Outlying hospital mistakes

[clgmezzo]

Hi! heres the deal. At our regional burn center we have seen a good number of BAD mistakes made by paramedics our outlying ERs and Docs that didnt know what the heck they were doing with burns. I suspect we arent the only ones to see this, so please share, what have you seen come through your doors in the way of complete screw ups . . ?

For my part i have seen an ER doc leave a mayo dressing on a tar burn victim for 2 days instead of just using it to get the tar off. Paramedics once packed a major body surface area burn ompletely in ICE during transport to us, and the pts temp was almost unbelievable low. Not to mention, lol, the way they tend to screw up fluid resucitation, which you know just isnt funny when its a big burn.and a few other things . .

[traumaRUs, MSN, APRN]

clgmezzo - Sorry you were offended. However, your original post:

"At our regional burn center we have seen a good number of BAD mistakes made by paramedics our outlying ERs and Docs that didnt know what the heck they were doing with burns. I suspect we arent the only ones to see this, so please share, what have you seen come through your doors in the way of complete screw ups . . ?"

...was rather antagonistic. When you accuse people of making "dumb mistakes" you are itching for controversy. I think that in re-reading this thread - everyone has been very respectful and only trying to explain to you that they take the best care of the patient that they can and that if you feel that there are mistakes in patient care being done, there are steps you can take to remedy the situation, ie education of the outlying hospitals. Good luck...judi

[gwenith, BSN, RN]

We honestly did not mean to "knock" anyone - more to express support for the smaller and rural hospital staff. The problems of "big centre vs rural" is a world wide phenomenon and I do want to encourage people from all areas to use the forum.

[clgmezzo]

My apologies for offense, i was writing from a standpoint where i assumed that most persons in this forum were burn nurses. Rural hospitals are outlying, just as metropolitan ones are, I never mentioned rurals to begin with. One outlying facility, which is a large teaching hospital in this area made a horrible mistake, burn knowledge is scarce regardless of the setting. Its the patient that pays for it when i peel dry kerlix of a fresh burn. Thats why we DO spend so much of our time, our own personal time in education.

I just wish that folks would not simply assume that i was pointing anything to rurals, outlying in my area= non burn center facilities.

Hope to see some burn nurses around at some point in the future.

[Dixielee, BSN, RN]

I have been on both sides of this situation, not as a burn nurse but as an ER nurse. I recently worked in the ER of a large metro hospital with the regional burn center, so we got a lot of transfers. I know that burn care has come a long way in improving survival but the expectations may be over rated. Last year we got a farmer who had been burned trying to get his truck out of some burning grass when the truck exploded. He was taken to a local hospital and stabalized. He was sent to us with 99% 2-3 degree burns. I could not find the 1% that was supposedly not burned! Of course he was intubated and had several large bore IV's, getting fluids etc. The pre hospital care was appropriate but the expectation was not. He was in his 70's, was sent by helicoptor while his family was sent by car and did not arrive for 4 hours. Of course the burn surgeon said there was nothing we could do for him, and he died within an hour after arrival to us. The family had been given hope that if he could just "get to the burn center", he might have a chance. In addition to the horrible expense of his transport and treatment, the family had to deal with being in a strange town with a dead loved one that had to be sent back "home". It was very sad indeed.

I have worked in community hospitals that had to transfer patients to burn centers and I agree the communication could be better. Of course the first thing we were told to do after IV fluids was to dress the wounds with silvadene, and cover....then the first thing they do at the receiving hospital is take OFF the silvadene and dressings and put them in the tank. It seems to me that in a non life threatening situation, the transfering physician (and nurse) should get appropriate guidance from the receiving staff and proceed appropriately. After all that is what the COBRA transfer stuff is all about, making sure all the appropriate people are getting the info they need.

Even in the hospital with the burn center there were problems with communication between the burn center and the ER. The burn center staff, not ER received report form the transfering facility. We would get the patient sometimes not knowing what we were looking for and it took an hour or more before the burn staff could come to the ER. Sometimes the burn problem was over rated by the transfering facility and after many hours of travel for transfer was sent home by the burn staff who evaluated and determined that the patient did not need to be admitted.

Burn care is changing like other areas of medicine and I think the message is not getting out as to the changes. Burns are scary to most people because sometimes what looks benign can be life threatening. Yes, we need better communicaton and education among health care staff.