Dr. Richard Grossman Burn Center

Clarence Warner and I recently met with world-renowned burn specialist Dr. Richard Grossman at his Burn Center facility at the West Hills Hospital, in West Hills, California. Dr. Grossman and his Nursing Administrator, Kelli Rix, gave us a personal tour of their new burn center. (For additional information see Dr. Grossman’s website at http://www.grossmanburncenter.com. In addition, I suggest you read some burn victim stories. Go to the following website: http://www.grossmanburncenter.com/burn-survivor-stories.php).

The burn center is a part of the hospital which has normal emergency room services as well as trauma services. The E.R. is not a part of the burn center, it is a separate unit within the hospital. Dr. Grossman also has an office in a medical office building on the campus where he does both pre- and post hospitalization exams, as well as elective major and minor surgeries.

Burn Center ICU

The burn center has a separate ICU specific to burn patients. The ICU monitors the patient’s body functions much like a regular ICU. The staff is specifically trained for the burn unit. There are individual patient rooms with sliding glass doors for direct staff visibility. The nurse’s station accommodates multiple nurses with computers for each nurse. Typically 1 nurse is assigned to each patient. However, in acute cases, multiple nurses are assigned to the patient until the latter is fully stabilized. The ICU also has a hydrotherapy room with one hydrotherapy bed which uses treated water to wash the wounds in a very sterile environment to reduce the risk of infection. The ICU is on the second floor directly above the E.R. in the hospital. This relationship and closeness facilitates early acute patient care.In the burn unit,  there are specially designed cribs that serve as a hospital beds for small children. These beds also have a top to prevent the child from exiting the crib. Small children usually have an adult who is with the child 24 hrs a day for direct monitoring. Family can participate and are encouraged to stay with the child unless the child is the victim of abuse. Once stabilized, the patients can be transferred to the burn center treatment area.

Burn Center Patient Treatment facility

This is another unit which is one step-down level of treatment for burn patients. It is very similar to other hospital patient rooms and nursing facilities. This patient area is arranged in a circular pattern with the nursing station in the center/core and the patient rooms on the perimeter. Some key differences are that there are a few additional rooms. It is recommended that burn victims have a family lobby or waiting area specific to the burn center. For children that are ambulatory, there is a children’s play room with adult supervision (either a family member or a nurse). For patients who need constant monitoring or have small wounds, hydrotherapy using treated, sterilized water is done at bedside. Each day the piping system is cleaned to remove any bacteria that could be in the hydro lines. The floor should have a good drainage system.

Hyperbaric Treatment

In addition, there is a hyperbaric treatment room with two hyperbaric treatment chambers. Dr. Grossman has advised, “It is most important to have the larger units for overweight people.” For the comfort of those being treated, there is a flat screen television to watch while in the chamber. The chambers are clear and this helps to reduce problems with patient Claustrophobia. Each of the chambers can be adjusted from 1 atmosphere to 3 atmospheres in oxygen pressures. Only patients not needing any other attached monitoring or intravenous connections are placed in the hyperbaric chambers. Each chamber also has patient connectivity to communicate with the nurse if they are experiencing problems. In order to remove the patient, the oxygen is released and de-pressurized slowly. The gas is released to the outside of the building. The supply of oxygen is usually in a large bulk oxygen tank located a distance from the main building. The distance is approximately 50 ft. In the United States, the bulk oxygen tank is typically considered a H-2 occupancy and a fire hazard.

Associated services

The hyperbaric facilities are capable of handling other wound care patients other than burn patients. Diabetic patients can be treated to avoid amputation. Other types of wound care can also be treated as well. According to Dr. Grossman, it is important to have psychological services available to the patients. The patients are often in a complete shift of their life experience. One of the burn patients that we met had been a patient for 7 years, needing over 30 surgeries to date to be re-constructed after the severe burns he suffered.

Plastic surgery should be offered as a part of the process of helping the patients to achieve a greater degree of normalcy after a burn event. Reconstructive surgery is often needed in major burn cases.

Dietitians, rehabilitation therapists and respiratory care are essential to the complete burn center approach. Dr. Grossman has found that his comprehensive team approach with burn victims has enhanced the great successes in burn treatment and therapy.

The specialty of a burn center greatly increases the potential for surviving a major burn. Trauma Centers without such services may need to transfer a patient to a burn center in another city. Any transfer may reduce the survivability rates of patients.

Gary Heathcote