By:Carrie James
Medical center offers Nassau's only Burn Center for Nassau County
When the World Trade Center erupted in flames and collapsed Sept. 11, Nassau University Medical Center's Burn Unit waited to receive a handful of burn victims from the city.
They never made it to the East Meadow hospital. Each day, however, the staff at the only burn center in Nassau County handles several patients, on an in- and out-patient basis - including one World Trade Center victim who was initially treated in New Jersey and chose to be treated at NUMC.
"We're a 10-bed unit, and we've handled patients from 3 days old to 103 years old," said Burn Center head nurse Catherine Cipollina. "This man was treated in New Jersey for three weeks, and then when he went for out-patient care, he decided to come here."
The Nassau University Medical Center's Burn Center was established in the 1950s, Cipollina said. In 1973, Nassau County firefighters took over the Burn Center and created the Nassau County Burn Foundation, which raises funds to help keep the Burn Center on the front-line for wound care.
"They have been extremely generous with their donations to the Burn Center," said Dr. Roger Simpson, director of the center for 20 years and a plastic surgeon. "You've got to feel their compassion. There are at least 30,000 firefighters in Nassau County, and I can never thank them enough for all they've done."
With the foundation's help, the Burn Center can handle the variety of burn victims that come to NUMC each day.
It's a long, difficult process to help a person recover from a burn, Cipollina said, especially of the degree that many suffered at the World Trade Center.
The hospital has set up a protocol to determine which burn patients need to be admitted. Typically children, especially toddlers and infants, with at least a 5 percent burn and adults with at least a 20 percent burn will be admitted to the Burn Center, Cipollina said. In both instances, the burns are usually second or third degree.
These are not absolutes, however, she said. Each case is looked at on an individual basis, and many patients with smaller burns or other injuries could also be admitted into the center.
"Any inhalation injury, any electrical burn, any adult with 20 percent burn is admitted," she said. "If it's a first degree burn, it usually has to be at least 50 percent of the body. If you have burns on a joint, you are more likely to be admitted."
The first step in burn treatment is to manage the person's pain. The staff typically uses morphine or another strong pain medication through an IV.
"When you first come in, the first thing we do is consider where the burn is, to keep them warm and get fluids in them," Cipollina said. "We weigh the patients, give them an IV and address their pain. Then, we treat their wounds. A patient would come in, we ask what pain they are in and make sure that is covered. Then, we address the burn. We are looking at the depth of the burn. If it's leathery and white, we know it's a third-degree burn. If it's painful, we know the patient probably won't need a skin graft because the nerve endings are still intact."
Burn Center staff, while treating the wound, don't make concrete decisions until after 72 hours have passed. This is because it takes that long for the true wound to show, Cipollina said.
After the initial consultation, Simpson said the staff, made up of 16 nurses and several consulting staff from other departments, constantly talk with one another about the patient's care and how it should be modified to benefit healing.
The Burn Center is an amalgamation of several different departments, including plastic surgery, nutrition, psychology, pediatrics, occupational and physical therapy, social work, pain management and even the clergy.
"We are dealing with multiple aspects with each patient," Cipollina said. "In addition, all children are seen by a SCAN (Suspected Child Abuse and Neglect) Team to check the welfare of the child. And if we suspect abuse with our older patients, they are seen by the SCAN team also. There are so many people who work together to make it work well for the patients."
Each burn patient goes through a hyper-cleansing treatment where they are in a shower and staff members clean the burns with sponges, Cipollina said.
"There is no more scrubbing with burns," she said. "It was believed that scrubbing promoted healing. Even just washing promotes the wounds to heal. With even this gentle washing, it is a very painful process for the patients."
At times, the hospital uses whirlpools where patients put their burns in the pool and let the water cleanse the wound. A hydrotank, similar to a large whirlpool, is also available to patients.
The wounds are also dressed for protection because burn victims are prone to infection, Cipollina said. The dressings are changed every 12 hours and can take at least 30 minutes to change.
At NUMC, Simpson said, the average burn covers about 15 percent of the body, and these patients usually stay about two weeks. Each patient heals differently, however, and many factors can impede or speed up the healing process, such as a person's age, medical history and other injuries.
Those with more extensive burns or who need skin grafts might stay in the hospital for months, Cipollina said. The longest she remembers was eight months.
Skin grafts are needed when the skin won't regrow itself, said Dr. Donald Baumann, the fellowship doctor who runs the unit on a daily basis.
The first step in skin grafting, Cipollina said, is to excise, or cut off, the burn. Then, plastic or general surgeons take a superficial layer of skin from a healthy part of the body and graft it onto the wounded area.
"It takes seven to 10 days for the most likely person to heal from this surgery," she said.
For the past five years, she said, the hospital has used a synthetic skin, called Integra, in some patients. This allows the doctors to use less real skin in the grafting, but it gets the same affect.
"They put Integra on and use an even more superficial layer of skin, and that builds and integrates an epidermis," she said. "Not everyone can use it because Integra can have complications. Each person is evaluated."
For either method, the skin is held in place with fibrin glue, and once it heals, the patients are fitted for a pressure garment. Then, they go for occupational and physical therapy to help regain the maximum use of what was injured in the burn.
Once patients heal to a certain point, they are released and come in regularly as out-patients.
In all, the process to heal from a burn can take several months or even years, depending on its severity. Many of the patients could spend up to a year just coming in for out-patient care, Baumann said.
"It takes a very long time period to relearn life's daily skills and to return to a normal life," he said. "The time involved in it is lengthy."
Many of the patients who spent months at NUMC's Burn Center don't recall their experiences there, Cipollina said. But that doesn't mean she and the rest of the staff don't carry some of the emotion from each incident brought to them.
"As nurses, we feel bad for the pain they are going through," she said. "Normally on any given day, we have eight patients. We have had toddlers and children who have pulled down hot tea or soup onto themselves. We had a girl who bit a wire who had a thermal burn in her mouth."
Each season, she and Baumann said, has burns associated with it. In spring, there are barbecue accidents, and in winter, homeless people come in because they were trying to warm themselves up. In the summer, there are Fourth of July accidents.
"I think when we have children who don't recover, that's the hardest," she said. "Also, watching the pain they are going through and seeing them in pain is very difficult."
Fortunately, Baumann said, the Burn Center's staff only see a handful of its patients not recover each year. In fact, he said, in the last four months only one person didn't survive.
"I would say that a good 90 percent of our patients will go on to do well," he said. "Only a handful don't."
Soon the Burn Center, like the rest of the hospital, will undergo a renovation and expansion. The only concrete plans thus far, Simpson said, include installing an operating room into the Burn Center so that patients who need skin grafts won't have to travel to the surgery unit.
"We're in the planning stages right now, but we have many ideas on how to improve the level of care," he said.
As for the hospital, spokeswoman Shelley Lotenberg said, it is committed to providing this service.
"It's a very expensive service, but one we want to continually provide," she said. "It's important for the residents to see this is a great service that we are committed to."
