinical Toxicologist; Muriel Leclercq, BSc (Nurs), Manager.

Correspondence: Dr Mark Little, Emergency Department, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Current address: Department of Emergency Medicine, Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia. Email: mark_little@health.qld.gov.au

Abstract

Objective

The Royal Perth Hospital (RPH; Perth, Australia) has been the receiving facility for burns patients in two separate disasters. In 2002, RPH received 28 severely injured burns patients after the Bali bombing, and in 2009 RPH received 23 significantly burnt patients as a result of an explosion on board a foreign vessel in the remote Ashmore Reef Islands (840 km west of Darwin). The aim of this paper is to identify the interventions developed following the Bali bombing in 2002 and review their effectiveness of their implementation in the subsequent burns disaster.

Methods

A comparative case study analysis using a standardised approach was used to describe context with debrief reports and ED photographs from both disasters used for evaluation.

Results

The implementation of regular ED disaster response planning and training, early Code Brown notification of the entire hospital with regular updates, early clearing of inpatient beds, use of Short Message Service to communicate regularly with ED staff, control of the public and media access to the ED, visual identification of staff within the ED, early panendoscopy to ascertain intubation needs, and senior clinical decision makers in all areas of the ED were all acknowledged as effective based on the debrief reports. There was a reduction in ED length of stay (150 to 55 min) and no deaths occurred; however, quantitative analysis can only be suggestive rather than a direct measure of improvement given the likelihood of other system changes.

Conclusion

There were a number of lessons observed from the Bali experience in 2002 that have led to improvements in practice and lessons learned.

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