Nicole E. Alden

Burn-injured patients in a disaster : September 11th revisited

We sought to review the steps taken by the NewYork Presbyterian Healthcare System to address disaster preparedness in the wake of the terrorist attacks of September 11, 2001. We reviewed the institutional records of emergency preparedness efforts, including improvements in infrastructure, employee education and training, and participation in intramural and extramural disaster response initiatives. We used a state discharge database to review burn injury triage within New York State (1995–2004). Since September 11, 2001, significant resources have been devoted to emergency preparedness: expansion of emergency services training, education, response, equipment, and communications; participation in regional disaster response exercises; revision of hospital preparedness plans; and development of municipal and regional responses to a burn mass casualty incident. A review of state and city burn triage patterns during the period of 1995 to 2004 revealed a decline in the number of burn cases treated in New York State-based hospitals by an average of 81 ± 24 (mean ± SEM) fewer cases/year (P = .01), occurring primarily in hospitals outside of New York City. Additionally, there was a steady increase in the proportion of New York City burn patients treated at burn center hospitals by 1.8 ± 0.1 % per year (P < .0001). In response to the events of September 11, 2001, this health care system and this hospital has taken many steps to enhance its disaster response capabilities.

Firefighter burn injuries: a 10-year longitudinal study.

Our metropolitan area employs approximately 11,000 firefighters who respond to more than 435,000 fire-related incidents per year. It is inevitable that some of these firefighters will suffer burn injuries. This 10-year retrospective review describes the epidemiology of firefighters with burn injuries who were treated at our burn center. From 1992 to 2002, 987 firefighters were treated at our burn center. The total number of firefighters treated for burn injuries and the number of firefighters who were treated for burn injuries to the lower extremities occurred in a bimodal distribution. Injury prevention efforts will continue to further reduce the incidence of burn injuries in the firefighters of our community.

Burn injury in patients with early-onset neurological impairments: 2002 ABA paper.

Many patients suffer from sensorimotor deficits that may contribute to burn injury. This retrospective study examines burn injuries in the subgroup of patients that suffer from the early onset neurological impairments of mental retardation, cerebral palsy, spina bifida, autism, and attention deficit-hyperactivity disorder. Fifty-one patients who suffered from the above-mentioned early-onset neurological impairments were admitted to our burn center during a 4-year period. The average TBSA burned was 8.9% yet resulted in prolonged hospitalizations. This study describes our burn centers experience in treating patients admitted with early-onset neurological impairments.

Contact burns : Is further prevention necessary?

Contact burns may result in severe burn injury due to prolonged transfer of heat from an object to the skin. Often, these burns occur with the use of household appliances and fixtures during routine activities of daily living. A retrospective review was performed. Data were obtained through a review of electronic medical records and the Burn Center’s National Trauma Registry of the American College of Surgeons database. Patients admitted to the burn center between July 1999 and June 2004, who had sustained a contact burn, were identified and included in the study group. During the study period, 336 patients (55% male) were admitted for treatment of acute contact burns. The mean age of patients was 18 years, and the median age was 2.4 years. The mean burn size of the study group was 2.1% of the total body surface area. During the study period, four patients required mechanical ventilation for a mean of 13.2 days. Surgical closure of the burn wound was required by 36% of patients. Eighty-nine percent of patients were discharged to home; mortality rate was 1.0%. The majority of burns (92%) were non-occupational. The findings of this study support the premise that significant morbidity from contact with heated objects continues to occur. During the past 5 years, the incidence of contact burns has remained steady, resulting in 10% of all aucte burn injuries requiring hospitalization at this burn center. The incidence reported here is similar to those reported both nationally and internationally and supports the need for continued burn prevention education.

Outpatient Firefighter Burn Injuries: A 3-Year Review

Previously, our Burn Center at the New-York Presbyterian/Weill Cornell Medical Center reported a decline during a 10-year period in the number of firefighters requiring hospitalization for burn injuries, from 53 patients per year to 15 patients per year. Because the incidence of structural fires continued at a constant rate of 26,240 to 30,841 per year during this time, it was postulated that an improvement in protective gear accounted for the decrease in injuries. However, it also was possible that more firefighters were being treated on an outpatient basis. Therefore, our Burn Centers outpatient treatment of firefighter burn injuries was reviewed to determine the epidemiology of firefighter burn injuries. On the basis of this study, the overall incidence of burn injuries in firefighters has continued at a constant level. These findings, however, demonstrate that the extent of injury has decreased in this population and suggest that the protective gear used by firefighters has contributed to these findings. These injuries, although minor to moderate, preclude the use of personal protective equipment until the burns are completely healed and contribute to a delayed return to full-duty status. These findings are consistent with nationally reported findings.

Burn camp: a positive experience for volunteer counselors.

Much of the success of burn camps is supported by the growing body of evidence concerning the positive impacts on the physical and emotional health of the pediatric burn survivor attendees. Camp activities challenge the children to succeed, encourage participation in recreation outside of normal routines, and provide for the development of independent and team-building skills and interests. As a result, campers report increased self-esteem and autonomy, reevaluate preconceived ideas of limitations, “feel normal,” and find comfort in sharing their experiences of living with the physical and emotional sequelae of a serious burn injury. Often, after camp, children apply personal successes achieved within the camp environment to other contexts, such as school and home. The nurturing environment of burn camp is created and maintained by many influences, including the camper-counselor relationships. The impact of these relationships upon the campers is well documented: children report feeling that counselors see them as individuals and not for their scars and that they receive unconditional support from these adults. In camps such as the Connecticut Burns Care Foundation Children’s Burn Camp (CBCFCBC; Union, CT), manyof the volunteer counselors aremembersof theburn community: firefighters, nurses, therapists, and/or burn survivors.Theseadultcounselorsareseenas rolemodelsby the campers. Although the benefits of the burn camp experience for campers are well documented, the impact of the burn camp experience upon the counselors remains unexplored. We hypothesized that as the positive burn camp experience carries over into academic, family, and social aspects of the campers’ lives, it will similarly influence the personal and professional aspects of the counselors’ lives. The purpose of this study was to evaluate the impact of camp upon the counselor experience.