|KNOW YOUR BURN UNIT
|Year : 2017 | Volume
| Issue : 1 | Page : 14-17
Burn Care Unit, Tata Main Hospital, Jamshedpur
Prasenjit Goswami, Amit Kumar Sinha, Pankaj Kumar Sinha
Burns and Plastic Surgery Department, Tata Main Hospital, Jamshedpur, India
|Date of Web Publication||13-Dec-2017|
Dr Prasenjit Goswami
9, Dindli enclave, Punsa road, B H Area, Kadma Jamshedpur - 831 005
Source of Support: None, Conflict of Interest: None
Consequent to a big fire tragedy which occurred at a function on 3rd of March 1989 at Jamshedpur which left many people dead and an even more number of people with severe burn, a serious need was felt regarding having of a specialised burn care unit in the region.
Foundation stone for the burn care unit (BCU) of TMH was laid on 19th December 1989. This self-sufficient unit became fully functional from August 1992 with 18 beds divided into two zones – Septic and Aseptic, and was headed by Plastic Surgeon Dr R Bharat, who served the department till his retirement in the year 2008.
The present BCU has fifteen beds in separate cubicles and is provided with all the modern facilities such as modern critical care beds, wall mounted gas pipe lines and suction, monitors and Ventilators. Apart from its therapeutic endeavours, the department has constantly forayed into the realm of social responsibility by undertaking community awareness programmes on prevention of burns through its several outreach programs within the premises of the Tata Steel industrial areas as well as the community at large, in keeping with the Tata steel’s Corporate Social Responsibility.
Keywords: Burn care unit (BCU), Tata main hospital, Jamshedpur
|How to cite this article:|
Goswami P, Sinha AK, Sinha PK. Burn Care Unit, Tata Main Hospital, Jamshedpur. Indian J Burns 2017;25:14-7
| Introduction|| |
From humble beginnings in tents in 1908, Tata Main Hospital, Jamshedpur has evolved through multiple epochs to attain its present stature. Over the years, the hospital has accumulated experience, added departments, and disciplines. All forms of surgical and critical care departments have been functional in the hospital since long. However, till the late 1980s, the hospital did not have an organized setup to deal with major burns.
| The fire tragedy|| |
Consequent to a big fire tragedy which occurred at a function on March 3, 1989 at Jamshedpur, which left many people dead and an even more number of people with severe burn, a serious need was felt regarding having of a specialized burn care unit (BCU) in the region [Figure 1]. Decision was taken to set up a dedicated Burn Centre within the premises of Tata Main Hospital with state of the art facilities to cater to the needs of the employees and families of Tata Steel Limited and Community at large.
|Figure 1: File picture of J R D Tata visiting victims of burn disaster in 1989|
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| The genesis of the burn care unit in Tata Main Hospital|| |
A concerted effort was made on behalf of the company, and an advisory group, comprising Dr G K Lath from Tata Main Hospital and Mr Ashok Mehta from Tata Steel Administration, was formed. This advisory group visited multiple burn centers across USA, Europe, and Japan to assimilate knowledge and technical expertise and to get the best possible design to set up a burn care unit. Foundation stone for the BCU of TMH was laid on December 19, 1989 by Dr Russi Mody [Figure 2]. This self-sufficient unit became fully functional from August 1992 with 18 beds divided into two zones—Septic and Aseptic, and was headed by Plastic Surgeon Dr R Bharat, who served the department till his retirement in the year 2008 [Figure 3].
|Figure 2: Foundation stone for the burn care unit of TMH being laid on 19th December 1989 by Dr Russi Mody|
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In the years following the establishment of the BCU, there was a surge in the number of critical care cases. In the year 2002, critical care unit was shifted and became functional within the same premises. This left the BCU with nine functional beds, which resulted in scarcity of beds during the peak seasons. Old intensive care unit (ICU) was planned to be converted to BCU with 15 functional beds and an upgraded and refurbished BCU was inaugurated by Group chairman Mr Cyrus Mistry on March 2, 2014 [Figure 4].
|Figure 4: Upgraded BCU inauguration by Mr Cyrus Mistry on 3rd March 2014|
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| The present burn care unit|| |
The Burn Centre is a self-sufficient unit. This fully air-conditioned, state of the art center offers round-the-clock treatment to burn patients of all ages from resuscitation to rehabilitation in a completely sterile environment. Special care is taken to keep the area germ free by regular disinfection measures, and cross infection is prevented by practicing strict nursing techniques. The unit has isolated glass cubicles arranged in a circular pattern with all the modern facilities such as critical care beds, wall-mounted gas pipe lines and suction, monitors, and ventilators along the circumference of the round stand-alone building with the nurses’ station at the center [Figure 5].
