CBRN Disaster Preparedness, Triage & Burn Center Transfer — Questions and Answers
Question 1: Which patient meets American Burn Association criteria for referral to a burn center?
- A 2% superficial sunburn on the back
- A partial-thickness burn involving the hands (Correct answer)
- A small first-degree burn on the thigh
- A 1% partial-thickness burn on the calf
Correct answer: A partial-thickness burn involving the hands
ABA referral criteria include burns involving the face, hands, feet, genitalia, perineum, or major joints, as well as full-thickness burns, partial-thickness burns of 10% TBSA or more, and electrical, chemical, or inhalation injuries.
Question 2: Using the 'rule of tens' for initial resuscitation in an austere or mass-casualty setting, what is the starting fluid rate for a 70-kg adult with a 40% TBSA burn?
- 100 mL/hr
- 200 mL/hr
- 400 mL/hr (Correct answer)
- 700 mL/hr
Correct answer: 400 mL/hr
The rule of tens sets the initial rate at %TBSA × 10 mL/hr for adults weighing 40–80 kg, so 40 × 10 = 400 mL/hr. The rate is then titrated to urine output.
Question 3: In a mass-casualty event with overwhelmed resources, a patient with very extensive burns and severe inhalation injury is most likely to be triaged as which category?
- Immediate, first in line for the OR
- Expectant, receiving comfort measures while resources go to survivable patients (Correct answer)
- Minimal, can wait
- Delayed, treated at the bedside last
Correct answer: Expectant, receiving comfort measures while resources go to survivable patients
Crisis standards of care prioritize the greatest good for the greatest number. Patients whose injuries carry very low survival probability may be classed as expectant, receiving comfort care and reassessment if resources allow.
Question 4: A patient is being prepared for transfer to a burn center. Which action is appropriate before transfer?
- Extensively debride and apply thick topical agents
- Secure the airway as indicated, establish IV access, cover wounds with clean dry sheets, and keep the patient warm (Correct answer)
- Withhold analgesia so the burn team can assess the patient
- Delay transfer until all fluids are completed
Correct answer: Secure the airway as indicated, establish IV access, cover wounds with clean dry sheets, and keep the patient warm
Transfer preparation focuses on airway, breathing, circulation, resuscitation, warmth, and pain control. Wounds are covered with clean dry dressings. Heavy topical agents obscure the burn center's assessment, and transfer should not be delayed for debridement.
Question 5: A patient contaminated with an unknown chemical agent arrives at the emergency department. What should happen before treatment inside the facility?
- Immediate bedside resuscitation with no precautions
- Decontamination by removing clothing and rinsing, with staff wearing appropriate PPE (Correct answer)
- Transfer to radiology
- Waiting for lab results
Correct answer: Decontamination by removing clothing and rinsing, with staff wearing appropriate PPE
Decontamination at the entry point protects staff and other patients from secondary contamination. Removing clothing eliminates most contaminant, and responders use appropriate PPE.
Question 6: Which activity belongs to the 'preparedness' phase of the disaster management cycle?
- Treating victims during the event
- Writing the disaster plan and conducting drills and training (Correct answer)
- Rebuilding facilities afterward
- Debriefing after the event
Correct answer: Writing the disaster plan and conducting drills and training
Preparedness includes planning, training, drills, and stockpiling before an event. Response happens during the event, and recovery and evaluation come afterward.
