Hospitals shutting down burn centers

[Future Fireman 4]

Hospitals Are Shutting Down Burn Centers

Tuesday, August 7, 2007 2:49 PM EDT

The Associated Press

By BILL POOVEY Associated Press Writer

U.S. hospitals are increasingly shutting down their burn centers in a trend experts say could leave the nation unable to handle widespread burn casualties from a fiery terrorist attack or other major disaster.

Associated Press interviews and an examination of official figures found that the shrinking number of beds is a growing cause for concern in this post-Sept. 11 world.

Experts say burn centers are expensive to maintain and often lose money because they are staffed with highly specialized surgeons and nurses and stocked with sophisticated equipment designed to ease patients' excruciating pain, fend off deadly complications and promote healing.

The number of burn centers in the U.S. has dropped from 132 in 2004 to 127, and burn beds have fallen from 1,897 to 1,820, according to American Burn Association records compiled from voluntary reporting by hospitals.

The U.S. Department of Health and Human Services puts the number of burn beds even lower, at just 1,500. And most of those are already filled, with the number available on any given day variously estimated at just 300 to 500.

"If something happens and we need the beds for burn patients, it is going to be a real catastrophe," said Dr. Alan R. Dimick, past president of the American Burn Association and founder of the burn center at the University of Alabama at Birmingham.

Some states — Mississippi, North Dakota, Montana, Wyoming, Idaho and New Hampshire among them — have no burn centers at all. South Carolina has only a children's burn center, and there are just a few dedicated burn beds in Maine, Alaska and Hawaii.

"People ought to be pretty frightened by this," said Dr. Barbara Latenser, burn center director at the University of Iowa Hospitals. "Some people who live out West, they are 800 miles from a burn center."

Many hospitals contend their general trauma units can handle burn victims adequately. But many authorities say burn units are far superior because of the equipment and expertise they offer.

"You need a burn team to take care of folks, not just docs and nurses," Dimick said.

HHS oversees the Homeland Security Department's efforts to prepare the nation's medical system for a disaster. HHS preparedness spokesman Marc Wolfson acknowledged that a disaster such as nuclear blast in a large urban area could produce thousands of burn victims, and that there would not be enough burn facilities to treat everyone.

"The number of total beds available in hospitals, we don't have direct control over that," he said.

But he said he hopes some of the money the government has been dispensing to hospitals since 9-11 for disaster readiness goes toward preparing for a surge of burn victims, even if does not lead to an increase in burn beds.

Wolfson said that if burn beds are full, patients can be taken to trauma units. Also, he said some veterans hospitals have beds that could be used in a fiery catastrophe. And he said burn centers can be expanded in an emergency.

Some burn experts are not reassured.

Severely burned patients suffer extreme pain, their bodies lose the ability to regulate temperature and fluid levels, and they are highly vulnerable to infections because their skin has been stripped away.

Burn centers are staffed by medical professionals specially trained in treating people with severe burns.

They also have special features such as individually temperature-controlled rooms, mattresses with circulating air to support a burn victim, and beds that automatically turn immobile patients to prevent further skin damage.

In addition, there are warming devices for beds since burn patients get cold easily, and tubs in which patients can be immersed to clean their wounds and promote drainage.

Other burn center features include synthetic material that serves as a temporary skin substitute, and a device that uses ultrasound to determine the severity of burns without having to touch a seriously burned patient.

The exact number of burn beds in the U.S. is a matter of dispute, and may well be overstated, because hospitals do not always distinguish between specialized burn beds and beds that are used for various traumatic injuries, including burns.

Wolfson said one recent report to the federal government showed that only 520 beds were actually available for use. Dr. William B. Hughes, director of the Temple University Hospital Burn Center in Philadelphia, said that more commonly, only about 300 beds are available at any one time.

Hughes said the United States had easily more than 3,000 dedicated burn beds in the early 1970s. But there has been a steady decline since then.

"We keep hearing we are ready for a terrorist attack," said Dr. Jeffrey Guy, director of the 29-bed Vanderbilt University Burn Center in Nashville. But even now, "our space is full almost all the time."

Guy said it is not uncommon for regional burn centers to be full and for patients to be transported long distances. "There are days we are taking burn calls for Chicago," he said.

Burn center directors say more beds are likely to disappear. Most burn centers are losing money because Medicare and Medicaid reimbursements have not kept up with the cost of providing care, experts say. Private insurers often follow Medicare's lead.

Since it costs about $10,000 a day to treat a patient with severe burns, and such patients typically require 50 days of intensive care, a single uninsured patient can wreck the finances of a small burn program.

Some burn centers around the country have lost a lot of money treating uninsured adults and children who were severely burned in explosions of clandestine methamphetamine labs.

"Burn units are money-losers," Hughes said.

Some health industry officials say that it is unreasonable to expect the nation's hospitals to be prepared for a worst-case burn scenario at all times.

