• Mark Little, Jim Cooper, Monica Gope, Kelly A Hahn, Cem Kibar, David McCoubrie, Conrad Ng, Annie Robinson, Jessamine Soderstrom, and Muriel Leclercq.
• Emergency Department, Royal Perth Hospital, Perth, WA 6000, Australia. mark_little@health.qld.gov.au
• Emerg Med Australas. 2012 Aug 1;24(4):420-9.

ObjectiveThe 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.MethodsA 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.ResultsThe 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.ConclusionThere were a number of lessons observed from the Bali experience in 2002 that have led to improvements in practice and lessons learned.© 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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