|KNOW YOUR BURN UNIT
|Year : 2018 | Volume
| Issue : 1 | Page : 6-8
Restoring hope: The Burn Unit, KEM Hospital
Vinita Puri, Raghav Shrotriya
Department of Plastic Surgery, KEM Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||11-Mar-2019|
Prof. Vinita Puri
Department of Plastic Surgery, 2nd Floor, Near Ward 16, Gynaec Wing, Old Building, KEM Hospital, Parel, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Puri V, Shrotriya R. Restoring hope: The Burn Unit, KEM Hospital. Indian J Burns 2018;26:6-8
The burn unit associated with the Department of Plastic Surgery at Seth Gordhandas Sunderdas Medical College and King Edward Memorial (KEM) Hospital in Mumbai is one of the oldest in the country. The seeds of its inception were sown during the Indo-Pakistani war in the year 1965. Preparing for the war-related eventualities, space was allocated and plans made for managing up to 25 burn patients. Although the war ended shortly thereafter, it was decided to convert the preparations into a “permanent burn care facility.” After much deliberation and planning, Dr. KS Goleria, the erstwhile head of department, had put forward a proposal for burn ward in July 1971. One of his letters to the Dean reads “…. hence my request that we start with a small effort to build a nucleus of intensive treatment in this area and thereby create a team, which will be in a position to cope with increasing loads (of burn patients)…” Administrative sanction was obtained on June 2, 1976, and Dr. Goleria's vision, the burns intensive care unit (ICU) in KEM Hospital, became operational on June 1, 1981. Hence, his plastic surgery ward 16 had an addendum, the burn ward, 16 A. The decision of admitting only female patients was mentioned in a letter as “…. emanates from the fact that undisputedly this area carries the highest mortality and morbidity.” Until 2012, only female burn patients were managed in the burn ward. We included pediatric burn patients from 2012 owing to reduced number of female burn patients and with the intent of extending burn care to children.
Our burn ward is an attempt to provide the best care for our burn patients in a low-resource setting. We attempt to make the best use of the available resources to achieve that target. The burn unit is situated on the same floor as the rest of our department and operation theaters. This enables easy access and prompt response in emergencies. It is a 12-bedded ward which caters to female and pediatric burn patients. Six beds on each side of the ward are evenly spaced and one side caters to high-percentage adult patients, whereas the other to pediatric and low-percentage adults. Each patient is provided a separate set of dressing drums, utensils, buckets, etc., to avoid cross infection. Our burn ward has around 125–150 admissions every year, of which about 30%–40% are children below the age of 12 years. The ward also has a central nursing station, a resident duty room, one minor procedure room, a pantry, and a bathroom for the burn patients to be bathed and cleaned daily.
One of the corner beds doubles up as an ICU bed if need be, and there are two ventilators and multipara monitors in the ward which are used as per the requirement. Our plastic surgery operation theater's anesthetists double up as intensivists and provide support always as required. There is a pantry where a specialized high-protein, high-calorie diet, called banana and butter milk diet, is made for the patients by the ward staff. It provides around 1500 kcal per liter and is provided to all burn patients directly or as nasogastric feeds in addition to their regular food to bridge the calorie deficit.
According to their burn percentages, the patients are started on lactated Ringer's solution at 4 ml/kg/% total body surface area (as per the Parkland formula), and it is modified according to the urine output. Over the years, there has been an evolution of our dressing techniques. Open wound care for high-percentage burns in the initial phase gave way to silver sulfadiazine ointment dressings, most of which have now been supplanted by the use of bovine collagen sheets and silver ion-based dressing materials. All wounds, except the obviously full-thickness deep burns, are covered with the collagen sheets. Infected wounds are treated with a 1% solution of acetic acid, which has been microbiologically proven to be efficacious against many bacteria and even fungi. Silver ion-based antimicrobial foam dressings are used, especially in pediatric burns, and preclude the need for daily dressings.
Over the years, our patient load has slightly decreased for good (from 196 in 1998 to 115 in 2017). However, there has been a persistent trend in pediatric burn cases. There has been a shift from high-percentage accidental or suicidal flame burn injuries in young females to accidental scald burn injuries of varying depth in infants and toddlers. On the one hand, this points toward an improving civic sense in the society with a better regard for household safety measures; much work is still wanting in the field of burn prevention, particularly in the pediatric population.
