COMMENTARY BURN CARE FALL 2020 - Burn and Reconstructive Centers of America
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FROM THE BURN CENTER Specialized Burn Care is Helping Patients Changing Lives in Your Community and Their Families in eight states, including Colorado, “Family is powerful medicine” and Florida, Georgia, Idaho, Mississippi, Dr. Joseph M. Still understood the Nevada, South Carolina, and Texas. power of family three decades ago Annually, we treat more than 20 when he created the Burn Foundation percent of the nation’s burn injuries. in Augusta, GA. Today, BFA’s reach includes all the facilities served by Burn As the recently named CEO, I am and Reconstructive Centers of America proud to be at the helm and will and Joseph M. Still Burn Centers, Inc. continue steering BRCA towards treatments that will positively affect We offer support to burn patients and patient outcomes. We will continue the their families through the healing legacy of providing expert burn care process, their transition home and by developing burn centers in areas back for follow-up visits. Our support of need. Additionally, BRCA’s newly- includes a friendly conversation over established burn fellowship program lunch; a place to sleep at the Chavis will enable us to instill proven practices House retreat; a gas card or bus ticket and techniques into future generations for their follow-up appointment; or of physicians specializing in burn care. assistance with other items to ensure a successful recovery. Our comprehensive list of services for adult and pediatric patients includes In 2019, BFA provided: acute and reconstructive care for burn + 7,986 nights of free lodging injuries, hand/extremity and wound + Transitional services to 1,093 burn injuries, skin and soft tissue disorders, patients hyperbaric oxygen therapy, and + $184,779 in direct patient IN THE LAST 80 YEARS, dramatic plastic surgery. For a complete list of assistance, including transportation, improvements have been made services offered by BRCA, please visit and other needs. in burn care that have resulted in burncenters.com/services. Services quicker healing, fewer complications, are available 24/7. And we did every bit of this at no less debilitating scars, and higher charge to the patients and their survival rates. BRCA is committed to making the families. However, those services are transfer of patients seamless, quick, only available at no charge because of BRCA has been a part of those and as convenient as possible. For countless corporate and community improvements since 1978 and is consultations, referrals or transfers, partners, as well as those whose lives recognized nationwide as a leader call 855-863-9595 or use the burn have been affected by burn injuries. in burn care. BRCA’s reputation was app. To learn more about the burn app, built upon our mission statement: please visit burncenters.com/app. If BFA’s goal – in the words of a family Healing Patients, Healing Families, you have any suggestions to improve member we assisted – is to be “what Healing Lives®. Our entire team our processes, please feel free to families need in a time of crisis of providers and support staff contact me. and (be) great listeners and prayer is committed to that mission by warriors.” We’re proud to work toward employing the latest technologies and Claus Brandigi, M.D., FACS that goal every day, one patient and product advancements, as well as by CEO, Burn and Reconstructive Centers one family at a time. If you have a participating in multi-center research. of America question about the Burn Foundation Medical Director, Joseph M. Still Burn of America or want to find out ways to BRCA is the largest burn care network Center at WellStar Cobb Hospital in support our programs, please give us a in the United States with 15 locations Austell, GA call at 1-800-650-BURN (2876). ◆ 2 Burn Care Commentary | FALL 2020
15 LOCATIONS AND GROWING | 20% OF THE NATION’S BURN ADMISSIONS COLORADO GEORGIA NEVADA AURORA ATLANTA* LAS VEGAS DENVER AUGUSTA* SOUTH CAROLINA FLORIDA VALDOSTA * CHARLESTON * MIAMI IDAHO TEXAS TALLAHASSEE* IDAHO FALLS PLANO TAMPA MISSISSIPPI SAN ANTONIO JACKSON* *JMS BURN CENTERS, INC. LOCATIONS Our Services: Adult and Pediatric Services vary by location BURNS HYPERBARIC SKIN & SOFT TISSUE DISORDERS + Chemical OXYGEN THERAPY + Crush injuries + Electrical + 24/7 coverage + Degloving + Friction burn/road rash + Carbon monoxide + Diabetic wounds + Frostbite + Dive complications + Fournier’s gangrene + Inhalation + Wound healing + Necrotizing fasciitis + Radiation + Necrotizing soft tissue diseases + Thermal MICROVASCULAR + Skin sloughing disorders SURGERY + Staphylococcal scalded skin syndrome HAND AND + Stevens Johnson syndrome (SJS)/ EXTREMITY INJURIES PLASTIC AND toxic epidermal necrolysis (TEN) + Complex/traumatic injuries RECONSTRUCTIVE + Crush injuries SURGERY CRITICAL CARE + Degloving + Laser scar therapy + Adult + Replantation + Scar revision + Pediatric © Burn and Reconstructive Centers of America, LLC | www.burncenters.com 3
