When to seek treatment at a burn center

“Why do I have to drive into the middle of D.C. to a burn center? There’s a hospital right by me.”

We hear this question all the time. I answer that burns are wounds, but wounds aren’t burns. Burn injuries are unique and require specialized treatment.

Dr. Johnson
Dr. Jeffrey Shupp, director, Burn Center

Even burns that appear mild or small can turn into serious injuries without proper treatment. Too often I treat patients whose wounds become infected after non-specialized treatment at a local clinic or wound center – even those that say they treat burns. It’s unfortunate when we have to perform surgery or a skin graft on a patient who may have been healed by now if they had come to a burn center for their initial treatment.

About 486,000 burn injuries require medical treatment in the United States every year – and they can happen to anyone, anywhere, at any age. We treat about 1,000 patients a year, with 600 admitted to the hospital.

 

When should I go to a burn center for treatment?

 “I don’t want to bother the burn center specialists. It’s just a little burn. They’ll think I’m overreacting.”

I can’t say it enough: You’re not bothering us, and we don’t think you’re overreacting. We’d much rather see you now for a burn that doesn’t require a lot of care, than to later manage an infected wound or perform surgery that could have been avoided.

"Even if you think it’s just a mild burn, go to a burn center." via @MedStarWHC

The American Burn Association has a list of criteria  for which they recommend you receive treatment from a burn center, including:

  • Burns that involve the face, hands, feet, genitalia or major joints
  • Third-degree burns, which can appear whitish, charred or translucent with no pinprick sensation in the burned area
  • Burns that cover more than 10 percent of total body surface area
  •  Electrical or chemical burns
  • If you have pre-existing medical conditions that can complicate recovery

If you have a burn that meets these criteria or that you would like a burn specialist to look at, request an appointment or call 202-877-7347.

What makes a burn center unique?

“I liked the plastic surgeon who performed my surgery last year. Can’t he do a skin graft?”

Surgeons outside of burn centers can perform amazing skin grafts and debridement (removing damaged tissue from a wound). But what makes a burn center unique is the team approach we take to treating burn patients.

Burn center specialists are dedicated to treating only burn patients. They can include:

  • Burn rehabilitation specialists
  • Burn surgeons who have additional training in burn, trauma or critical care
  • Dietitians
  • Nurses with special training in caring for burn patients
  • Pharmacists
  • Social workers

When you’re not treated at a burn center, coordinating care becomes more difficult. You may have surgery at one place and rehabilitation across town. Getting plugged in with a burn center from the beginning makes coordinating downstream care that much easier and can benefit your physical and psychosocial health.

The biggest progress made in burn injury survival did not come from antibiotics or advances in critical care. It was the organization and verification of regional burn centers.

Centers such as The Burn Center at MedStar Washington Hospital Center must meet rigorous criteria to be considered a burn center. There may not always be one right next door. After ours, the next closest burns centers are in Baltimore and Richmond, Va.

D.C. residents are fortunate to have a burn center nearby. For those who do not have a burn center in their community, travel to the nearest burn center for care if you can. I want you to receive appropriate care from the beginning so you can avoid potential complications down the road.

Why We Must Address the Psychological Impact of Burns

Survival rates for burn patients have improved drastically over the years thanks to advances made in burn treatment. Unfortunately, the physical needs of patients often overshadow their emotional needs.

As more patients survive their injuries and return home, we must direct more energy toward efforts to reintegrate patients into society and home and treating the psychosocial effects of burn injuries. The emotional trauma caused by a burn can affect all parts of a person’s life: put stress on relationships, lead to depression or substance abuse, and even put additional strain on their physical health.

According to a study in Neuropsychiatric Disease and Treatment, stress disorders, including post-traumatic stress disorder (PTSD), are reported in as many as one-third of burn patients. These problems can develop up to a year or more after the injury. And these aren’t just people who had severe burns. Even a moderate burn that didn’t require much treatment can be emotionally devastating.