We started offering early excision to our burn patients since 2012 and have steadily seen an increase in the number of patients operated along with our growing experience (from 2 in 2012 to 15 in 2016). In spite of being a low-resource setting, we have endeavored to provide this standard-of-care service to the indicated patients. We procure cadaveric skin grafts from any of the three skin banks, LTMGH at Sion, National Burn Center at Airoli, and Masina Hospital at Byculla. Over the years, our use of cadaveric grafts has increased which might be secondary to increasing ease of procurement owing to an increase in a number of skin banks.
We have a dedicated team of both occupational therapists and physiotherapists for the burn ward, who hold twice-daily sessions of a group or individual therapy for the burn patients. There are activities of daily living board, a rope on pulley, and various other activity props to keep the patients busy and help them with mobilization exercises in a fun way. A television in the pediatric section plays cartoons and keeps the kids distracted during dressings [Figure 1]. Children are also indulged with pursuits such as coloring books and crayons and colorful building blocks.
|Figure 1: A corner of the burn ward with a burn patient enjoying the television after dressing|
Click here to view
When the patients get admitted in the wards, initially, they are visited by psychiatrists. Later, they are visited by the counselors of Society for Nutrition, Education, and Health Action, a nongovernmental organization, which works for women rights and women safety. They provide general counseling to the patients and family members. When required, they provide legal assistance, shelter facilities, and even vocational advice to burn survivors commensurate with their education and deformities. They have an in-house outpatient department at our hospital, visit the burn ward twice weekly, and also keep a follow-up of the patients with postdischarge home visits and organize support group meetings along with other activities.
In keeping with our founding vision, we endeavor to provide burn care as a holistic measure to our patients. It is oftentimes noticed that children with postburn deformities often suffer from poor self-esteem, feel desolate, and find it difficult to reintegrate into the society. Across the world, burn survivor camps have been shown to improve the psychosocial outcomes of pediatric burn survivors., India's first and the only pediatric burn survivor camp, Camp Karma, attempts reintegration of burn survivors back into the society. Twenty-one children participated in the 2013 camp, 20 in 2015, 26 in 2016, 23 in 2017, and a projected 22 in the upcoming camp in 2018. The campers participated in various physical, social, and recreational activities. For the burn survivors to regain confidence and accept their scars, group activities and competitions play a major role and give them a sense of achievement and worth.
In our country, burn survivors and their families, already drained financially by protracted treatment and therapy sessions, find it difficult to continue with the treatment of these postburn contractures (PBC). To help such patients, organizations such as ReSurge International ® provide support to these patients. Since our association with ReSurge International in 2015–2016, this program has been able to support more than 60 patients of PBC in their surgery, splints, and pressure garments. Such initiatives definitely go a long way in reducing the overall cost of care in postburn contracture patients.
The department has a respectable academic presence with multiple publications in national and international burn journals and many presentations in the national burn conference every year. Our work force includes four full-time consultants, two post M. Ch. senior residents, and nine M. Ch. Trainees, of whom two are placed on dedicated burn ward posting every month. With the aim of widening our knowledge base, we frequently host guest faculty at our department. The department also hosts both national and international observers from various institutes.
The department aims to grow and develop as a tertiary care research and training center in the field of burn injuries and work primarily toward the prevention of burn injuries as well as improving the primary treatment of such injuries at peripheral centers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Goleria KS, Rana RE. The history of the plastic surgery department, K.E.M. Hospital, Mumbai, India. Indian J Plast Surg 2004;37:136-42.
Agrawal KS, Sarda AV, Shrotriya R, Bachhav M, Puri V, Nataraj G, et al.
Acetic acid dressings: Finding the holy grail for infected wound management. Indian J Plast Surg 2017;50:273-80.
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Puri V, Shrotriya R, Venkateswaran N, Ghubade N. Holistic burn care: Survival and beyond. Burns 2017;43:1131-2.
Bakker A, Van der Heijden PG, Van Son MJ, Van de Schoot R, Van Loey NE. Impact of pediatric burn camps on participants' self-esteem and body image: An empirical study. Burns 2011;37:1317-25.
Venkateshwaran N, Puri V. Israel burn camp visit: Reflections and reactions. Indian J Burns 2012;20:3-4. [Full text]
Puri V. Survivors of pediatric burns-reclaiming the joys of childhood. Indian J Burns 2013;21:1-2. [Full text]