Dr. Jeffrey Guy oversees the Vanderbilt Medical Center Burn Unit in Nashville, Tenn. 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. CLICK FOR LARGE
Loss of burn centers could risk lives
Hawaii's Straub Clinic is planning out how to handle an influx of patients, officials say
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, 2001, 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 to 127 from 132 in 2004, and burn beds have fallen to 1,820 from 1,897, 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 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.
The burn unit at Straub Clinic & Hospital in Honolulu has three beds, but officials say they are planning to handle an influx of burn patients in case of a disaster or terror incident.
"If there is a disaster, we're definitely not going to be able to deal with that," said Dr. James Penoff, plastic surgeon heading the burn unit.
He said discussions began months ago to figure out how to handle an unexpected number of burn cases in an emergency but that plans are not finished. The thinking is that Straub would stabilize and take care of patients, using its facilities and adjacent hospitals, and the military would transport those who could be moved to California burn centers or elsewhere, he said.
Since 9/11, Penoff said, a weekly survey has gone to every burn unit in the country to see how many beds are occupied. "They're trying to nationalize where vacancies are and overfilled."
Penoff, who works in the unit with plastic surgeons Randy Wong and Robert Schulz, said sometimes the burn-unit beds are empty, and sometimes there is an overflow. The number of burn patients varies each year, from 25 or 30 to 55, he said.
Donna Gabriel, manager of the burn unit, said it has had as many as seven patients at one time. She also manages the critical care unit, and its beds are used for burns if necessary, she said.
"We have saved quite a few people's lives," she said.
Nationally, 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 a 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.
The exact number of burn beds in the U.S. is a matter of dispute, and could 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 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 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, Tenn. But even now, "our space is full almost all the time."
"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."
The Associated Press and Star-Bulletin reporter Helen Altonn contributed to this report.