Critical Care: Why northwest Michigan needs a burn center
A friend told me a story this summer. Her two-year-old boy pulled a pot of scalding water onto his chest from the stove. They were away from home when it happened. So EMS was called, and the solution was to strap mom to the gurney, holding the child. Screaming. To Grand Rapids.
Once there, the burn was assessed. Not as severe as first thought. The child was discharged. And returned home to Traverse City in mother's arms, again belted to the gurney.
To me that sounded like torture for all involved.
According to the American Burn Association (ABA) there are 500,000 burns requiring medical treatment each year. The vast majority of these are not fatal and, in fact, less than 10 percent require hospital admission. Most are referred to specialized centers that receive "verification" from the ABA and the American College of Surgeons based on performance – which is great if you live in Manhattan, where there are seven burn centers within 40 miles.
But our nearest center, and the one to which most patients are referred, is 140 miles away. Imagine having a hospitalized loved one at that distance. Or, perhaps worse, the need for specialized outpatient care on a weekly basis. That drive gets old.
There is no slow season for burn injuries. The summer brings fireworks and campfire accidents. The winter is most depressing; the burns are largely a consequence of socio-economic hardship – heating the home in an unsafe way, or boiling water for a bath.
The care of a burn varies depending on the mechanism of injury, the depth or "degree" of burn, and the overall body surface area involved. Small wounds to less-sensitive body areas can be treated with topical ointments that serve to prevent infection while the body repairs the skin. Deeper injuries cannot heal by themselves because all layers of skin have been damaged. This is the definition of a "third-degree" burn. These typically require an operation, during which the surgeon removes the burned tissue, and applies a skin graft for closure – literally borrowing from one area and giving to another.
Not all injuries are so straightforward. Take a patient with a 90-percent body surface burn. Where does one obtain enough new, healthy skin? Tissue banks can now multiply cells obtained by a tissue biopsy. Given three weeks – and a substantial fee – new skin of a significant quantity can be grown and applied to a waiting patient. Technology like this has led to tangible improvements in survival.
Having not lived in northern Michigan for all that long-my wife and I, along with our two boys, moved here from Indianapolis a year and a half ago – I have limited historical perspective on the evolution of medicine in the region. What is clear to me is this: The level of care provided by the doctors and staff in this area is brilliant, and Munson Medical Center is respected as a center of excellence. A multitude of awards attest to this. Why, then, are we not comprehensively treating burns?
A nurse who works in the emergency department in Frankfort recently described to me a redundant pathway by which small burns are often addressed. Patients are typically evaluated and, if not clearly requiring admission, referred to their general practitioner. With no specialty center at their disposal and sparse training in wound management, the primary care physicians do the best they can. Often, though, the patients end up back in the ER for wound care – sometimes on a weekly basis – which duplicates service and increases cost.
A better scenario to avoid frustration and societal expense is the provision of a burn clinic in northern Michigan. Such a resource would be beneficial to general practitioners in the region, as well as piece of mind for every parent who has watched their two-year-old fall near a campfire or reach for boiling water.
Treating patients with massive burns in the past, I can attest to the professional satisfaction that accompanies the multi-specialty effort required in these cases. Physicians and surgeons in trauma, plastic surgery, gastroenterology, ophthalmology, pulmonology and internal medicine are but a few of the critical players. All take rightful pride in the successful rehabilitation of the burned patient.
Having become accustomed to downstate transfers, referring institutions have stopped calling our facilities with burn injuries, necessitating in many cases the kind of struggle our friend described. It seems time to reverse this trend. With the commitment of medical staff and, importantly, community leaders, I believe we can deliver burn care on a level that rivals any institution in Michigan.
Dr. Jeffries, board-certified in General Surgery by the American Board of Surgery and affiliated with Munson Medical Center and The Northwest Michigan Surgery Center, is a partner at the Center for Plastic Surgery at Copper Ridge. 231-929-7700, tc-plasticsurgery.com