Factors influencing the pre-hospital management of civilian burn mass casualty incidents in the 21st century: a scoping review.

Background: Burn mass casualty incidents (BMCI) are unique and catastrophic events that are uncommon but recurring and comprehensively challenge all emergency services involved. The causes range from forces of nature to accidental or intentional explosions, indoor fires and chemical burns. A growing population, climate change exacerbated fire weather, increasing industrial activity and a rising threat of worldwide transnational terrorism all increase the risk of BMCIs. Emergency response strategies are thus of critical importance and can be improved upon by learning from previous incidents through the identification of recurrent themes.

Objectives: Identify, categorise, and describe key themes and factors reported as having a favourable or detrimental influence on the professional management of civilian BMCIs.

Materials and methods: A scoping review following the Arksey and O'Malley framework with enhancements by Levac, Colquhoun and O'Brien, and PRISMA-ScR, was conducted using six electronic databases, including a search for grey literature from January 2001 to March 2024. A total of 51 documents, containing descriptions, discussions, and/or experiences of the pre-hospital management of burn mass casualty incidents in civilian, non-war settings, were included and analysed using thematic analysis for qualitative data and labelled for themes and factors.

Results: Thirteen key themes and 71 factors were identified to influence the pre-hospital management of BMCIs. The key themes were Command, Communication, Contextual, Education, Environment, Evacuation, Fortuity, Human Factors, Preparedness, Response Tactics, Safety, Triage, and Volunteer. The 71 identified factors were for example self-evacuation, varied non-medical transport methods, traffic congestion and decontamination.

Conclusion: The identified themes and factors provide insights from real-life incidents on what is reported to influence the situation at hand. The identified factors can be used to target specific areas for further improvement in future BMCIs, particularly in preparedness planning and training, for example by taking self-evacuation into account in future disaster plans.