Geospatial Mapping as a Guide for Resource Allocation Among Burn Centers in India

2019 ◽  
Vol 41 (4) ◽  
pp. 853-858
Author(s):  
Kavitha Ranganathan ◽  
Charles A Mouch ◽  
Michael Chung ◽  
Ian B Mathews ◽  
Paul S Cederna ◽  
...  
Keyword(s):  
Burn Injury ◽  
Cross Sectional ◽  
Burn Centers ◽  
Optimal Outcomes ◽  
Burn Care ◽  
Burn Center ◽  
Level Data ◽  
Burn Units ◽  
Time Required ◽  
Reallocation Of Resources

Abstract Timely treatment is essential for optimal outcomes after burn injury, but the method of resource distribution to ensure access to proper care in developing countries remains unclear. We therefore sought to examine access to burn care and the presence/absence of resources for burn care in India. We surveyed all eligible burn centers (n = 67) in India to evaluate burn care resources at each facility. We then performed a cross-sectional geospatial analysis using geocoding software (ArcGIS 10.3) and publicly available hospital-level data (WorldStreetMap, WorldPop database) to predict the time required to access care at the nearest burn center. Our primary outcome was the time required to reach a burn facility within India. Descriptive statistics were used to present our results. Of the 67 burn centers that completed the survey, 45% were government funded. More than 1 billion (75.1%) Indian citizens live within 2 hours of a burn center, but only 221.9 million (15.9%) live within 2 hours of a burn center with both an intensive care unit (ICU) and a skin bank. Burn units are staffed primarily by plastic surgeons (n = 62, 93%) with an average of 5.8 physicians per unit. Most burn units (n = 53, 79%) have access to hemodialysis. While many Indian citizens live within 2 hours of a burn center, most centers do not offer ICU and skin bank services that are essential for modern burn care. Reallocation of resources to improve transportation and availability of ICU and skin bank services is necessary to improve burn care in India.

102 Wildfire Burns: Implications for Burn Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Tina L Palmieri ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Length Of Stay ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Mass Casualty ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Injury Incidence ◽  
Burn Centers ◽  
Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

Inpatient Data of Occupational Burn Injuries Treated at a Tertiary Burn Center

2019 ◽  
Vol 41 (2) ◽  
pp. 398-401
Author(s):  
Abdulkadir Basaran ◽  
Ozer Ozlu
Keyword(s):  
Hospital Stay ◽  
Burn Injury ◽  
Health And Safety ◽  
Length Of Hospital Stay ◽  
Burn Injuries ◽  
Occupational Accidents ◽  
Cross Sectional ◽  
Work Related ◽  
Burn Center ◽  
Electrical Burns

Abstract Occupational burns are among the important causes of work-related injuries. We aimed to investigate the epidemiology and reasons of occupational burns and thereby to emphasize preventive measures. Between January 2017 and December 2018, the data of major occupational burn injury patients admitted to our burn center were evaluated in this cross-sectional retrospective study. During the study period 342 patients older than 16 years were admitted to the burn center. Among them 80 patients with occupational burns (23.4%) were identified. The mean age of the patients was 34.73 ± 12.3 years. Seventy-eight patients (97.5%) were male. Electrical burns and flame burns were the two leading type of occupational burns. The most common occupation of our patients was construction work. Dangerous behavior, carelessness, lack of protective equipment, and failure to follow instructions were causes of injury. Only 14 patients (17.5%) experienced unavoidable accident. Thirty-seven patients (46.3%) worked on temporary basis. Occupational experience was under 5 years in majority of the cases (62.5%). For the occupational burns the percentage of burned TBSA was 17.08 ± 14.5 (1–60) and the length of hospital stay was 23.94 ± 21.9 days (2–106). There were no significant differences between occupational and nonoccupational burn injuries considering TBSA, total length of hospital stay, and complications (P > .05). Occupational burn injuries are common in less experienced and younger workers. Therefore, recognition of the problem and maintaining awareness is important. In order to prevent occupational accidents and burns, occupational health and safety rules must be obeyed.

