Gordana Georgieva

In March 2025, a catastrophic fire in Kočani, North Macedonia, resulted in a mass casualty incident more than 200 patients, predominantly young individuals. Of these, 129 sustained cutaneous burns and 80 presented with inhalation injuries, with 38 requiring intubation. The scale and severity of injuries rapidly overwhelmed national healthcare capacities, necessitating immediate activation of a coordinated, multi-level response.

Initial management was guided by Advanced Trauma Life Support (ATLS) principles, with rapid triage, airway stabilization, and early fluid resuscitation forming the cornerstone of care. Patients were distributed across multiple healthcare facilities based on injury severity and resource availability. Given the limited capacity for advanced burn care, 115 patients were transferred to specialized burn centers abroad through international collaboration and activation of the European Civil Protection Mechanism.

This experience highlighted the critical importance of structured triage systems, interhospital coordination, and early decision making regarding patient transfer. The high incidence of inhalation injury underscored the need for prompt airway management and intensive care preparedness. Furthermore, the incident emphasized the value of international networks in managing large-scale burn disasters, particularly for smaller healthcare systems.

Beyond the acute phase, ongoing challenges include long term rehabilitation, reconstructive needs, and psychosocial support for survivors. The Kočani fire serves as a significant case study in disaster preparedness, demonstrating how coordinated national and international efforts can optimize outcomes in mass burn incidents and providing important lessons for future emergency response planning