the pursuit of parkinson's - The University of Alabama at Birmingham

Battling Burns and Winning
Treatment Comes a Long Way
By Roger Shuler
James Cross, M.D., and
Alan Dimick, M.D., along
with many other physicians
and staff, are part
of the Burn Center’s
ongoing commitment
to burn care.
When James Cross, M.D., is asked about progress
made in the treatment of burns, he thinks
about a scene from the 2001 film Pearl Harbor.
“In the movie there is a scene where the
Japanese have attacked, and the hospital is inundated with
patients,” Cross says. “The doctors are triaging the patients,
and when they have a burn patient, they say, ‘Put him over
there under the tree.’ Back then, it was assumed that a patient
with a severe burn was going to die.”
That scene was set in 1941. Cross, director of the UAB
Burn Center, says the medical approach to burns has changed
dramatically since then.
“Now we work under the premise that most burn patients
are going to live,” Cross says. “We don’t save everyone. Patients
with severe smoke-inhalation injuries, and those with burns
over 60 to 70 percent of the body surface area—we have trouble
saving them. But if the burn area is less than that, we work
on the premise that we can save the patient.”
Challenges and Complications
Burns present some of the most difficult challenges in medicine.
“With a severe burn, every single organ is affected,”
Cross says. “Dealing with the burn to the skin is often the easy
part. The difficult part comes when the lungs go bad, when the
kidneys and the gastrointestinal tract aren’t working.”
For example, a severe burn can cause swelling in the GI tract
that makes it difficult for a patient to absorb nutrients. In fact,
swelling in general is a major complication with burns. “When
you get a bee sting, you have swelling right around the site,”
Cross says. “A burn is like a total-body bee sting.”
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For patients burned over more than 70 percent of their bodies,
the mortality rate is very high. “Several things happen,”
Cross says. “Often they don’t make it through the initial resuscitation
effort; the insult to the body is so great that they just
can’t tolerate it. If they get through that, they often succumb to
other complications, such as infections or respiratory problems.”
But because of progress in burn care, even severely burned
patients can sometimes pull through. Alan Dimick, M.D., has
seen the progress from the front lines.
Dimick helped found the UAB Burn Center in 1970. He
retired as burn center director in 1998, but he still serves as a
consultant at Children’s Hospital and is a site reviewer for the
American Burn Association’s verification program.
“Before I retired, I had 15 patients walk out of the hospital
after coming to us with 80- to 85-percent burns,” Dimick says.
“If they were to walk into a room with their clothes on now,
you couldn’t tell they had a burn.”
Shortly after Dimick joined the UAB faculty in 1963, Chief
of Surgery Champ Lyons, M.D., asked him to attend a meeting
on burns in Galveston, Texas. “I saw how bad things were in
burn care and how badly we needed to improve it,” Dimick says.
A major step in that direction came when UAB hosted the
first meeting of the American Burn Association (ABA) in 1967.
“We had about 200 people at that first meeting,” Dimick says.
“Now we have about 3,000 at the annual meeting.”
Secrets of Survival
UAB is one of 130 burn centers in the United States and
admits about 250 burn patients a year. Another 150 burn
patients are admitted each year at Children’s Hospital.
A patient’s length of stay, which once was usually two to three
months, now averages 21 to 28 days. But the hospital stay is just
the beginning of the challenge. “We call burns a two-year disease,”
Dimick says. “That’s how long it often takes to recover.”
When Dimick began to oversee burn care at UAB, he did
not have many competitors for the job. “Everyone was happy
for me to take care of the burn patients,” he says. “You have
patients with raw, open wounds, crying and smelling bad,
hurting all the time. Nobody wanted to deal with them.”
It didn’t help that outcomes often were not favorable. But
gradually, that began to change.
Early surgery for burn patients was a major step forward.
“In the ’60s and ’70s, we used to wait until the burned tissue
was completely off the patient before we did any skin grafting,”
Dimick says. “Now we take them into the OR during the
first couple of days. We now know that once you cut off the
dead tissue and cover the burn with a skin graft or artificial
skin, the patient gets much better.”
The value of nutrition also became apparent. “When you
sustain a burn, the body begins working overtime to heal the
wounds,” Dimick says. “Your metabolic rate goes up 100 to
200 times. So we have to put a tube into the stomach and literally
pump food into the patient.”