Healing the Burn: Patient Care on the Front Lines EVERY 23 MINUTES A PERSON IN THE UNITED STATES GETS BURNED. That equates to more than 1.1 million burns annually, with nearly half of those seeking some kind of medical treatment. Burns most often happen in places where people are most comfortable – at home, and are usually (86%) thermal burns from fire or touching a hot surface. Whether it’s cooking or one of the estimated 379,600 house fires (U.S. Fire Administration – 2018), odds are, a patient will end up in your ED, ambulance, or office. Burn and Reconstructive Centers of America wants you to be prepared because appropriate care before the patient arrives at one of our burn centers helps ensure the best outcomes. First and foremost: Concentrate on the ABCs – Airway, Breathing, and Circulation. Check the patient for any signs of other trauma and respond accordingly. Don’t let the burn injury distract you. Treating the burn can wait; severe trauma cannot. Airway and breathing are the first + Is the patient’s chest constricted by FLUID RESUSCITAITON steps in the ABCs of initial care and burns? Are the burns full-thickness? transfer preparation. Once the patient has been assessed + Is there evidence of an inhalation for trauma and stabilized, you can Due to the nature of their injuries, burn injury, like singed facial hair or turn your attention to the burn patients may have some component residue in the mouth? injury. One of the most important of an airway injury. The importance aspects of pre-burn center care is of assessing the airway and breathing + What is the patient’s proper fluid resuscitation. The goal ability cannot be overstated. Intubation carboxyhemoglobin level? of fluid resuscitation is to maintain may be necessary, but there are several perfusion and organ function while factors to take into consideration: + If edema develops, will the patient’s avoiding inadequate or excessive airway be impacted? fluid replacement. It’s important to + Is the patient’s voice hoarse? accurately dose fluid, as an overloaded + If you decide there is no need for patient often experiences increased + Is the patient’s Glasgow Coma Scale intubation, the patient should be mortality and morbidity rates. score below 8? administered 100% humidified Oxygen. 4 Burn Care Commentary | FALL 2020
MECHANISM OF BURN of our burn team at 855-863-9595. REFERRAL CRITERIA BRCA’s burn experts have treated tens America’s burn cases of thousands of burn patients and are The American Burn Association break down into four available 24/7 to assist in ensuring not has established 10 criteria that only the accuracy of fluid calculation, necessitate transferring a burn- main mechanisms: but also the general need for fluids. injured patient for treatment. Patients outside these criteria may + 86% suffer from REFERRING TO A BURN CENTER also benefit from the treatment thermal burns modalities offered by BRCA: - 43% fire/flame If the patient requires transferring to one of our burn centers, the following 1. Partial-thickness burns with a - 34% scalds steps should be taken to prep them ≥10% TBSA - 9% hot objects for transfer: + 4% suffer from 2. Burns involving the face, hands, electrical burns + Monitor urine output hourly feet, genitalia, perineum, or major joints + 3% suffer from + Ensure patient is being kept warm chemical burns 3. Third-degree burns of any size + 7% suffer from other + Always assess pulses in the extremities in any age group causes + For chemical burns, brush off any 4. Electrical burns, including chemical residue lightning strikes Proper fluid resuscitation is dependent + Find out about the patient’s medical 5. Inhalation injuries on the accurate calculation of the history and ask when and how they patient’s Total Body Surface Area were burned 6. Chemical burns (TBSA). TBSA is the percentage of the body that has been injured or burned + Cover the burned areas in dry 7. Burn injuries in patients and is usually assessed using the Rule dressings and try to elevate with pre-existing medical of Nines. It’s important to note the injured areas disorders that could complicate distinctions between the adult and management, prolong recovery, pediatric Rule of Nines. There are two Once the patient is ready