title: 'Lessons learned': A comparative case study analysis of an emergency department response to two burns disasters.
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.
  
  
  CONCLUSIONS
  There were a number of lessons observed from the Bali experience in 2002 that have led to improvements in practice and lessons learned.
authors.affiliation: Emergency Department, Royal Perth Hospital, Perth, WA 6000, Australia. mark_little@health.qld.gov.au
authors.forename: Mark
authors.initials: M
authors.lastname: Little
authors.forename: Jim
authors.initials: J
authors.lastname: Cooper
authors.forename: Monica
authors.initials: M
authors.lastname: Gope
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Hahn
authors.forename: Cem
authors.initials: C
authors.lastname: Kibar
authors.forename: David
authors.initials: D
authors.lastname: McCoubrie
authors.forename: Conrad
authors.initials: C
authors.lastname: Ng
authors.forename: Annie
authors.initials: A
authors.lastname: Robinson
authors.forename: Jessamine
authors.initials: J
authors.lastname: Soderstrom
authors.forename: Muriel
authors.initials: M
authors.lastname: Leclercq
mesh_terms: D054042:Bombs; D002056:Burns / Q000628:therapy*; D003142:Communication; D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005107:Explosions; D006302:Health Services Research; D006742:Hospital Bed Capacity; D006801:Humans; D007400:Interprofessional Relations; D007902:Length of Stay; D015397:Program Evaluation; D014904:Western Australia