Massive numbers of burn victims would have to be transported out of state should a terror attack strike the Lowcountry.

And the concept of treating dozens of burn casualties at once is so new that local officials have rarely drilled specifically for it.

"Our mass casualty plan that we currently have is not disease- or injury-specific," Raymond Barteet, public health preparedness director for the Charleston region, said Wednesday.

The textbook response, he said, is to stabilize burn victims locally, then fly or drive them elsewhere, depending on available resources.

Charleston's situation is not unusual, especially when it comes to being able to treat burn victims. U.S. hospitals are increasingly shutting down their burn centers, something experts say could leave the nation unable to handle widespread burn casualties from a fiery terrorist attack or other major disaster.

An Associated Press study this week found that the shrinking number of beds is a growing cause for concern in this post-Sept. 11 world. A major reason is that burn centers are expensive to maintain and often lose money. They are usually staffed with highly specialized surgeons and nurses, and stocked with sophisticated equipment designed to ease patients' excruciating pain, fend off deadly complications and promote healing.

The number of burn centers in the U.S. has dropped from 132 in 2004 to 127 today. The number of burn beds has fallen from 1,897 to 1,820, according to American Burn Association records.

Some states — Mississippi, North Dakota, Montana, Wyoming, Idaho and New Hampshire among them — have no burn centers at all. The only burn center in South Carolina is a children's unit at the Medical University of South Carolina.

Much of Charleston's deficiency stems from the 2002 closing of a 10-bed burn unit at MUSC. After the burn surgeon left, MUSC officials said the unit was too small to be successful, and even if it did have the money to expand, it didn't have the space to.

While the children's unit is still in place at MUSC, the move forced part of the state, including Charleston, to rely on the next closest burn facility in Augusta for burn treatment.

Nationally, officials say the decrease in beds is significant. "If something happens and we need the beds for burn patients, it is going to be a real catastrophe," said Alan Dimick, past president of the American Burn Association and founder of the burn center at the University of Alabama at Birmingham.

"People ought to be pretty frightened by this," said Barbara Latenser, burn center director at the University of Iowa Hospitals. "Some people who live out West, they are 800 miles from a burn center."

A worst-case scenario is what happens if a nuclear device exploded in an urban area, perhaps injuring thousands.

Barteet, who works for the S.C. Department of Health and Environmental Control, said mass casualty events have been effectively drilled in the Charleston area. One reason why a specific burn-victim drill hasn't been undertaken is the logistics involved, he said.

"Not having a burn unit in our area is problematic," he added, "should something happen."

The Associated Press contributed to this report. Reach Schuyler Kropf at 937-5551 or skropf@postandcourier.com.

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