"You don't want to have so much capacity you lose your shirt on it," said Jim Bentley, the American Hospital Association's senior vice president for strategic policy planning.

Dr. David Mozingo, director of the Shands Burn Center at the University of Florida in Gainesville, said state officials there have, in fact, begun committing some terrorism and disaster-preparedness money to burn care.

"They have been buying equipment and training. A lot of supplies and equipment have been distributed that are burn-care specific," he said.

Some burn-care experts warn that in an all-out disaster, health professionals would have to conduct a pitiless form of triage and decide which patients get sent to burn centers and which ones do not.

"The person on scene is going to look at people who have the best chance of surviving," Iowa's Latenser said. "We will not have the resources."

Burn care professionals "spend a lot of time talking about, `How do we get the government to listen to this?'" Latenser said. "You can't have the disasters and then say, `Oh golly, we should have had the centers.'"

[firecapt32 282]

Future fireman

You are correct that the number of Burn Centers are closing down New York is no exception, the Longo Burn Center located in westchester Medical Center is the only Center between NYC and Canada.

The Center is only a 10 bed center and if there was a disaster I am not sure how the County would handle it--right now i am not sure wether there is a plan in place for any overflow or if there is a disater plan for burns. I am sure that BurnCare...Foundation Inc. is doing it's best to help burn victims and their families-- education young children and older adults in the devastation that burns can cause.

Walter Ferguson

Director BurnCare Foundation Inc

[Guest alsfirefighter]

Just another casualty in the hospital politiics of things. Unfortunately there isn't any catchy adverstisement for quality burn treatment & rehab like strokes, colonoscopy, breast cancer and such.

The one thing I can say is that Walter does any excellent job advocating for the Longo Burn Center, assisting the staff with needs there and most importantly assisting family members of patients whom are receiving care at the facility.

If any agency/organization who is thinking of running a fund raiser for a great cause the burn center is definately it, contact Walter and I am sure he can assist you in ensuring your assistance goes to the right places.

[firecapt32 282]

Just to add to Toms statement I can't tell you not to give to the BurnCenter but I can tell you it might not do what you want it to do!! all my programs are dedacated to improving the quality of life for patients and families of burn survivors.

The Longo BurnCenter located in westchester Medical Center is attached to a level one trauma center and takes in burn survivors from 7 surounding counties besides being the only center from here to Canada.

BurnCare works directly with the staff at the Center, althought we cant help every burn survivor we are always there for support for the family.

Firefighters if there comes a time that you get burned at a fire-your department may have to transport you to a local hospital-due to the nearness of it. Be aware that YOU can insist that you be seen at the BurnCenter.

[Bababoosky 24]

Does this have anything to do with the direct privatization of hospitals? Or does it seem more like an HMO issue? Hospitals around here are losing money everyday on patients that walk in to the ER, get treated, and vanish as if they never existed. THis leaves the hospital to foot the bill.

Hopefully more money from the government will allow for the remaining burn centers to stay open, or in fact, increase their size and their staff.

[firecapt32 282]

Hospitals are increasingly becomng "for profit" corporations and like any other for profit--it's the bottom line that counts the most.

[Guest partyrock]

I just want to add to what fire capt said. If you get burned get yourself to a burn center at some point. Even an apparently minor blistering on the edges of your ears can turn ugly. The help is there use it. Think about it this way, if you're insured or it happened on the job you're helping to ensure that burn center stays open.

[RescueKujo 130]

Does this have anything to do with the direct privatization of hospitals? Or does it seem more like an HMO issue? Hospitals around here are losing money everyday on patients that walk in to the ER, get treated, and vanish as if they never existed. THis leaves the hospital to foot the bill.

Hopefully more money from the government will allow for the remaining burn centers to stay open, or in fact, increase their size and their staff.

Bababoosky,

You kind of hit the nail on the head about inability to pay. Insurance companies end up footing the bill as charges are inflated to recoup the costs of people unable to pay. But as we all know, insurance companies will only pay a certain percentage. So who ends up paying for this? You and I, the taxpayers.

You cannot staff hsopitals to the worst case scenerio. Make sure everyone has some training in the specialities, and in a disaster everyone handles everything (trauma, pediatrics, burns) because the specialty hospitals are going to be overrun with patients.

[Bababoosky 24]

Honestly, why do you think that United Hospital closed down in Port Chester? The inability of the majority of their patients to pay their bills, plus they would just walk out on them anyways. This is an ugly growing trend in the healthcare industry and its sickening to know that yours and my co-pay, and taxes increase every year because of this.

[Guest pentax02839]

it has do with the hospitals are tring to make money.if it is not money maker then they get rid of it.also the insurance companies have something do with it.the goverment should step in and offer some help.here is good example of people needing burn treatment.remember the station night club fire.they ended up sending some the victims to the shriners hospital in boston.that was the first time that they treated adults there.im not sure of the nearest burn center to me.

Edited August 11, 2007 by pentax02839