SHORT: “We are a unique blend. We are a community hospital who is running a phenomenal burn program.” (Photo by Tim Mueller)
On April 2, 2015, at the beginning of the evening shift, supervisor Brandon Nickens and his crew were performing routine equipment checks before starting up a Geismar refinery. Without warning, the seal blew on a pump. A mixture of hydrogen, diesel and reacted animal fat spewed out with 1,800 pounds of pressure and enough friction to ignite. In a matter of seconds, the six men were engulfed in flames.
“Your instinct takes over,” Nickens says. “I ran while I was still burning. My shirt was on fire. There was a wet slab outside, I stopped and rolled on my side, [but] I couldn’t get the flames out. One of my operators saw me and came to my aid. By then, I guess the liquid burned itself out.”
As soon as the fire was detected, a plant operator activated Geismar Area Mutual Aid, a collaborative of first responders from area plants. GAMA ambulances transported the men to St. Elizabeth Hospital in Gonzales. There, they were triaged. The badly burned workers were stabilized, administered pain control and prepared for transfer.
“If [we] wouldn’t have had on FRC [flame retardant clothing] and PPE [personal protective equipment including safety glasses, hard hat and gloves], that is standard practice, [we] never would have gotten out,” Nickens says.
“We escaped it. Nobody lost their lives. Two of us were burned pretty severe. The rest escaped without any kind of injury. The flames were over 60 feet tall. They did a lot of heavy damage to our plant.”
In 1970, Baton Rouge General established the Regional Burn Center (RBC). A dedicated team of physicians, nurses, therapists and other medical professionals treat adults and children injured by flame, scalding, electrical, chemical, steam and other burns.
The team provides a full spectrum of specialized services, from intensive inpatient care to outpatient rehabilitation, skin grafts, laser treatments and long-term monitoring to address scarring, pain, contracture and other burn-related issues that occur as patients age and tissues heal.
According to the American Burn Association an estimated 486,000 burns are treated in the United States annually. Nearly 70% of burn victims are male and 30% female. Due to recent advances in earlier recovery and fluid resuscitation, early debridement and closure, and the use of antibiotics, the survival rate has now risen to 96.7%.
The majority of burn centers are anchored to the trauma programs of academic medical centers. While Baton Rouge General has an affiliation with both LSU and Tulane medical schools, “We are a unique blend,” explains RBC Medical Director Tracee C. Short, M.D. “We are a community hospital who is running a phenomenal burn program. But, we are hanging with the best of them—and, in some areas, surpassing them. We’re doing good stuff; but, we don’t fit the classic mold.”
In fact, the RBC is one of only 63 ABA-accredited centers nationwide—and the only verified facility of its kind in a 300-mile radius.
RBC has forged relationships with referring facilities and physicians and provided education and telemedicine capabilities. That means professionals in outlying and rural areas can now transmit the images of burns and get an immediate consult with an RBC specialist on the transfer or treatment options.
In the last three years, the RBC has treated 90% of burn patients injured in the metro area and patients from more than 150 ZIP codes across the Gulf Coast.
Upon being alerted about the accident, Nickens’ family had driven from their Ponchatoula home to Gonzales and followed the ambulance to Baton Rouge.
By 10:30 p.m.—only four hours after the blast—Nickens, his injured colleague and their families had all arrived at the Regional Burn Center.
“I was not aware that we had that unit so close. I’m so thankful we have it here. It almost seems like a miracle that [these professionals] are there,” says Nickens.
“If it had been any other way, it would have been more traumatic and a lot more painful for me, and it would have been so much harder on my family. [Now,] I can’t even comprehend not having that unit here in Baton Rouge. It was a personal miracle to me.”
UNDERSTANDING INDUSTRIAL BURNS
Of the 700 adult patients who arrive at the RBC each year, approximately 100 have been injured in industrial accidents.
“Having a burn unit like the Baton Rouge General Medical Center in our region is a resource we can be thankful for when seconds count in treating a burn,” says Connie Fabré, executive director of the Greater Baton Rouge Industry Alliance.
As Short notes, the definition of an industrial burn extends beyond the plants lining the Mississippi River.
“[Industrial burn patients] come from anywhere—shrimp boats, river traffic in the Gulf, oil rigs or right here in petrochemical alley.”
Recently, she recalls a patient who was originally from the Ukraine and was injured during a fire on a freighter. After leaving their shipmate in the care of the RBC, the ship continued to its destination.
Despite the differences in the way workers get injured, Short has noticed some common characteristics among industrial burns.
“It is rarely an isolated one-person event and, unfortunately, there’s sometimes some fatalities involved,” she says. “[The RBC] can get multiple people with various severity all arriving at one time. The last [incident] we had, we received four patients. The one before that, we got a call for one person; but, there was one fatality at the scene.”
As far as the patients’ injuries, she says, “When you are dealing with gas, oil and hydrocarbons, it is usually a large injury. There is usually trauma [to underlying organs] related to it.”
Many people anticipate they might land in the hospital for elective procedure, broken bone or other injury or illness at some point in their lives. However, “No one ever plans or prepares to have to be a burn patient,” Short maintains.
“There’s such an element of surprise to the injury that I really see people at their lowest,” she says. “The thing that I like is you get to see them beyond, in that recovery phase. You see the progress they make, and you get to be that cheerleader.”
All patients and burns heal differently. But, the severity and percentage of the body burned, the patient’s age, pre-existing medical conditions and overall health conspire to determine the prognosis for recovery.
And, the percentage of burn is also a relatively reliable indicator of how many days a patient will spend in the hospital. For example, a patient with a 30% burn can expect to spend a month in the hospital.
Nickens remained hospitalized for three days. “They were trying their best to let us be home for Easter,” he recalls.
