Burns experts issue warning on relying on US for skin donations

Twenty years after the Bali bombings, burns experts warn Australia is “under-prepared” for mass casualties, despite the threat from natural disasters.

Some of Australia’s top burns surgeons say lessons from the Bali bombings have been forgotten, leaving the country under-prepared for mass-casualty incidents, ­including major bushfires.

Twenty years after the country’s hospitals rallied to treat survivors of the 2002 terrorist attack, a leading Victorian burns surgeon has warned a plan developed in the aftermath, to help hospitals share resources and ­patients, has been neglected.

Australia and New Zealand Burn Association (ANZBA) president ­Jeremy Rawlins described the issue as “top of the agenda”, while White Island volcano survivor Stephanie Browitt said supply of donor skin was ­“literally a case of life and death” and shortages were “horrifying”.

Victorian Adults Burns Service director Associate Professor Heather Cleland said burns needed intensive, specialist treatment.

“It only takes a few patients to overwhelm a burns service,” she said.

White Island eruption survivor Stephanie Browitt. Picture: Mark Stewart

A former ANZBA president, Prof Cleland said she was not aware of any exercise to test mass burn casualty plans, and generic disaster frameworks did not always capture burns’ specific challenges.

“In the last 20 years, I haven’t been involved in another exercise to test plans and frameworks and ­capacity,” she said.

“It’s pretty easy in Australia to run out of dressings, for example”.

Dr Rawlins, a Perth surgeon, said historically, “we were better”.

“We had systems in place,” he said.

“We had Ausburnplan, which was a national plan in the event of mass casualties, for us to be able to move ­clinicians or indeed move patients.

“We have let that slip a little bit.”

He said the professions’ “close-knit” nature had covered for this drop in planning, but warned that conversations between members to co-ordinate hospital transfers themselves would not always be enough.

“We need to put those … informal phone calls and emails into a more concrete plan that will stand the test of time in the event of a natural disaster, or a terrorist attack or big plane crash,” he said.

Victorian Adults Burns Service director Associate Professor Heather Cleland. Picture: Facebook

A 2021 McKell Institute report into Victorian burns care described Australia’s system as “fragmented”, while a 2020 royal commission into natural disaster ­arrangements noted there “may be benefit in reviewing” plans including ­Ausburnplan”.

Prof Cleland also called for funding to establish a ­national skin bank to cover local shortages, and said they ran out of donor tissue in the aftermath of the 2019 White Island volcano eruption in New Zealand and the Bali bombings.

“In the Black Saturday bushfires, we ran out of skin again and we couldn’t get any from the US, which is our fallback position, because they were having problems as well,” she said.

“We still don’t have a ­national stockpile should another incident like that occur, which puts us at the mercy of being able to import skin from other countries.

“(This) is really a huge deficit in our preparedness for another mass burn casualty episode.”

Ms Browitt, who suffered severe burns and lost her ­father Paul and sister Krystal, in the tragedy off the east coast of the North Island, supported the call for change.

She said she wouldn’t be alive without the donor skin that had to be flown in from the United States.

“It is incredibly horrifying to know that our lives were depending on the availability of skin donation from overseas because our own country just doesn’t have enough supply for these huge disasters,” she said.

“To still be facing these issues two decades later, speaks volumes of how overlooked this extremely important issue is.

“Our burn units are ­extremely under-prepared when it comes to readily available skin for mass casualty events.

“Australia, a bushfire-prone country, is sadly bound to suffer mass casualty events in the future.”

Stephanie Browitt after the tragic eruption. Picture: Alex Coppel

It comes after a framework for the sector, released by the federal Health Department earlier this year, acknowledged that Australia’s tissue supply was “highly unlikely” to become fully self-sufficient.

“Current resourcing and infrastructure limitations mean that donation does not always proceed even where consent has been given,” it stated.

Dr Rawlins said he wasn’t sure if burns units which used different methods would want to devote the time and resources to reforming differing and ­“archaic” state laws.

But Prof Cleland said Australia’s busiest burns services — including Victoria — used “lifesaving” donor tissue stored by various banks.

In a joint submission to a Black Summer Senate inquiry, she and leading Queensland burns surgeon Michael Rudd said access to this tissue was part of best- practice burn care worldwide, and called for Australia to develop a stockpile.

A Victorian Health Department spokesman said it would continue to work with federal and interstate colleagues to support access to these “life-changing treatments”. Victoria’s guideline for managing multiple burns casualties were “regularly reviewed”.

A federal Health Department spokesman said the plan which included Ausburnplan was replaced by an updated framework for “all-hazards incident of national significance”. Other post-Bali bombings recommendations, such a deployable, emergency response team, remained.

“The Australian government recognises the need to have agreed national plans to ensure adequate capacity and support jurisdictions in the event of any mass casualty/injury event,” he said.

“The treatment of burns victims occurs in hospitals, managed by individual jurisdictions. A commonwealth-operated skin bank would need to be considered in the context of established state and territory banks.”