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The Crans-Montana bar fire on January 1, 2026 caused a major burn casualty incident (MBCI) in Switzerland, with more than 40 patients sustaining severe burns (TBSA >20%) requiring specialized intensive care. At the University Hospital, an established incident command structure (“Führung in ausserordentlichen Lagen”, FaoL) and a dedicated MBCI response concept were in place and were activated. This study evaluates the multidisciplinary management during the first 96 hours.

Alarm procedures, command structures, and organizational processes were analyzed through structured debriefings across institutional committees after the incident. Their alignment with institutional frameworks (USZ MBCI concept) and national response plans (Swiss national alarm plan) was assessed. Multidisciplinary organization of patient care during the first 12 hours in the emergency department was reviewed, followed by analysis of the subsequent 72 hours, including international coordination for transfer of patients to specialized burn centers across the European Union.

The institutional incident committee (FaoL) and MBCI framework enabled rapid implementation of a clear command structure. Early on-site assessment by emergency physicians and direct communication with the receiving hospital allowed timely estimation of patients requiring specialized burn ICU care. Personnel recruitment, including surgical staff, was organized at departmental level, enabling rapid mobilization. Operational flexibility and adaptive decision-making by a core multidisciplinary leadership team comprising plastic surgery, traumatology, anesthesiology, and intensive care were supported by prior collaboration. The Swiss national alarm plan was not fully operational and was discontinued early. Within the first 12 hours, FOCP intervention, in coordination with ERCC, enabled transfer of patients to specialized burn centers across the EU, allowing definitive burn care within 96 hours.

Pre-existing institutional incident structures and a dedicated MBCI response plan at USZ strongly supported coordinated management and delivery of specialized burn care during the critical first 12 hours. Early communication, multidisciplinary collaboration, and international coordination were key to managing this large-scale burn casualty event.

On January 1st, 2026, a mass casualty incident in Crans-Montana, Switzerland led to the simultaneous admission of multiple severely injured patients to several hospitals, requiring rapid mobilization of emergency, critical care, and surgical resources. Such events challenge hospital preparedness, surge capacity, and interprofessional and interdisciplinary coordination. This study aimed to describe the clinical characteristics, injury patterns, and in-hospital management of patients admitted in this context to the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland and to evaluate the organizational and medical response of this tertiary care center despite the non-activation of the institutional burn disaster plan and the planned plastic surgery mobilization protocol.

The retrospective observational study included all patients admitted to CHUV on January 1st, 2026, in relation to this delocalized mass casualty incident. Demographic data, total body surface area (TBSA), inhalation injury, as well as timing and anatomical distribution of emergency escharotomies, were extracted from medical records.

A total of 22 patients were admitted. The mean age was 18 years, the majority (68%) were male and inhalation injury was present in 18 of 22 patients. 73% required emergency escharotomies and 82% were admitted to the ICU (18/22). The mean TBSA was 36% (range: 6% - 70%), the mean rBaux score was 62 and the mean time to surgery was almost 6 hours (range: 1.14 h - 14.55 h). Upon arrival to the emergency department, six patients (30%) were already intubated. Thirteen patients required transfer to specialized burn centers outside Switzerland, the majority of which occurred within the first 48 hours of arrival (12/13).

Due to the high severity of injuries, most patients required not only ICU-admission, but also urgent surgery. Emergency escharotomies were performed in nearly three quarters of the cases, with a mean time to surgery of less than six hours. These results demonstrate that rapid ICU surge capacity and surgical response can be achieved in a mass casualty incident through effective local coordination, even without a fully implemented national burn disaster plan.

Massive casualty events (MCE) of more than 50 victims are rare in western Europe, and healthcare systems in most countries are not geared up to handle a sudden increase in critically injured patients. Various management plans exist to handle these high stress events.
In early 2026, a large civilian incident in Switzerland generated over 115 burn casualties and activated local, regional, national and international response structures.
Our objective is to reconstruct the management of this burn MCE across the continuum of care, compare the real‑world response with existing MCE action plans, and identify system strengths and weaknesses to inform emergency and disaster medicine planning.

Patient‑level clinical data are withheld pending completion of the official investigation; the present analysis focuses on organisational processes, workload indicators and staff‑related outcomes. A detailed chain of events was reconstructed using present healthcare provider interviews, augmented by in silico summaries of online sources. This summarised narrative chronologic sequence was then compared to several MCE action plans: WHO, Swiss civil and military MCE plans and specific MCE burns plan. Differences were recorded and analysed by both human experts and publicly available artificial intelligence bots.

Significant differences were noted from the actual sequence of events, and the planned emergency protocols. Personal, voluntary engagement and the ability to organise theatre availability “on the fly” enabled a comprehensive triage and primary wound management. European cooperation enabled rapid transfer to tertiary burn centres. The response remained primarily civilian, with no escalation to military command. Healthcare provider care and debriefing were conducted secondarily, with primary focus on patient management. Regional hospitals played a significant role in primary management of patients.

This incident exposed important gaps between planned MCE procedures and actual practice, but also highlighted adaptive behaviours that were critical to maintaining effective burn care under extreme surge conditions.
High personal initiative and cooperation enabled rapid, efficient and state of the art treatment in adverse conditions. Availability of specialists and logistical availability of theatre enabled good care of burn victims.

The surgical management of major burns is complex, with limited data on strategy sequencing, especially in mass casualty cases. Improved characterisation of surgical approaches and outcomes could guide treatment algorithms and resource allocation.

