American Burn Centers: There Are So Few Burn Centers in the US

Burn centers are specialized medical facilities dedicated to the treatment of severe burn injuries, focusing on acute care, rehabilitation, and support services for patients. These centers provide comprehensive care that includes advanced surgical techniques, pain management, psychological support, and long-term rehabilitation.

However, there are relatively few burn centers in the United States. As of 2024, there are approximately 127 burn centers, unevenly distributed across the country. This limited number is due to several factors:

• High Costs: Establishing and maintaining a burn center requires significant financial investment in specialized equipment, highly trained staff, and comprehensive support services.
• Specialized Staff: There is a shortage of medical professionals trained specifically in burn care.
• Geographical Constraints: Rural areas often lack the resources to support such specialized centers.

What We Learned From the 2023 Maui Fires

In 2023, the Maui fires highlighted the inadequate preparedness and progress in burn care. The situation was exacerbated by the failure to adhere to established protocols, the transmission of non-HIPAA compliant images via text, and the scarcity of ICU beds (only 4) on the main Hawaii island, posing significant challenges in determining patient transfer.

Consequently, burn patients in less populated areas face longer travel times to receive the care they need, which can impact outcomes. Efforts to address this disparity include telemedicine and regional partnerships to extend the reach of existing burn centers.

Factors Contributing to the Limited Number of Burn Centers

High Costs of Establishment and Maintenance of a Burn Center

Establishing a burn center demands significant financial investment. Initial costs include acquiring advanced medical equipment, constructing specialized facilities, and securing regulatory approvals. For example:

• Specialized Equipment: Ventilators, hyperbaric oxygen chambers, and advanced wound care supplies
• Facility Construction: Dedicated ICU units, operating rooms, and rehabilitation spaces
• Regulatory Approvals: Compliance with stringent health and safety standards

Ongoing operational expenses further strain budgets. Staffing a burn center with highly trained professionals, including burn surgeons, nurses, and rehabilitation therapists, incurs substantial costs. Additionally, maintaining a continuous supply of specialized medications, dressings, and ensuring round-the-clock patient care adds to the financial burden.

Specialized Staffing Needs 

Specialized staffing needs significantly contribute to the high costs of burn centers. Employing burn surgeons, specialized nurses, and rehabilitation therapists demands substantial financial resources. Recruitment and retention of these highly trained professionals involve competitive salaries, extensive training programs, and continuous education.

• Burn Surgeons: Require advanced surgical skills and expertise in burn care.
• Specialized Nurses: Must be proficient in wound care, pain management, and patient support.
• Rehabilitation Therapists: Focus on long-term recovery and functional restoration.

Ongoing operational costs include maintaining a dedicated team for round-the-clock care, ensuring optimal patient outcomes. These financial demands make sustaining specialized staff a critical, yet costly, component of burn centers.

Advanced Technology and Equipment

Advanced technology and equipment are crucial in burn centers, contributing to their high costs. Setting up a burn center requires significant investment in state-of-the-art tools, such as:

• Ventilators and Monitors: Essential for critical care and monitoring of burn patients.
• Hyperbaric Oxygen Chambers: Used for promoting wound healing and reducing complications.
• Laser Therapy Devices: Aid in scar management and functional recovery.

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Impact on Patient Care

Specialized burn centers offer significantly better care compared to general hospitals. Patients in burn centers benefit from advanced technology, specialized staff, and comprehensive rehabilitation services, leading to improved outcomes.

• Advanced Technology: Access to state-of-the-art equipment ensures precise treatment and faster healing.
• Specialized Staff: Expertise of burn surgeons, nurses, and therapists enhances patient care and recovery.
• Comprehensive Rehabilitation: Focused programs support physical and psychological recovery, reducing long-term complications.

Efforts to Improve Burn Care Availability

Role of the American Burn Association

The American Burn Association (ABA) plays a crucial role in improving burn care availability. They advocate for better funding and resources, aiming to enhance the quality and accessibility of burn treatment nationwide. Through support initiatives, the ABA collaborates with healthcare providers and policymakers to establish more burn centers.

• Training Programs: The ABA offers specialized training for burn care providers, ensuring high standards of care.
• Certification Programs: These programs certify professionals in burn care, promoting expertise and consistency.

Pediatric and Adult Burn Care Programs

Specialized programs for pediatric and adult burn care are essential due to the distinct physiological and psychological needs of each patient group. Children’s bodies are still developing, necessitating treatments that consider growth and long-term development. Pediatric programs must also address the significant psychological impact burns can have on young minds, providing comprehensive emotional and psychological support.

In contrast, adult programs prioritize advanced pain management, rehabilitation, and restoring functional independence, focusing on the complexities of mature physiology and potential comorbidities.

• Pediatric Programs: Shriners Hospitals for Children provide comprehensive burn care, including surgery, rehabilitation, and emotional support.
• Adult Programs: The University of Chicago Medicine’s Burn and Complex Wound Center offers advanced treatments and rehabilitation services.