for transfer, or adversely affect recovery main differences: the referring facility should have as much of the following information 8. Any burns in a patient with 1. A child’s head is proportionally readily available as possible: concomitant trauma in which larger at birth, and accounts for the burn poses the greatest risk 18% of its body area. As the child + Patient Demographics (name, age, of morbidity and mortality. If ages, subtract 1% each year from sex, weight) the trauma poses the greatest the head up to nine-years-old. The risk, the patient should be head of children ages 10 and up + Burn information (time of injury, stabilized in a trauma center should be calculated at 9%. estimated TBSA%, cause of burn, before being transferred to a areas burned, associated injuries) burn center. 2. At the same time, you should add 0.5% to each leg for each year up to + Allergies 9. Pediatric burns in settings nine-years-old. without qualified personnel + Current medication or equipment for the care of The move towards specialized burn children care has enabled burn centers to + Medical history (smoker, alcohol, research, implement and improve early tetanus status) 10.Burn injuries in patients who resuscitation practices to avoid over- will require special social, aggressive fluid treatment. However, + Current status (inhalation injury, alert emotional, or long-term not all burn patients need to be & oriented, intubated, circumferential rehabilitative interventions. resuscitated. Burns under 10% TBSA burn, pulses present, escharotomies, do not require fluid resuscitation. If you foley, vitals, IV Lactated Ringers rate have any doubts, please call a member and total infused) © Burn and Reconstructive Centers of America, LLC | www.burncenters.com 5
team focuses on their long-term recovery. For some patients, this may mean reconstructive surgery to rebuild and repair injured parts of their body. Sometimes the focus is on the scarring caused by a burn injury. Scars can be constricting, painful, and itchy, all symptoms that can severely alter a patient’s quality of life. One of the tools BRCA utilizes to help treat these FIRST-DEGREE BURN SECOND-DEGREE BURN symptoms is laser therapy. Often, patients can see dramatic results within just a few laser treatments. In addition to reconstruction and scar management techniques, BRCA partners with physical, occupational and mental therapists to ensure patients sustain not only their physical recovery, but also their mental wellbeing. THIRD-DEGREE BURN FOURTH-DEGREE BURN Each patient admitted to one of BRCA’s facilities is evaluated to determine the potential benefit of physical (gross motor function), It is also important to determine the + FOURTH-DEGREE BURNS (deep occupational (fine motor function and severity or depth of a burn injury, full-thickness burns) involve exposed cognitive skills) or speech therapy which is broken up into four categories: muscle, tendon, and bone. These (beneficial to those who suffered burns require multiple surgical inhalation injuries or were intubated). + FIRST-DEGREE BURNS are procedures to heal and amputation Rehab is integral to enhancing a superficial, such as minor sunburns. is a possibility. patient’s quality of life by preventing They are red and painful, with no loss of function, improving function, blistering and usually heal without Remember: When a burn first and providing the patient with tools to medical intervention. happens, what you see initially is not promote healing such as splints and always the final outcome. A burn can compression garments. We understand + SECOND-DEGREE BURNS (partial- progress over the first 12 to 24 hours, how stressful this process can be on thickness burns) are red and which means such injuries should be our patients and aim to accommodate painful with large blisters or a wet regularly monitored. them as much as possible by arranging appearance. Blisters do not indicate their rehab to take place at a facility only a second-degree burn, but at BURN CENTER CARE AND BEYOND local to their hometown. least a second-degree burn. Medical intervention may be required to Once a patient arrives at one of our Depending on the details of their promote healing, depending on the burn centers, our team immediately accident, the severity of the burn, severity of the burn. begins the assessment and treatment and the treatment options available, process. Depending on the depth a patient may not only feel physically + THIRD-DEGREE BURNS (full- of the injury, the intervention can altered but mentally altered as well. thickness burns) are charred, involve surgical procedures and the Around 16% of