Among a group of doctors at Vancouver General Hospital, several physicians from our team at Iridia present the first known BC Provincial major burns clinical practice guidelines in an attempt to provide more consistent care for burn patients.
View the guidelines:
Vancouver Sun, Mon Feb 20 2012, Page: A4, Section: Westcoast News, By: Mike Hager
A team of doctors from Vancouver General Hospital’s burn unit have created a set of guidelines aimed at standardizing care for serious burn patients throughout the province. “Before our little group got together, there was no unified single message that Vancouver General – as the provincial burn centre – was putting out to other practitioners in the province,” said Dr. Mark Vu, an anesthesiologist who helped shape the new protocol. About 100 severe burns (second and third degree) are treated at the VGH’s provincial burn centre each year, with about 90 per cent of patients coming from outside the Lower Mainland. Many, like those in last month’s Burns Lake mill fire, work in natural resource industries in the north.
The guidelines for standardized care will help those in remote areas of the province who treat patients in the critical first 24 hours as they are being transferred to Vancouver, Vu said. “Because these patients are so complex to manage and because major burns trauma doesn’t happen that often, it’s not something people get that much experience practising,” Vu said. “[The protocol] means that the decisions you’re going to make hope-fully are going to be better.” The new guidelines make it easier for doctors to standardize care, like managing the amount of fluid a victim receives, says Vu’s colleague Dr. Sol Gregory. Gregory said after the landmark 1942 fire at a Boston’s Cocoanut Grove nightclub – almost 500 people died, but the treatment of dozens of burn victims led to advances in care – the medical community realized the importance of rehydrating burn victims.
“Early and aggressive fluid [is important], because once you lose your skin you desiccate,” Gregory said. “Over the past 20 years we’ve realized we actually have gone too far and are giving too much fluid.” Too much fluid can lead to potentially fatal complications like abdominal compartment syndrome, where internal pressure cuts off blood flow to organs like the stomach. The new guidelines, available on a website and in printed form, include items like a chart that helps estimate the extent of a victim’s burns. That will in turn help give a more accurate account of the amount of liquid required. The Clinical Practice Guideline for Major Burn Resuscitation has been adopted by the Vancouver Coastal and Fraser Health authorities, the B.C. Ambulance Service and the B.C. Trauma Advisory Committee. “When there’s no standard of care . then it’s hard to say, ‘Okay are we doing well? Are we improving?’” Gregory said. “It gives us a way of doing quality control on our treatment and hopefully in the short term it will help people, and that’s ultimately the goal.”