A few years ago, a patient of mine brought into sharp focus the challenges that accompany helping someone deal with the emotional side effects of a burn injury. This experience caused me to ask myself how my team could better address that aspect of the burn recovery process and ultimately led to a new position on our staff – a dedicated psychologist for The Burn Center.

How burns can take a psychological toll

Along with the physical pain of burns and the treatments they may require, patients also may face psychological stressors, such as:

  • Changes in body image
  • Depression
  • Family problems
  • Financial concerns
  • Vivid memories of the accident

These stressors can manifest in many ways. For example, symptoms of PTSD can include:

  • Avoidance of places that are reminders of the accident (such as a burn center)
  • Difficulty sleeping or having nightmares
  • Flashbacks of the accident
  • Irritability
  • Loss of interest in previously enjoyable activities
  • Negative thoughts about oneself
  • Social withdrawal

If you or a family member are experiencing depression or PTSD symptoms or are struggling to adapt to life after a burn injury, know that you’re not alone. There are resources in your community to help. Talk to your doctor about your options.

Just as physical recovery occurs in stages, psychological needs differ over time as well. Patients often are elated when it’s time to go home. However, that also tends to be when they start to melt down. They didn’t expect the stares they would get. Food doesn’t taste the same. Families didn’t realize the amount of care their loved one would need.

We try to help patients manage expectations while in the hospital. For example, we may tell them, “Your skin is never going to look the same again.” But these statements don’t always sink in because they’re grappling with everything else going on in that moment. In the back of their heads, they think that one day they’ll take off their compression garment and everything will look like it did before. When they realize this is never going to happen, it can be devastating emotionally.

Clinical challenges of treating the psychological side of burn injuries

Coordinating psychological care for burn patients is challenging, as was highlighted by my patient a few years ago. As an electrician, he suffered an electrical burn. We treat quite a few electricians and powerline workers with these types of burns, which can cause neuropathic pain for years despite all tests coming back normal. They require care from a neuropsychologist.

Because neuropsychologists are so specialized, they may not address depression or PTSD, instead focusing on the patient’s physical pain. So the patient also may need a psychologist to provide psychotherapy or a psychiatrist to prescribe medication. Coordinating this interwoven care can become immensely difficult. And community-based mental health centers often are unable to provide such complex care for these specific needs.

This was the challenge we faced with my patient. He had developed depression and substance use issues after his burn injury, and his relationship with his wife and children had become strained.

It took seven months to line up care to address his emotional issues. That was too long. I knew we had to do more.

How we treat the emotional side of the burn recovery process

Along with the after-care programs and services we offer, we’re also one of 60 Phoenix Society SOAR (Survivors Offering Assistance in Recovery) hospitals. The Phoenix Society is a not-for-profit founded by burn survivors. Many of our therapists are certified to train past patients to become peer supporters. These volunteers meet with patients one-on-one and lead group sessions.

Thanks to funding from organizations such as the DC Firefighters Burn Foundation, we also provide opportunities to attend adaptive recreation trips, in which an activity such as cycling or canoeing is adapted to accommodate a person’s specific needs.

Because a burn patient’s PTSD likely will manifest differently from someone who experienced another type of trauma, we shouldn’t treat them the same. Unfortunately, there just isn’t a lot of research and data to guide us in effectively treating the psychosocial side of burn injuries.

To help change that, we created a position within The Burn Center for a full-time psychologist. This person will provide more specialized, coordinated care for burn patients as well as study and develop best practices to treat psychosocial health from the moment of admission through treatment and beyond.

I expect this to be just the tip of the iceberg. At any given time, 50 to 70 percent of our burn patients are eligible to enroll in a clinical trial. I expect these numbers to increase over the years as we include trials geared toward psychosocial health and reintegration into society and home.

As one of only a handful of burn centers in the country to have a dedicated psychologist on staff, I’m positive we can make an impact in this important emerging field of study.

Don’t “Feel the Burn” this Summer

Medical Intel Podcast – Dr. Jeffrey Shupp Discusses Summer Burn Prevention

Burns Come in Many Forms

Hear “summer” and “burns” in the same sentence and “sunburn” probably comes to mind.  But that’s not the burn that Dr. Jeffrey Shupp thinks of.