There are two plastic surgeons and four medical officers in the unit. Along with the doctors, there are 15 staff nurses, two technician-cum-dressers, and 11 hospital attendants to man the BCU.
The unit caters to a vast geographical region and patients from neighboring districts of the state and neighboring states, namely Odisha, West Bengal, and Bihar come to get treated in the unit. Admission is considered in cases of partial thickness burns greater than 10% total body surface area (TBSA), burns that involve the face, hands, feet, genitalia, perineum, or major joints, third-degree burns in any age group, electrical burns, including lightning injury, chemical burns, burns involving smoke inhalation injuries, burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality and full thickness burns where grafting is indicated.
On admission, general consent regarding treatment in the hospital is obtained from the patient/patient’s attendants. Specific consent for surgery, blood transfusion, and others, is taken on a patient-to-patient basis. Burn patients are received in the resuscitation room where thorough saline and diluted cetrimide/chlorhexidine bath is administered. Peripheral intravenous line and urinary catheter are introduced. Fluid resuscitation is started with Ringer’s lactate according to the Parkland’s formula. The detailed history is taken and noted and burn evaluation is done with respect to TBSA and depth. Lund and Browder chart is marked. Dressing is done in the dressing room with silver sulfadiazine/silver nitrate, and the wound is covered with Gamjee pads and bandages. Injectable antibiotics, proton pump inhibitors, and analgesics are started as initial drug therapy.
The BCU houses a well-equipped operation theater dedicated only for burns [Figure 6]. Patients are taken up for surgery as the situation demands, which ranges from early excision and grafting, debridement and dressing, escharotomy, fasciotomy, and amputations. In addition, corrective surgeries for postburn deformities and grafting for postburn raw areas are also performed in the operation theater.
Emphasis is laid on the nutrition of the patients and Curreri formula is used to calculate the calorie requirement of each patient. Hospital dietitian is responsible to give the calculated calorie in form of various food items. Ryles tube feeding is started if the patient is unable to take an adequate amount of feed orally. Enteral nutrition is given preference over parenteral nutrition.
Physiotherapy is adviced for all the patients and is done by the hospital physiotherapist who is assisted by the staff nurses of the unit. Special emphasis is laid on chest physiotherapy, spirometry, limb movements, and early mobilization. Patients are discharged when they are stable, after grafting has been done, or when there is minimal raw area remaining. They are followed up in the burns outpatient department, which runs thrice in 1 week.
In a recently published 5-year epidemiological study from the unit, the mean number of burn patients admitted in the unit annually was 395. Mean age of the patients was 29.16 years. There was a slight female predominance with male-to-female ratio being 1:1.05. The mean percentage TBSA burn of all the patients was 42.5%. Flame burns were the most common form of burn, accounting for 65.16% of all burns. As Jamshedpur is a steel-making city, thermal contact burns, which mostly result from contact with molten metal, accounted for 75 cases (3.8%) during the study period. The overall mortality of the patients over 5 years was 40.8%.
Over the past 24 years of its existence, the Burn Centre has treated over 8000 major burns. The center has earned the distinction of being the first systematized burn care unit in entire eastern India. The department has contributed immensely to this nascent discipline by formulating protocols and providing guidelines like value engineering and support to the neighboring hospitals and raw material locations. Apart from its therapeutic endeavors, the department has constantly forayed into the realm of social responsibility by undertaking community awareness programs on prevention of burns through its several outreach programs within the premises of the Tata Steel industrial areas as well as the community in large, in keeping with the Tata Steel’s corporate social responsibility.
The authors wish to express their heartfelt gratitude to Dr R Bharat for his contribution in writing this article.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Goswami P, Singodia P, Sinha AK, Tudu T. Five-year epidemiological study of burn patients admitted in burns care unit, Tata Main Hospital, Jamshedpur, Jharkhand, India. Indian J Burns 2016;24:41-6. [Full text]
Bharat R. Value engineering–a new concept in reducing cost of burn care. Indian J Plast Surg 1994;27:86-9.
Sundar S, Bharat R. Industrial burns in Jamshedpur, India: epidemiology, prevention and first aid. Burns 1998;24:444-7.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]