576 Firefighter Post-injury Return to Work: A Balance of Dedication and Obligation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S130-S130
Author(s):  
Lauren B Nosanov ◽  
Kathleen S Romanowski
Keyword(s):  
Return To Work ◽  
Burn Injury ◽  
Organizational Level ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Post Injury ◽  
Cross Sectional ◽  
Burn Center ◽  
Medical Evaluation ◽  
The Individual

Abstract Introduction Over the duration of firefighters’ careers there exists a high probability of sustaining burn injuries necessitating medical evaluation and treatment. While many are minor and do not significantly affect the ability to work in full capacity, there exists risk for both short and long-term incapacitation. It is not uncommon for firefighters to push for earlier return to work than is medically advisable. However, there are additional external factors which drive premature return to duty. Methods An online cross-sectional survey was sent to firefighters who were members of a statewide Professional Firefighters’ Union. A multiple-choice format was used to assess demographics, injury details, medical care received and return to work. Free text format allowed for elaboration regarding factors influencing decisions to return to work. Results The survey was sent to 30,000 firefighters, with 413 (1.4%) responses received. Excluding those with incomplete data, 354 remained for analysis. Of these, 132 (37.3%) reported a burn injury which required medical evaluation. The majority were sustained during active duty, with 90.7% using protective gear at the time. Most burns were small and affected the head (50.8%) and upper extremities (48.3%). The majority were not treated at a Burn Center. While 12 (16.2%) reported returning to work prematurely themselves, nearly half indicated that they knew a colleague whom they felt had returned to work too soon. Factors cited include firefighter culture, finances, limitations of workman’s compensation, pressure from peers and employers, dislike of light duty and a driving desire to get back to work. Conclusions While many cite love of the job and a culture of pride and camaraderie that is “in our DNA”, firefighters’ decisions to return to work after burn injury are equally driven external pressures and obligations. Additional education is needed at both the individual and organizational level, which may best be facilitated by evaluation and treatment at a Burn Center. Applicability of Research to Practice Improved understanding of factors driving firefighters’ views on returning to duty after injury may help establish support systems and improve education regarding risks of premature return to work, particularly with regard to reinjury.

581 Basecamp: Burn Efficiency Care Pathway

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S132-S132
Author(s):  
Carolyn B Blayney ◽  
Nicole S Gibran
Keyword(s):  
Burn Injury ◽  
Care Pathway ◽  
Wound Care ◽  
Medical Center ◽  
Patient Specific ◽  
Improvement Project ◽  
Burn Care ◽  
Burn Center ◽  
Resuscitation Guidelines ◽  
Standard Operating

Abstract Introduction Standardizing care has shown in the literature to be a means to improving the culture of safety in any field. Aligning burn surgeons, staff and ancillary services in the Burn ICU, Burn Acute Care floor, Burn Clinic who all have varying ideas, and plans of care creates toxic variation and communication challenges for bedside staff. While attending a medical center leadership development session, Burn Center Leadership collaborated on a project regarding burn center standardization. Methods A multidisciplinary Burn Center retreat in September 2017, launched the effort with a special emphasis on patient and family participation.We elicited feedback on what we did well and areas we could improve on. Using crowdsourcing methodology, the group selected 5 core QI/PI areas: resuscitation, wound care, pain/anxiety/delirium, physical mobility and psychosocial needs.Each multidisciplinary group, led by a non-physician chair and a Physician liaison established assigned tasks, rules of engagement and time frames. Work groups met weekly and reported progress to the Burn center QI committee.The project concluded with dissemination of the work products to staff. Patients and families were updated on the progress made to ensure we were still in alignment with our original goals. Results Burn Center orientation materials, standard operating practice documents and a Burn Center Standard of Care packet was developed. Documents were uploaded to a commonly accessible Burn Center Sharepoint website so there was one central source of information. The final BasECamP output was a daily checklist packet started on all BICU admits, that addressed key QI indicators and directives for care goals; 24 hr resuscitation guidelines, time to TF vs PO within 4 hrs of admit, daily weights, IV vs PO medication for wound care, time to first active mobility and a review of ICU and Hospital LOS per %TBSA. 71 adult burn patients >18 years admitted to the BICU between November 2018 and May 2019 were started on the pathway. Of the 71, 58 were admitted with a burn injury, 4 with TEN, 6 were burn post-ops and there were 3 deaths. The 58 new burn admits are reviewed below. Conclusions The BaSeCamP packet is turned in and reviewed with the team. Data shows significant improvement in knowledge of standard operating procedures, expectations and resource availability. With improved communication across the burn team, staff more clearly understand patient-specific expectations in burn care and are more easily able to educate patients and families about the plan. Applicability of Research to Practice This Process improvement project responds to patient and family feedback that burn teams must coordinate communication and eliminate variability in delivery of care.