burn patients suffer leathery, white, and dry in use of grafts using skin substitutes, from some form of PTSD.iii A patient’s appearance. Because this injury is such as cadaver skin, or the patient’s self-image can be irrevocably altered deeper, the nerves may be affected, own skin. Less severe injuries may be due to a burn or wound. This is most and there may be little to no pain treated topically. likely to occur in patients with burn associated with the burn. A skin graft injuries/scarring to their face or hands is most likely required. Once a patient has progressed through as these are prominently visible parts the acute phase of their care, BRCA’s of the body. In response to this, BRCA 6 Burn Care Commentary | FALL 2020
not only works collaboratively with America understands the impact burns to the work our team and its partners do mental health professionals, but also have on patients and their families. on a daily basis. We believe the healing of encourages and supports patient Founded on the belief that access to patients begins before they arrive at one support groups at each of our burn specialized burn and wound care should of our centers and extends beyond their centers. These groups provide burn be available to all patients, BRCA has initial discharge. ◆ patients the opportunity to share their treated patients from two days old to experiences with nonjudgmental and 105 years old, including those with burns like-minded people in an atmosphere covering less than 1% to burns more than TO LEARN MORE about our services, that promotes wholesome healing. 95% of the patient’s body. visit www.burncenters.com. To refer a patient, we can be reached 24/7 at As the nation’s largest burn care provider, BRCA’s mission of Healing Patients. 855-863-9595 or via our burn app Burn and Reconstructive Centers of Healing Families. Healing Lives.® speaks (www.burncenters.com/app). Access to burn experts in the palm of your hand In emergency situations, time is of the essence. In addition to our 24/7 call center, BRCA provides the Burn App to assist in initiating patient referrals. A password-protected, HIPAA- compliant app, the Burn App employs end-to- end AES 256-bit encryption to ensure patient data is always kept safe. The app allows users to securely send images and information to a BRCA expert, facilitating consultations, referrals and transfers in a HIPAA-compliant environment. To register, scan the QR code or visit us online at burncenters.com/app. © Burn and Reconstructive Centers of America, LLC | www.burncenters.com 7
“We were at the biggest race of the year,” he said. “It was a huge stage with thousands of people there and tens of thousands watching online. I mean, it was as big of a stage in radial racing as you could possibly race on.” He was about three-quarters of the way down the track in the opening round of qualifying when an electronics failure caused the dragster’s motor to explode, shattering his Corvette, delaying his drag racing dreams and nearly ending his life. “The entire inside of the car was on fire, all of it,” Barnett said. “It was just swirling around. It was everywhere.” And at drag-strip speed, he didn’t have a lot of options for escape. “You don’t bail out of a car at a hundred miles an hour,” he said. He felt the flames scarring his body. He felt the crushing impact of the wall. “I was still fighting for my life,” said the 29-year-old racer from Robbins, NC. “I was swattin’ around, squirming around, just trying to get away (from the flames).” Back on Track: Driver Beats It took 28 seconds for the car to slow to a point where he could bail. By Burn to Return to Drag Strip then, the flames had burned away the six-point harness and belts holding him in the seat, as well as part of the head and neck restraints he had been wearing. He swatted at the door, trying to find the handle. Finally, the door TWENTY-EIGHT SECONDS. doubt,” he said. “I just didn’t know how opened, and he rolled out. long it was gonna take for me to die.” Lyle Barnett was on fire for 28 seconds. His team ran down the track. The The September afternoon started as racetrack’s emergency crews drove His drag car exploded around him as he just another day at the track in 2015 toward the flaming wreckage. Barnett hurtled down the quarter-mile strip at for Barnett. At just 24 years old, he was rolled around on the asphalt, hoping to 170 mph. It started as a softball-sized competing at the Lights Out 6 event smother the flames. orb of ethanol-fueled flames that struck at South Georgia Motorsports Park in him right in the face. Instinct took over. Adel, GA. His custom Corvette, capable He was treated at the scene, loaded He took a deep breath, inhaling fire and of reaching 190 mph in a quarter-mile, into an ambulance and taken to a local fumes that scorched his lungs. was eight months old and had already hospital. From there, he was air-lifted taken him to the finals of another event. to the JMS Burn Center at Doctors “At that moment, I thought I was dead, no But Lights Out was different. Hospital in Augusta, GA. It’s a blur for 8 Burn Care Commentary | FALL 2020
