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In many hospitals, intensive care units (ICUs) operate at or above capacity on a daily basis. Multiple casualty incidents will create a sudden need for additional ICU beds and hospital planning for disaster response must anticipate the need for rapid ICU expansion. In this article, the authors describe the management of 6 patients who were burned in Guam and successfully transported a distance of 7,268 miles to San Antonio, TX, for tertiary burn center care. The mission required creation of a temporary burn ICU at Tripler Army Medical Center in Hawaii, approximately midway between the referring hospital and the receiving burn center. A method of creating a temporary burn center is described. Lessons learned, including the need to standardize equipment, and to cross-train and cross-credential medical personnel, are applicable to both military and civilian mass casualty management.

A civilian airplane crash on the island of Guam in 1997 produced 16 burned survivors. The U.S. Army Burn Flight Team and U.S. Air Force Critical Care Air Transport Teams conducted a joint aeromedical mission in response to this disaster. This experience was reviewed from the Burn Flight Team perspective. A record of events was made during the mission, and an after-action review was conducted after the mission. Twelve patients were transported to Korea, and four critically ill patients were transported to the U.S. Army Burn Center in San Antonio, TX. The latter mission required 21 hours of in-flight critical care and was completed 4 days and 3 hours after the crash. After-action review resulted in changes in communications procedures, administrative oversight, supplies and equipment, composition of the Burn Flight Team, and readiness and training. These peacetime lessons contributed to the military's ability to transport wartime burn casualties in ensuing years and indicate the close interdependence of the disaster response and combat missions.