“Dr. Short is the most wonderful doctor I have ever had the pleasure to meet. I can’t say enough good things about her and the [staff] in that burn unit. You felt like you were their main center of attention. Everyone was so professional and so caring.”
In addition to the medical staff, Nickens and his family credit another team member—volunteer Mike Gautreaux—for inspiring Nickens’ recovery.
“He comes to visit with patients and their families and to share his experience as a 15-year survivor of a 50% burn,” says Nickens. “It took a long time, [but] you can hardly tell that he has been burned. “[He’s proof] of what the medical team can do and the fact that you do go on with your life.”
A NEW NORMAL
Short says the indicators for leaving the hospital include the patient’s ability to control pain with oral medication; to have a family member or a home health professional provide wound care in their home; to maintain the motivation and marshal transportation, family support and other resources to continue outpatient rehabilitation and therapy.
After discharge, the RBC staff monitors patients in a weekly clinic for a month then every three months progressing to once a year.
While many patients can functionally return to their previous jobs or activities, some find that psychologically resuming their previous lives is no longer desirable.
“Burn [treatment] used to just focus on getting patients out of the hospital,” Short explains. “[But] the majority of patients treated do not have 50% burns, they are 3% to 6%. So, it was realized that [approach] is very shortsighted, because it doesn’t look at actually returning patients back to a normalcy of life. So, we explain to patients that life is never going to be normal again. But, you will have a new normal.”
Since the incident nine months ago, the 58-year-old Nickens has returned as an outpatient for multiple follow-up visits to clean and dress the wound and for physical therapy, three skin grafts and two laser treatments.
While he has regained full use of his arm, he still wears a compression sleeve, works with a specialist to achieve pain control and expects to have at least two more laser procedures.
“Dr. Short says a burn will teach you patience,” he says. “I was ignorant about how long a burn takes to heal. It seemed like it was going real slow. I’m still improving. I can see it every month. Hopefully, it won’t be nothing except a scar there left without any pain.”
A MAJOR EXPANSION
While there seems to be no shortage of patients, funding for this high acuity care that requires special staff, equipment, supplies and precautions can be scarce.
The average cost of care for burn inpatients is $41,000, compared to an average of $6,400 for all other admissions. More than half of burn center patients are uninsured or underinsured.
So, it’s no surprise that the number of burn units in the U.S. topped 200 in the 1970s and has now declined to 125.
Since moving from the General’s Mid City campus to its Bluebonnet campus in late 2015, the RBC has been planning a major expansion.
Because burn patients are particularly delicate, the unit is designed around the concept of moving the patient as little as possible, which means locating specialized equipment and services in close proximity.
Improvements include a 14-bed, state-of-the-art center with a decontamination infrastructure, a helipad, trauma elevator, dedicated emergency room, inpatient/outpatient areas, invasive and minimally invasive surgical suites, tub rooms, and ancillary and rehabilitation space, as well as family and visitor overnight amenities.
“This tremendous need [for burn care] is growing in Louisiana,” says Baton Rouge General President and CEO Mark Slyter.
Noting that there are more than 250,000 industrial workers in the region, Slyter also stresses the necessity of matching emergency services capabilities with the growth in the industrial sector.
The RBC itself is a major contributor to the region’s economy. Its annual economic impact to the state, including spending by the hospital, its employees and visitors, is estimated to be $15.3 million.
Furthermore, “We have the most experience on doing it in an efficient and effective manner. It would actually be worse for the state and our organization … to shift these patients to other states.”
Slyter cites not only the logistics issues involved in interstate medical transportation but an increase in cost to the patients, employer plans and insurers.
But those disadvantages pale in comparison to an intangible but important factor: “One of the most important pieces of [burn] recovery is that family network,” he explains.
“Many of these patients are dealing with not only their acute medical issues, but mental issues related to disfiguration and other things. You really do need a strong support network close by to help with the healing process. So to displace them from Louisiana would create a very big gap and a problem for us.”
Short says that’s especially true for patients burned in industrial accidents. “When you look at plant accidents, they are usually larger percentage burns, which means a longer stay in the hospital,” she says.
“[That can] disrupt family life for a long time. [Having a burn center in Baton Rouge] usually allows for the family disruption to be minimal. Spouses can still go to work. Children can still go to school. If we weren’t here, these patients would probably go to Shreveport or Alabama. That would be difficult.”
The expansion also ties into the medical center’s vision to become a tertiary referral center and a destination for advanced care. “The burn unit connects well with our emergency department, helipad, hazmat and decontamination infrastructure,” Slyter says. “All of those types of things just meld well with the burn center moving forward.”
That level of specialization comes with a price tag of $37 million. Construction should take 12 to 18 months, once the funding is in place.
To that end, Baton Rouge General has included a $20 million request in its capital outlay. The medical center hopes to raise the remainder through private and public sources. “We really do need public and private support to make this happen,” he says. “This is something we’re not going to be able to continue in the proper way moving forward, if we don’t get that public and private funding.”
Already, the Baton Rouge General’s plans seem to be sparking the interest of stakeholders throughout the state, including lawmakers.
“Many of our legislative leaders—at the state and federal level—[are] very supportive,” Slyter reports. “They’re just trying to help us find where the funding will come from, because they all recognize this is really an absolute for a state like Louisiana.”
“We have industry from Baton Rouge to below New Orleans,” says Nickens. “More than likely, if [workers are injured by burns], they’re going to end up at Baton Rouge General. It’s no more than an hour away from people along that river.
“I wish everybody in that industry realized what they have so close at hand. If they did, they’d be so grateful to know that the professionals and the latest technology are located in Baton Rouge.”
Originally published in the first quarter 2016 edition of 10/12 Industry Report. Read more from this issue at 1012industryreport.com.