title: Experience of distributing 499 burn casualties of the June 28, 2015 Formosa Color Dust Explosion in Taiwan.
abstract: OBJECTIVE
  To describe the experience of distributing 499 burn casualties of an unexpected event and determine whether patient transfer is associated with patient outcomes measured 2 weeks after the incident.
  
  
  METHODS
  All 499 patients injured in the event were included. For the 138 patients transferred to other hospitals after primary distribution, we evaluated whether the transfers were associated with patient severity. Furthermore, we used multinomial logistic regression to investigate the association of patient transfer with patient outcomes after controlling for age, gender, total burn surface area (TBSA), final hospital level, wound infection, and patient pneumonia.
  
  
  RESULTS
  We determined that on-site triage differed significantly from hospital triage (p<0.001). Furthermore, the secondary distribution enabled the transfer of a high number of patients to medical centers based on the availability of beds; however, such transfers were not associated with patient outcomes (p>0.05). Factors associated with patient outcomes were wound infection and TBSA (p<0.001).
  
  
  CONCLUSIONS
  In case of inadequate burn centers, satisfactory patient outcomes can be achieved by the immediate treatment of patients, despite the treating hospitals being lower-level hospitals. Regardless of the hospital level, immediate treatment of burn patients is crucial to reducing mortality.
authors.affiliation: Department of Medical Affairs, Ministry of Health and Welfare, Taiwan; Department of Public Health, School of Medicine, National Yang-Ming University, Taiwan. Electronic address: mdjoyce@mohw.gov.tw.
authors.forename: Tsung-Hsi
authors.initials: TH
authors.lastname: Wang
authors.affiliation: Department of Medical Affairs, Ministry of Health and Welfare, Taiwan. Electronic address: MDFLYER@mohw.gov.tw.
authors.forename: Wei-Siang
authors.initials: WS
authors.lastname: Jhao
authors.affiliation: Department of Public Health, School of Medicine, National Yang-Ming University, Taiwan. Electronic address: ewpk7x@icloud.com.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Yeh
authors.affiliation: Department of Public Health, School of Medicine, National Yang-Ming University, Taiwan. Electronic address: cypu@ym.edu.tw.
authors.forename: Christy
authors.initials: C
authors.lastname: Pu
mesh_terms: D001830:Body Surface Area; D002053:Burn Units; D002056:Burns; D004190:Disasters; D004636:Emergency Service, Hospital; D005107:Explosions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D054527:Mass Casualty Incidents; D015999:Multivariate Analysis; D010360:Patient Transfer / Q000379:methods*; D011014:Pneumonia / Q000453:epidemiology; D013624:Taiwan; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods*; D014946:Wound Infection / Q000453:epidemiology; D055815:Young Adult
keywords: Burn; Disaster management; Patient distribution