A retrospective study was conducted of patients admitted to CHUV Burn Center following the Crans-Montana fire on 01.01.2026. Adult patients with major burns (≥20%TBSA) were analysed, including patient and burn characteristics, surgical management, and clinical outcomes during the first 6 weeks of hospitalisation.

Among 22 admitted patients, 15 (68.2%) had major burns, of which 5 were repatriated, 6 hospitalised in the paediatric ICU, and 4 in the adult ICU. The 4 hospitalised adult major burn patients had a mean age of 18 (±0.8) years and median TBSA 60% (20-70%).

Escharotomies were performed on day 0. Starting on day 1, full-thickness burns were debrided to viable subcutaneous tissue, while partial-thickness burns were debrided to viable dermis.

Definitive wound coverage with split-thickness skin grafting (STSG) was prioritised and initiated during week 1 at the neck, hands, and for vascular access.

Subcutaneous wounds post-debridement were managed with STSG when donor sites were available. In cases with limited donor availability, temporary dermal substitutes (synthetic matrices, biologic dermal grafts) were applied at weeks 1-3 for neodermis formation, followed by cultured autografts from week 3 onward. Dermal wounds were treated according to depth with dermal substitutes (biologic dermal graft) and epidermal substitutes (synthetic matrices, autologous cell suspensions) during weeks 1-6.

Adjunctive dressings were tailored to wound characteristics: petroleum and silicone when stable, hyaluronic acid for atrophy, betamethasone for inflammation, antimicrobials for infection risk, and dexpanthenol when epithelialized.

Patients underwent a median of 6.5 (2-8) surgeries. Full coverage was achieved in 2 patients (50%) at week 2, with 1 patient extubated and discharged home. Complications included STSG lysis, Pseudomonas infection and pressure injuries.

Despite the high number of critically injured patients, individualized burn care was achieved through staged, multimodal and selective debridement and coverage strategies. Treatment was guided by burn depth, location, donor site availability and patient condition.

The Crans-Montana fire resulted in multiple severely injured patients requiring urgent surgical care. Plastic surgeons of the Burn Center at the University Hospital Zurich were closely involved in the initial treatment during the first critical days. Beyond the clinical challenges, this period placed considerable psychological and emotional demands on the multidisciplinary treatment team including surgeons. We aim to share reflections from the first 72 hours, focusing on the personal experience of surgeons working under sustained pressure.

We performed a retrospective narrative reflection on the first 72 hours following the incident. Through informal team discussions and individual recollections from plastic surgeons with varying years of clinical experience, we examined how this period was perceived, including emotional responses, perceived responsibility, and coping mechanisms with intensity and uncertainty while managing complex clinical situations.

The early phase was marked not only by intense clinical activity but also by a profound sense of responsibility toward severely injured patients and their families. Surgeons reported high cognitive load, emotional strain, and prolonged exposure to uncertainty while balancing rapid decision-making with the awareness of the gravity of the situation. Personal adaptability, informal peer support, strong interpersonal trust, structured communication, shared responsibility within the team, clear task delegation, and strong leadership presence were identified as central coping mechanisms that helped sustain focus, resilience and team performance.

Mass casualty events affect both healthcare systems and the individuals providing care. Reflecting on the first 72 hours after the Crans-Montana fire emphasizes the importance of acknowledging the emotional and psychological dimensions of surgical work in crisis situations. Sharing these personal experiences may contribute to greater awareness of surgeon wellbeing and resilience in the context of extreme clinical demands.

Major burn incidents, such as the December 31, 2025 event in Crans-Montana, Switzerland, expose victims and healthcare professionals to substantial psychological trauma and elevated risk of post-traumatic stress disorder (PTSD). Semantic confusion persists between operational debriefing (after-action review, AAR), Critical Incident Stress Management (CISM) as a multi-component program, and Critical Incident Stress Debriefing (CISD) as a single-session intervention. Plastic surgeons are involved from the acute phase through long-term reconstruction, placing reconstructive care at the interface between tissue repair and psychological recovery.

We conducted a narrative review of current clinical practice guidelines, systematic reviews, meta-analyses, and randomized controlled trials addressing debriefing practices, PTSD and healthcare professional trauma exposure in major burn incident settings, with a focus on implications for reconstructive plastic surgery practice.

Burn injury, visible disfigurement, repeated painful procedures and multiple reconstructive stages are major risk factors for PTSD (prevalence 19-24%) and body-image disturbance. Single-session psychological debriefing (CISD) does not prevent PTSD and may be harmful therefore it is not recommended routinely. Current evidence supports a staged “support, screen and treat” approach with immediate Psychological First Aid (PFA) followed by targeted interventions for persistent symptoms. Early trauma-focused cognitive behavioral therapy (TF-CBT) constitutes the evidence-based treatment for established PTSD. Progressive information, pre-procedural psychological preparation and narrative integration of scarring may support adaptation during reconstruction. Healthcare professionals are also at risk. Operational AAR serve quality improvement and organizational learning purposes and should be distinguished from voluntary peer-support approaches within CISM frameworks.

After major burn incidents, optimal management combines tissue reconstruction and psychological recovery without mandated early psychological debriefing, but through integrated support, systematic screening and targeted care. Plastic surgeons should incorporate PTSD and body-image screening, structured patient information and multidisciplinary psychological collaboration while ensuring structured support for healthcare professionals.