Funding and Policy Initiatives

Efforts to improve burn care availability focus on funding and policy initiatives. Government grants and private donations significantly support the establishment and maintenance of burn centers. Programs like the Health Resources and Services Administration (HRSA) provide financial assistance for developing burn centers, while organizations such as the American Burn Association (ABA) raise funds for research and facility upgrades. Policies aimed at increasing the number of burn centers include incentives for hospitals to develop specialized units and streamlined regulatory processes. These initiatives ensure more comprehensive burn care access, enhancing patient outcomes and expanding treatment availability nationwide.

Challenges Faced by Emerging Burn Centers

Emerging burn centers face numerous challenges in improving burn care availability. High costs associated with establishing and maintaining specialized facilities pose significant financial barriers. Acquiring advanced medical technology, such as ventilators and hyperbaric oxygen chambers, requires substantial investment. Recruiting and retaining specialized staff, including burn surgeons, nurses, and rehabilitation therapists, further strains budgets. Additionally, these centers must meet stringent regulatory standards, which can be both time-consuming and costly.

• Funding: Securing sufficient financial resources from government grants and private donations is often difficult.
• Staffing: Attracting and retaining highly trained professionals presents a significant challenge.
• Technology: Acquiring and maintaining state-of-the-art equipment demands continuous investment.

Despite these obstacles, emerging burn centers play a critical role in enhancing patient outcomes. By overcoming these challenges, they can provide comprehensive care that addresses the unique needs of both pediatric and adult burn patients, ensuring better recovery and quality of life.

What is the typical treatment plan for a person who has severe burns?

The treatment plan for a person with severe burns involves multiple stages, focusing on immediate stabilization, wound care, prevention of complications, and long-term rehabilitation. Here’s a typical outline:

Immediate Stabilization

Initial Assessment and Resuscitation:

• Airway Management: Ensure the airway is clear, and administer oxygen if needed.
• Fluid Resuscitation: Administer intravenous fluids to maintain blood pressure and prevent shock, often guided by formulas like the Parkland formula.
• Pain Management: Provide pain relief through medications.

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Burn Assessment:

• Determine the extent and depth of burns using tools like the Rule of Nines.
• Assess for inhalation injury, carbon monoxide poisoning, or other trauma.

Wound Care and Infection Prevention

Cleaning and Debridement: Clean the burn wounds and remove dead tissue to prevent infection.

Dressing and Topical Treatments: Apply antimicrobial dressings and ointments to protect the wound and promote healing.

Infection Control: Administer antibiotics if signs of infection are present. Maintain a sterile environment to prevent infections.

Surgical Interventions

Escharotomy and Fasciotomy:
Perform these procedures if necessary to relieve pressure and improve circulation.

Skin Grafting:
Apply skin grafts to cover large burn areas, using either autografts (patient’s skin) or allografts (donor skin).

Rehabilitation and Long-term Care

Physical Therapy:
Initiate early physical therapy to maintain joint function and prevent contractures.

Occupational Therapy:
Focus on activities of daily living and improving functional abilities.

Scar Management:
Use pressure garments, silicone sheets, and other techniques to minimize scarring.

Psychological Support:
Provide mental health support to address trauma, anxiety, and depression.

Ongoing Monitoring and Follow-up

Regular Assessments: Monitor wound healing, fluid balance, and overall health regularly.

Nutritional Support: Ensure adequate nutrition to support healing and recovery.

Long-term Follow-up: Schedule regular follow-ups to address any complications, such as infections, scarring, or mobility issues.

This comprehensive approach ensures that severe burn patients receive the necessary care to promote healing, prevent complications, and improve their quality of life.

What are the 6 C’s of burn care?

The 6 C’s of burn care are a set of principles designed to guide the effective treatment and management of burn patients. These principles ensure comprehensive care, focusing on various critical aspects of burn treatment. Here are the 6 C’s of burn care:

1. Clothing Removal

• Purpose: Remove all clothing and jewelry from the burn area as quickly as possible.
• Importance: This helps to stop the burning process, prevent further tissue damage, and reduce contamination.

2. Cooling

• Purpose: Cool the burn with running tap water (not ice) for at least 20 minutes.
• Importance: Cooling the burn helps to reduce pain, swelling, and tissue damage. It is most effective if done within the first three hours after the burn injury.

3. Cleaning

• Purpose: Gently clean the burn wound with mild soap and water.
• Importance: Proper cleaning helps to reduce the risk of infection and prepares the wound for further treatment.

4. Chemoprophylaxis

• Purpose: Use topical antibiotics or antimicrobial dressings to prevent infection.
• Importance: Burn wounds are highly susceptible to infections. Applying appropriate antimicrobial treatments helps to protect against bacterial colonization and infection.

5. Covering

• Purpose: Cover the burn with a clean, non-stick dressing.
• Importance: Covering the burn helps to protect the wound from contamination, reduces pain by shielding exposed nerve endings, and aids in moisture retention to promote healing.

6. Comfort

• Purpose: Provide adequate pain relief and psychological support.
• Importance: Managing pain is crucial for the patient’s comfort and recovery. This includes administering appropriate analgesics and offering emotional and psychological support to help the patient cope with the trauma of the burn injury.

These principles ensure that burn patients receive thorough and effective care, promoting better outcomes and faster recovery.