|
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.
[to top of second column]
 |
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.'"
___
On the Net:
Health and Human Services:
http://www.hhs.gov/disasters/
Vanderbilt Burn Center:
http://www.vuburncenter.com/
University of Iowa Burn Center:
http://www.uihealthcare.com/
depts/burntreatmentcenter/
[Associated Press;
by Bill Poovey]
Copyright 2007 The Associated Press. All rights reserved.
This material may not be published, broadcast, rewritten or
redistributed.
|