scholarly journals Comparison of PRE and POST COVID-19 Pandemic burn statistics: Initial experience from Rawalian Burn Center, Holy Family Hospital, RMU, Rawalpindi, Pakistan

2021 ◽  
Vol 25 (1) ◽  
pp. 48-52
Author(s):  
Sajid Rashid
Keyword(s):  
Mortality Rate ◽  
Surface Area ◽  
Burn Injury ◽  
Control Period ◽  
Burn Patients ◽  
Chi Square ◽  
Cross Sectional ◽  
Burn Center ◽  
Chi Square Test ◽  
Surgery Department

Objectives: To determine the change in the trend of burn patient epidemiology after the COVID-19 pandemic in terms of frequency of burn injury and mortality rate.Material and Methods: This cross-sectional descriptive study was carried out at Rawalian burn center, Plastic Surgery Department, Holy Family Hospital RMU Rawalpindi from 1st March to 31st July over a period of 05 months. All burn patients reporting to the Rawalian burn center during the specified period were included in this study by consecutive sampling. Patients were mainly admitted from emergency and some from OPD following the standard admission, inclusion, and exclusion criteriaResults: Mean age of patients in the pre-COVID (Control) period March to July 2019 was 28.84 years with an SD of ±3.73. There were 63% females and 37% males. The total burn surface area range was 8-65% during this period. Whereas in the post-COVID period, March to July 2020 mean age of patients was 29.13 years with an SD of ±4.06. There were 60% females and 40% males. Whereas the total burn surface area range was 10-61% during this period. Frequency per month of burn injury progressively reduced to 58 patients and mortality rate to 1 in July 2020 (post-COVID period). The overall frequency of burn injury (n) during the control period was 367 patients whereas in the post-COVID period is reduced to 326 patients. So there was an 11.17% reduction as compared to the control period. A Chi-square test was applied and was found significant.Conclusion: Based on the current study it can be concluded that there is a progressive fall in frequency of burn injury and mortality rate during the ongoing COVID-19 pandemic as compared to the PRE-COVID period however further studies are needed to explore the cause of this falling trend.  

Firefighter Postinjury Return to Work: A Balance of Dedication and Obligation

2020 ◽  
Vol 41 (5) ◽  
pp. 935-944
Author(s):  
Lauren B Nosanov ◽  
Kathleen S Romanowski
Keyword(s):  
Return To Work ◽  
Burn Injury ◽  
Significant Risk ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Burn Center ◽  
External Pressures ◽  
Full Capacity ◽  
Additional Education

Abstract Firefighters are at significant risk for burn injuries. Most are minor and do not significantly affect ability to work in full capacity, but there exists risk for both short- and long-term incapacitation. Many push for earlier return to work than is medically advisable. An online cross-sectional survey was sent to a statewide Professional Firefighters’ Union. Multiple-choice format was used to assess demographics, injury details, medical care received, and return to work, with free-text format for elaboration. The survey was sent to 30,000 firefighters, with 413 (1.4%) responses. After exclusions, 354 remained for analysis with 132 burn-injured. Burns were small and affected the head (45.5%) and upper extremities (43.2%). Reported gear use was 90.7%, and the majority were not treated at a Burn Center. While 12 (12.1%) returned prematurely, nearly half knew a colleague who they felt had returned too soon. Factors cited include firefighter culture, finances, pressure from peers and employers, dislike of light duty, and a driving desire to get back to work. While many cite love of the job and a culture of pride and camaraderie that is “in our DNA,” firefighters’ decisions to return to work after burn injury are equally driven external pressures and obligations. Additional education is needed, which may best be facilitated by treatment at a Burn Center. Improved understanding of factors driving firefighters’ views on returning to duty after injury may help establish support systems and improve education regarding risks of premature return to work, particularly with regard to reinjury.

scholarly journals 42 COVID-19 Slowdown? Not in Our Burn Center!