Barnett; his memories aren’t clear until your independence, so the time I spent Barnett also returned to the burn center two weeks after he arrived in Augusta. without them was humbling.” to talk with patients who were going During those first few weeks, he said, through similar situations. He provided his life hung in the balance. Second- At one point, doctors even reconstructed mini-race cars to help transport young and third-degree burns covered 15% his eyelids. They made his hands work patients around the hospital. He sent of his body, but the damage inside was again. They helped heal his lungs. Christmas gifts. He wanted to give the far worse. patients hope, provide some light at the “How they did it, I don’t know,” end of their tunnel. Mainly, he answered “There were times there that they Barnett said. “I just know that when questions, especially ones about life thought I wasn’t going to make it, I was prepped for surgery and (Vice after the burn center, the people that especially when they found the President of Non-Physician Providers stare, the face and body patients see in inhalation damage to my lungs,” Beretta Coffman) would come in and the mirror. Barnett said. “For seven days, it was tell me how it was gonna go, nothing touch and go, you know: Is he gonna was sugarcoated. … But what they “I don’t even remember what I looked make it? Is he not gonna make it? Is he said they were gonna do, they did, and like before,” he said. “You know, I can gonna be on a vent for the rest of his they did it perfect.” look at pictures, and it just doesn’t life? What’s going to happen?” relate anymore. I had the thickest, After he was discharged from the darkest, blackest eyebrows you’d ever During his five months in the burn unit, hospital, Barnett’s healing continued. seen in your life. Now, I ain’t got a stitch. Lyle underwent multiple surgeries, He returned to the Augusta burn … They tell me, ‘Oh we can graft those, many of which focused on his severely center for a series of laser treatments we can give you new eyebrows.’ I don’t burned face and hands. Various skin on his scars. The procedures helped want new eyebrows. This is me. You substitutes, including porcine and reduce redness, irritation and itching either take me or leave me.” cadaver grafts, were used to help cover associated with his scars. the larger burned areas and allow He is grateful to the dedicated burn them to heal some before applying “Today, I really don’t have any side professionals for not only saving his permanent skin grafts. effects that keep me from doing my life, but allowing him to thrive and push normal day-to-day thing,” he said. “My forward. He’s gotten engaged. He’s “During all this, I was learning to walk hands...are very tender. Just walking back in the driver’s seat of a dragster. again, eat on my own again, coming by a door jamb can knock the hide off of a ventilator, and trying to regain off. I have to be careful in the sun with “It’s all I know,” he said of racing. some range of motion in my hands,” he my face graft, but with a good layer of “It’s what drives me to get out of bed said. “Your hands are 100 percent of sunscreen and a hat, I’m good.” in the morning.” ◆ © Burn and Reconstructive Centers of America, LLC | www.burncenters.com 9
BRCA FOUNDATION Improving patient care through access to education Burn Symposium, an annual gathering or search CloudCME in your chosen app of medical professionals dedicated to store. Burn Care Radio podcasts can the constant improvement of burn care be found on Amazon Podcasts, Apple in America. Podcasts, Google Podcasts, iHeart Radio, Spotify and BuzzSprout. In addition, the Foundation recently introduced two new initiatives to help promote burn care and burn Founded in 2018, our mission is simple: prevention education: BRCA Foundation is committed to helping patients and their families, CONTINUING MEDICAL EDUCATION AND while continuously working to improve IT IS THE GOAL OF BRCA CERTIFIED EDUCATION OPPORTUNITIES care throughout the world. FOUNDATION to enhance clinical care through improved access to Burn, hand and wound education and dissemination of burn care resources are now available