From Rescue to Recovery
OTs in the Country's Top Burn Centers
Monday March 16, 2009
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A Special Bond
Joan Jung-D’Amico, OTR/L, who treats burn patients at the Baltimore-based hospital, says the little girl came to the center as a 3 1/2-year-old with 95% of her body covered in third degree burns; she was not expected to survive. After more than 30 skin graft surgeries and months of treatment, she was released back home, just before her fifth birthday.
“She was an especially rewarding case,” Jung-D’Amico says. “When I first started with her, her skin was so thin and fragile, it was like working with a baby again. Now she’s riding a bike and using a walker.”
The girl’s mother and sister survived the fire too, but the mother’s time was split between her two girls. When her mom couldn’t be there, everyone stepped up as a surrogate parent.
“We loved [this little girl] so much; we bought toys for her and would incorporate them into her imaginative play therapy,” Jung-D’Amico says. “I don’t treat her anymore, but I visited her at the inpatient rehab center.”
It’s that bond and dedication that keeps OTs in burn units coming in every day.
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The American Burn Association estimates 500,000 people are treated for burns in the U.S. each year. The number represents the range of burn injuries — from mild burns treated in doctors’ offices to those severe cases admitted to one of the country’s 125 hospitals with specialized burn units. For those admitted to a burn center, there is a 95% survival rate, thanks in large part to the early intervention protocols of multidisciplinary teams, in which OTs play a crucial role.
“From the moment a burn patient hits the doors of our center, an OT evaluates them within the first 24 hours of their stay,” says Mark Prochazka, MOTR/L, part of a staff of OTs dedicated to the North Carolina Jaycee Burn Center in Chapel Hill.
At St. Louis Children’s Hospital in Missouri, staff members have perfected a protocol that includes the use of conscious sedation during a pediatric patient’s regular dressing changes. After the patient’s dressings are changed, there is just enough sedation time for OTs and PTs to perform exercises they might not otherwise be able to do. This practice — known as pediatric ambulatory wound service, or PAWS — was studied at St. Louis Children’s Hospital by the burn center’s former chief surgeon, Robert Foglia, MD. The results were published in the Journal of Pediatric Surgery.
“Being there when they unwrap a patient is so helpful,” says Kate Corrigan, OTR, a dedicated burn unit OT at St. Louis Children’s Hospital. “We can see where the burn is deep and where it is not, and that gives us a clear idea of what help they need. We’re usually in and out in about 15 minutes.”
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Resources
- • American Burn Association: www.ameriburn.org
• Celis M, Suman O, Huang T, et al. Effect of a supervised exercise and physiotherapy program on surgical interventions in children with thermal injury. Journal of Burn Care & Research. 2003; 24(1): 57-61.
• Foglia R, Moushey R, Meadows L, et al. Evolving treatment in a decade of pediatric burn care. Journal of Pediatric Surgery. 2004; 39(6) :957-960.
“When you meet a patient on day one, you are looking at someone who went through a life-altering event and needs a guide, a therapist who can tell them it will be OK,” Prochazka says. “I can tell patients, ‘You are going to be OK … I’ve seen patients with your type of burn.’ If I didn’t see my patients as outpatients six months or a year out, I couldn’t make this assessment with confidence.”
It takes extra communication and commitment from the team to follow pediatric patients all the way through their treatment. While two staff OTs are dedicated to the burn center, there are other OTs trained in burn treatment, as well as OT interns and OTAs, all of whom play a critical role in managing care.
“It really takes a team, because this level of care can wear you out, but it takes this intensity of care to get that great outcome for your patients,” Prochazka says. “Everyone is doing what needs to be done for the child.”
Marnie McLeod Santoyo is a medical writer for the Gannett Healthcare Group. To comment, e-mail oteditor@gannetthg.com.