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S31-S32
Author(s):  
David G Greenhalgh ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
Tina L Palmieri
Keyword(s):  
Burn Injury ◽  
Admission Rate ◽  
Late Summer ◽  
Risky Behaviors ◽  
Burn Injuries ◽  
Fiscal Year ◽  
Care Needs ◽  
Burn Centers ◽  
Burn Care ◽  
Significant Burden

Abstract Introduction There has been a great concern that the COVID-19 pandemic has interfered with burn care. The feeling has been that resources have been shifted to treating the COVID patients and that “shelter-in-place” requirements have reduced the risks for burn injury. The ABA and other organizations have sent biweekly surveys in order to determine how the pandemic has interfered with burn care. Despite these concerns, we seemed very busy. Methods The inpatient data was collected in our adult and pediatric burn centers between January 1, 2020 and August 31, 2020. Results During the COVID-19 pandemic there was an increase in burn admissions in both adult and pediatric centers. At the same time there were 1270 COVID-19 adult admissions and 4 COVID-positive admissions at the pediatric center. In the adult center, there was increase from 414 total admissions from fiscal year 2019 (7/2018-6/2019) of 414 to 495 for fiscal year 2020 (7/2019-6/2020). The average daily census also increased from 18.33 to 18.36 during the same period. The monthly number of burn admissions increased from 38.5/month for the last six months of 2019 to 44/month for the first six months of 2020. The admission rate continued in July (41) and August (47). In the first 8 months of 2020, there were 356 admissions with a mean TBSA of 11.3%. There were many large burns admitted in late summer. The mean TBSA of the 12 bed ICU on September 11, 2020 was 60.6% (range 25–85%). In the pediatric unit, there were 174 admissions through July 2020, a 6% increase from the preceding same period. There was a 6% decrease in burn reconstruction. Conclusions Despite a significant burden of COVID-19 patients, burn admissions also increased at the same time. There was no evidence that “shelter-in-place” requirements changed the risk for burn injuries. Resources for critical care needs should not be siphoned away from burn centers during pandemics. Risky behaviors leading to burns do not go away despite new health crises.

scholarly journals Updating the Burn Center Referral Criteria: Results From the 2018 eDelphi Consensus Study

2020 ◽  
Vol 41 (5) ◽  
pp. 1052-1062 ◽  
Author(s):  
Amanda P Bettencourt ◽  
Kathleen S Romanowski ◽  
Victor Joe ◽  
James Jeng ◽  
Jeffrey E Carter ◽  
...  
Keyword(s):  
Injury Severity ◽  
Burn Injury ◽  
Clinical Trial Data ◽  
Patient Characteristics ◽  
Stevens Johnson Syndrome ◽  
Burn Care ◽  
Medical Needs ◽  
Burn Center ◽  
Referral Criteria ◽  
Johnson Syndrome

Abstract Existing burn center referral criteria were developed several years ago, and subsequent innovations in burn care have occurred. Coupled with frequent errors in the estimation of extent of burn injury and depth by referring providers, patients are both over and under-triaged when the existing criteria are used to support patient care decisions. In the absence of compelling clinical trial data on appropriate burn patient triage, we convened a multidisciplinary panel of experts to execute an iterative eDelphi consensus process to facilitate a revision. The eDelphi process panel consisted of n = 61 burn stakeholders and experts and progressed through four rounds before reaching consensus on key clinical domains. The major findings are that 1) burn center consultation is strongly recommended for all patients with deep partial-thickness or deeper burns ≥ 10% TBSA burned, for full-thickness burns ≥ 5% TBSA burned, for children and older adults with specific dressing and medical needs, and for special burn circumstances including electrical, chemical, and radiation injuries; 2) smaller burns are ideally followed in burn center outpatient settings as soon as possible after injury, preferably without delays of a week or more; 3) frostbite, Stevens–Johnson syndrome/TENS, and necrotizing soft-tissue infection patients benefit from burn center treatment; and 4) telemedicine and technological solutions are of likely benefit in achieving this standard. Unlike the original criteria, the revised consensus-based guidelines create a framework promoting communication so that triage and treatment are specifically tailored to individual patient characteristics, injury severity, geography, and the capabilities of referring institutions.

Burn Center Referral Practice Evaluation and Treatment Outcomes Comparison Among Verified, Nonverified Burn Centers, and Nonburn Centers: A Statewide Perspective

2020 ◽  
Author(s):  
Zhenna Huang ◽  
Linda Forst ◽  
Lee S Friedman
Keyword(s):  
Treatment Outcomes ◽  
Injured Patient ◽  
Linear Regression Models ◽  
Hospital Data ◽  
Skilled Nursing ◽  
Burn Centers ◽  
Burn Center ◽  
Referral Criteria ◽  
Burn Units ◽  
Level I

Abstract The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.4–0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4–0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4–0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6–0.9), shorter length of hospitalization (VB vs OF: β: −0.4, P < .001; NVB vs OF: β: −0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97–1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7–1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.

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