Background
Mass burn casualties are no longer only a potential scenario. Our Burn Center had been prepared for burn mass casualties for several years. Early burn eschar removal up to 20% TBSA should be advised even in austere conditions. In mass casualty events there is a limitation of blood supply, operating room, medical staff, and equipment. In our opinion, enzyme debridement optimizes the treatment, and its costs. In terms of shortage of supplies, enzymatic eschar removal might be an alternative to early surgery. The dermal tissues left after enzymatic debridement significantly reduces the area of the burn and promotes self-healing. Time gained can be used to transfer patients and stabilize austere situation. Also, enzymatic debridement performed in selected cases may prevent from progression of the depth of the burn.  The aim of this study is to share our internal plan for dealing with mass burn casualty events.
Material and Methods
The plan was developed basing on military experience of the Head of the Department and current literature. There are many descriptions of prehospital triage methods. However, there are limited data on patient selection, timing of early burn excision, and surgical technique. Our plan precisely described segregation of duties and timing of surgical intervention in a burn unit. The plan prepares for severe circumstances with limitation of sources, equipment, and medical staff.
Results
We created burn teams that include burn surgeon, 2-3 burn nurses and hospital ward. Each burn team is able to perform up to 3 early eschar removals during 12 hours. Having 3 burn teams we are able to perform enzymatic debridement in even 9 patients during 12 hours, which is impossible in case of surgical excision. The indications for enzymatic debridement in our frontal hospital include deep burns with the extension up to 20% TBSA. We also have experience in younger patients with good prognosis with burns of 60% TBSA. In these cases we performed enzymatic debridement of 15% each day. There is a nurse training team and a plan to create burn teams in non-burn centers that could cooperate with us.
Conclusions
Mass burn incidents are an example of a situation where the resources of the rescuers may prove insufficient. Surgical excisions call for operating room, specialistic equipment, blood supply, and experienced burn surgeons. Early enzymatic debridement should be considered instead of surgical excision in some cases. Domestic and international burn mass casualty response plans should be develop.

P.052 Novel approach to early burn eschar removal in massive casualty events

Dear friends and colleagues,

We will be pleased to welcome you in Turin (Italy) for the 19th European Burns Association´s Congress in 2022. Italy is honored to hold the meeting of the European Burns Association for the second time, after Verona in 1995. Turin is easily reachable from everywhere in Europe, either travelling by car, train or choosing flight connections. During the meeting, held in the renewed industrial center of the main Italian historical automotive factory (i.e. Lingotto-FIAT), we will meet international burn specialists, focusing on standards of care, progresses in burn treatment, strategies to face disaster situations, with a special attention to education of younger colleagues. However, in your spare time, you might enjoy the sweet days of Italian late summer, simply wandering in the green parks and gardens along the two rivers which cross the city, or you might decide to discover the numerous art galleries, churches, palaces, libraries, walking across elegant squares and large boulevards, passing through centuries of art and history; finally, you may choose to immerse yourself in some of the most exciting museum experiences, such as the Cinema Museum and the Turin’s Egyptian museum.

Looking forward to seeing you all in Turin for the 19th European Association´s Congress in 2022!
Maurizio Stella, Congress President, Turin Burn Centre