The Department of Health (DOH), through Department Order (DO) 2020-0653, established a One Hospital Command System (OHCS) to facilitate coordination among health care facilities and enhance the referral system for patients with COVID-19.1 2 On August 6, 2020, the DOH and the Inter-agency Task Force on Emerging Infectious Diseases (IATF-EID) launched the One Hospital Command Center (OHCC) at the Metro Manila Development Authority Arena, Makati City.

On July 4, 2021, a Philippine C-130 military plane carrying 104 personnel crashed in Patikul, Sulu after attempting to land at Jolo Airport, killing 53 individuals and injuring 50 others, both on board and on the ground. Some of the injured sustained multiple injuries, including fractures and burns. This incident triggered a swift response from various agencies. Mass casualty incidents, including those with multiple burn-injured patients, pose significant challenges to health care systems and can lead to high morbidity and mortality rates.1 2 3 Burn injuries, which account for at least 200,000 deaths annually, are a major global public health issue, particularly in low-resource settings, and can easily overwhelm the limited burn resources available.4 5 6 Efficient management of mass casualty incidents, proper triage decisions, and sound health care planning are crucial for optimizing patient outcomes and matching potential needs with available resources.7 Burn mass casualty incidents (BMCI) are incidents that involve at least three burn victims. These incidents, whether due to natural or human-caused accidents, can occur anywhere and anytime. The injuries are unpredictable and involve a large number of victims, requiring a significant consumption of logistics and medical attention. Medical response tasks in massive burn injuries are much more challenging than those required in separate burn incidents due to the unexpected nature of the events and the simultaneous involvement of a large number of patients. Such situations require the immediate mobilization of a significant number of personnel, resources, and facilities to address upcoming issues. In this article, we describe the management of BMCIs based on our experiences in responding to the Patikul incident. We elucidate the strategies that are put into action and offer insights aimed at improving protocols for handling BMCIs in the future. Our goal is to contribute to the body of knowledge in this field and aid in the development of more effective responses to such critical situations.
Mass Casualty Incidents ; Burns

Background: Fluid management is crucial during the first 24 hours after a burn injury due to different systemic responses of the body Objective: To compare the outcomes of patients with partial- or full-thickness burns initially managed using the Parkland (PRK) formula with those initially managed using the Rizal D. Aportadera (RDA) formula, a fluid resuscitation formula with added sodium bicarbonate. Design: Cohort study. Participants: 181 male and female patients, aged 7 months to 78 years, with partial- or full-thickness burns. Setting: RDA Burn Unit of Southern Philippines Medical Center, Davao City, from January 2008 to December 2018. Main outcome measures: Proportions of patients with prolonged hospital stay, sepsis, and death; odds ratio of having the outcomes for selected factors. Main results: Of the 126 males and 55 females, with overall mean age 25.70 ± 20.92 years, included in this study, 175 (96.69%) had partial-thickness burns and 6 (3.31%) had full-thickness burns. Among the patients, 108/181; 59.67% were managed with the PRK formula, while 73/181 (40.33%) were managed with the RDA formula during fluid resuscitation. Compared to the PRK group, the RDA group had significantly lower mean length of hospital stay (11.67 ± 9.69 days vs 17.22 ± 20.45 days; p=0.0317) and lower proportion of patients with prolonged hospital stay (2/73, 2.74% vs 13/108, 12.04%; p=0.0287). Full-thickness burns had independent association with prolonged hospital stay, while major burns had independent association with death. Conclusion Compared to patients in the PRK group, those in the RDA group had significantly shorter hospital stay. Full-thickness burns and major burns were independently associated with prolonged hospital stay and death, respectively.

A burn mass casualty incident (BMCI), an incident that involves at least three burn victims with severe injuries,1 presents several unique challenges. In a mass casualty event, between 25 and 30 percent of those injured can sustain moderate-to-severe burn injuries.2 Management of burn patients necessitates a significant amount of health resources and logistical support, along with prompt and high-quality care to optimize the functional and cosmetic outcomes of severely injured patients. While some developed countries have sound disaster management plans, many countries where most BMCIs occur lack such well-established plans.3 The effective management of BMCIs is crucial for positive patient outcomes. Given resource scarcity, especially in geographically isolated and disadvantaged areas, comprehensive mitigation and preparedness strategies are essential. These strategies must address worst-case scenarios that may challenge the existing internal protocols, especially at the local level.4 The surge in health care facility capacity during BMCIs can quickly overwhelm local and regional resources, from prehospital care to specialized burn centers. In the Philippines, disaster response levels and adequacy may vary widely among different regions and local government units (LGU). While the Department of Health has issued guidelines for health emergency and disaster response management,5 there are currently no policies or guides on specifically addressing preincident planning for BMCIs. The aim of this article is to recommend policies that will potentially improve the current health care approach to BMCIs.
Mass Casualty Incidents ; Burns