anytime, As an accredited provider of AMA PRA education. We work with physicians anywhere, through BRCA Foundation’s Category 1 Credit™ Continuing Medical and health care professionals to new online courses and podcasts. Education Credits, BRCA Foundation enhance knowledge, competence, CloudCME and Burn Care Radio allow offers both Continuing Medical Education and performance in practice, and, health care professionals access to and Certified Education credits for many ultimately, improve patient outcomes. continuing education credits, the newest of the online modules. ◆ medical topics provided by experts in As part of the effort to improve access the field, and live virtual and in-person to burn care education, the Foundation education opportunities. You can register FOR MORE INFORMATION, please serves as the host of the Joseph M. Still online at burncenters.cloud-cme.com visit burncenters.cloud-cme.com. PHOENIX POWERS TM TM Extending its education outreach beyond medical professionals, BRCA Foundation proudly introduces Phoenix Powers! A superhero fighting to prevent burn injuries, Phoenix Powers is dedicated to empowering children through burn prevention programs and safety activities. At home or at school, Phoenix Powers collaborates with parents, caretakers, and teachers to defend children from preventable burn accidents or help them establish steps to take if one occurs. For more information and to download a Phoenix Powers coloring page, please visit: burnfdn.org/phoenix-powers. ◆ 10 Burn Care Commentary | FALL 2020
Remembering Dr. Fred Mullins, 1966-2020 BURN AND RECONSTRUCTIVE and the globe. Dr. Mullins practiced him and around him. We’re proud to CENTERS OF AMERICA LOST ITS under the leadership of the founder of purposefully deliver acute, life-saving care FOUNDER IN JUNE. the Augusta burn center, Dr. Joseph M. and long-term reconstructive planning Still. Dr. Mullins became the Medical and therapy to new burn patients, while Dr. Fred Mullins faithfully served Director of the burn center in 2003 and also offering reconstructive and plastic as the Medical Director of the JMS led the center’s transformation into Burn surgery programs to restore function and Burn Center at Doctors Hospital and Reconstructive Centers of America form to the lives of burn survivors and and President/CEO of Burn and – a national presence with 15 locations other patients across the nation. Reconstructive Centers of America. in eight states. Dr. Mullins’s legacy is not what BRCA In his more than 30 years of caring for Above all, Dr. Mullins was committed to has achieved so far. It’s what’s on the thousands of patients, Dr. Mullins helped the care of our patients. That’s the ethic horizon beyond what we can see. It’s transform burn care across the nation he instilled in everyone who worked with what we will become. ◆ © Burn and Reconstructive Centers of America, LLC | www.burncenters.com 11
ONLINE 2020 JMS BURN SYMPOSIUM - ON DEMAND Visit burncenters.cloud-cme.com | Available starting October 19 In order to register for the course, you must have a CloudCME account. When and if you have a CloudCME account, by selecting Online Courses you can locate one of the CME CREDITS courses promoted. After selecting the course you can now register. By completing the pre-test, post-test and evaluation, you will be rewarded the credit associated with the activity. Each credit hour is $10, and you can pay securely online. THE ONDEMAND LIST IS AS FOLLOWS: + 2020 JMS Burn Symposium + 2020 JMS Burn Symposium + 2020 JMS Burn Symposium Advances in the Treatment The Healing Power of Art Virtual Reality for Reducing Pain and of Major Burns Joel Thomas Hall Perioperative Anxiety in Pediatric David Herndon, M.D. Activity Code 400, 1 credit hour Burn Patients Activity Code: 349, 1 credit hour Heather Schwartz, DNP, MSN, APRN, + 2020 JMS Burn Symposium CPNP-AC, FNP-C + 2020 JMS Burn Symposium Things That Make You Go Hmmm… Activity Code: 403, 0.25 credit hour Case Study: Care of the Burned Kim Linticum, ACNP-BC Pregnant Patient Activity Code: 401, 0.50 credit hour Beretta Craft-Coffman, PA-C Activity Code: 398, 0.25 credit hour + 2020 JMS Burn Symposium Creative Reconstructive Options for + 2020 JMS Burn Symposium Severely Traumatic Injuries Back to the Basics of Burns Benson Pulikkottil, M.D. Shawn Fagan, M.D., FACS Activity Code: 402, 1 credit hour Activity Code: 399, 1 credit hour S AV E T H E D AT E FEBRUARY 28 - MARCH 1, 2021 Château Élan | Braselton, Georgia Joseph M. Still Burn Symposium is hosted by BRCA Foundation. For more information, visit burncenters.com/symposium
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