Burn Care and Burn Teams

Burn CareBurn care is a complex yet rewarding task that hopefully leads to a surviving patient who can return the best way possible to society.  Prior to the mid-twentieth century, burn care was taken on by regular surgeons and nurses on ordinary hospital wards.  Because burns are difficult to treat, the survival rate was suboptimal.  Records show that burn care prior to 1951 was painful and fraught with complications.  In the age group defined by 15-43 years, the death rate of severely burned patients was 45 percent.

By 1991, there had been advances in burn medicine so that if the total burn surface area was greater than 70 percent, the mortality rate was 49 percent.  In the Twenty First Century, burn care has advanced even further so that most pediatric burn patients survive and nearly fifty percent of burn patients over the age of 65 survive with severe burns.

Some of the things that have improved burn care in recent years have been:
  • Better topical antibiotics to stave off local or generalized infections
  • There are better fluid resuscitation protocols
  • Nutrition has improved
  • There are better systemic antibiotics
  • There are more and efficient burn units throughout the country
  • Doctors do surgery on burn patients much earlier now than before
  • There is better treatment of inhalation (lung) injuries so that there is less fluid on the lungs and a lesser risk of pneumonia
  • There are better skin substitutes
The first burn unit was opened at the Medical College of Virginia in 1946.  Through increased research indicating best practices available in burn units, more burn units were opened so that there is at least one burn unit in every major city in America.

The Burn Team

The treatment of burns is so complex that the job cannot be delegated to just one person.  This means that a burn team needs to be gathered that understands and can perform all the duties necessary to care for the complicated burn team.  The members of the burn team include:
  • Burn Surgeon.  This is the medical doctor that performs the various skin grafts or amputations needed to treat the burn patient.  He or she provides leadership and guidance to the rest of the team and is ultimately responsible for signing off on all orders in the patient’s medical record.
  • Nurses.  They provide the continuous, round the clock care to the burn patient; they provide both emotional and technical support and identify any changes that go on in the course of the patient’s care and provide interventions.  They coordinate care between the doctor and the rest of the burn team.
  • Anesthesiologists.  They provide pain comfort to burn patients and facilitate the surgery by providing proper anesthesia and pain control.  They may often be contacted to provide pain control for often painful dressing changes and things like the removal of staples.
  • Respiratory therapists. They help the patient recover from respiratory injuries, pneumonia and issues of prolonged bed rest.  They may also help in ventilator support in seriously injured patients.
  • Rehabilitation therapists.  These include both occupational and physical therapists that start early in the course of treatment to prevent burn contractures of the joints, increase strength, and maintaining what function the patient has.  In addition, they specialize in the art of positioning and splinting of extremities as the wounds heal.  They have the hard job of dealing with painful patients who must do physical activity.
  • Nutritionists or Dieticians.  They monitor the patient’s daily weight and intake of calories in order to optimize nutrition when the patient is in the “high metabolism” state following the burn.  They provide vitamins and other supplements used to promote wound healing.
  • Psychosocial Experts.  These include psychiatrists, psychologists and social workers to help develop behavioral interventions if the patient develops behavioral concerns.  They also help to allay anxiety as the patient transitions from burn unit to the outside world.
  • Exercise physiologists.  They help to monitor lung and heart function as they pertain to the patient getting exercise.  They give exercise prescriptions.
  • The family.  The family is an important part of the burn care team, aiding in communication between the patient and the staff and helping to make decisions regarding their loved one’s care.
The burn care team is a diverse one but one that must work together to help heal the burned patient.  There needs to be ongoing trust between staff members and open communication on an ongoing basis.  Team meetings help to facilitate treatment and discharge management; a good team has shared common goals and values around burn treatment.  Coordination among members is vital.  There needs to be skillful leadership by the lead burn surgeon but with delegated leadership roles spread among others who become informal leaders.  The informal leaders are empowered by the group and the leader as a whole and the entire team works together under these rules in order to maximize treatment.

A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.
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