Hospitals are shutting down burn centers By BILL POOVEY, Associated Press

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Hospitals are shutting down burn centers

By BILL POOVEY, Associated Press Writer 5 minutes ago

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 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.

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. B. , director of the

Temple University Hospital Burn Center in Philadelphia, said that more

commonly, only about 300 beds are available at any one time.

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. 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, " 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. 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

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[Guest guest]

Interesting article. So, five programs closed, losing 77 beds. Grand

scheme, sounds like small numbers. What were their occupancy rates?

Were they truly having the volume to maintain their skills and justify

their existence? If there are around 500 or so beds empty at any one

time and they could be used to ease the bed crunch for other

conditions that are being held in EDs for days, why not use them?

We do need to have burn centers. But, should we consider

regionalizing that service so that the beds are spread a bit more

equitably? My guess would be that most are in the most populous

areas. Very logical, but maybe there should be some covering sparsely

populated areas. There should be less duplication in the populous

areas. Should they use burn care as marketing? I don't think so.

With healthcare dollars shrinking, severity of illness rising for the

admitted patients, patients discharged home sicker, and EDs operating

at over capacity, can we justify having empty beds, staffed without

patients?

Just a few rambling thoughts. Maybe we can get to set up air

transport for those patients....

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