“Between spring and fall, the top reasons for burns are outdoor barbecues, bonfires and fire pits,” says the director of the Burn Center at MedStar Washington Hospital Center, the only adult burn center in the Washington region. “Most cooking accidents involve a fire accelerant, like charcoal lighter fluid, or a backflash from a leaky gas grill or jet that’s been left on too long.”

According to the American Burn Association, gas grill or charcoal fires injure about 6,000 people each year. And while it’s true that being “under the influence” can be a factor, a more common cause is a false sense of security.

“So often we hear patients say: ‘But I’ve always done it this way.’ Unfortunately, those previous, accident-free experiences can lead to a lack of caution…and a second or third degree burn.”

Nowhere is that more apparent than with home fireworks, the second most frequent source of summertime burns at the Hospital Center. Nationwide, almost half of all firework burns affect children. 

“Fireworks can produce very serious injuries, sometimes even requiring amputation of the fingers,” warns Dr. Shupp who, as a six-year-old, was prohibited from ever using sparklers after a napkin caught fire at a family celebration.  

It’s an important warning to heed. The National Fire Protection Association reports that a seemingly innocent sparkler can reach 1,200°F. For perspective, water’s boiling point is 212°F; glass melts at 900°F.

Fortunately, most burns in the United States are first degree—mild injuries to the superficial layer of the skin, like sunburn, that can be safely treated at home.    

But up to 500,000 Americans each year need medical care for more serious burns that can be debilitating and even deadly.

To avoid the emergency room and assure a safe summer for you and your family, follow these simple tips:

  • Wear short sleeves or roll them up when grilling
  • Use long-handled barbecue tools
  • Establish a 3-foot “safety zone” around grills and open fires
  • Be cautious, careful and aware of your surroundings
  • Leave the fireworks in the hands of the professionals

Tune in to the full podcast with Dr. Jeffrey Shupp.
Have any questions?

We are here to help! If you have any questions about burns or the Burn Center call MedStar Washington Hospital Center at 202-877-3627.

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Preventing Frostbite in Bone-Chilling Temperatures

As temperatures plummet in the Washington, D.C. region, people heading outdoors for work or recreational purposes, should be aware that frostbite can occur at any time. Last year, we treated a dozen patients in the Burn Center due to frostbite. One year later, some of those patients are still undergoing treatment. How long you’re exposed to the elements and how cold the temperatures are outdoors, can put you at risk.

The best way to prevent frostbite is to stay indoors in bitterly cold temperatures. If you must go outside, get prepared in order to protect yourself. First, dress in multiple layers of loose, warm clothing. Limit the amount of time you’re exposed to cold, wet or windy weather. Change out of wet cold immediately, particularly gloves, hats and socks- to keep moisture away from the skin. Do not go outside alone, especially if you have pre-existing medical problems.

Symptoms

Frostbite is the freezing of body tissues, whether it’s the skin or bone, and it can look different on different people. Often, the damage begins long before a person can feel it. If you begin to notice changes in sensation to your extremities- finger, nose, ears, that’s a sign that you’re in trouble. Also look for:

• Numbness

• Skin color ranges from pale to excess redness, in severe cases skin turns blue to black

• Blistering

• Hard or waxy-looking skin

If you’ve been exposed to the cold and are concerned about frostbite injury to any part of your body, you need to seek medical attention. Frostbite can be treated and the prognosis is usually good, but severe cases due require surgery and potentially amputation.
People with pre-existing vascular diseases and diabetes can be at increased risk of frostbite and frostnip and should be extra vigilant in the cold weather.

The same preventative steps can also be taken to prevent your risk of hypothermia. Shivering and extreme exhaustion is an early sign that your body is losing heat. For both, the consequences of being exposed to the cold without taking the proper precautions can have long-term consequences on your health and well being.

 

Have any questions?

We are here to help! Contact us for more information about frostbite or to schedule an appointment. Call us at 202-877-3627.

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