[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 . .

[gwenith]

I remember some years back working in a major metropolitan hospital when the burns patient was admitted from a rural area. All the nursing staff could talk about was that the patient did not have this or that done?

I had worked near there and quietly pointed out that the TOWN was only 2 men and a big black dog - and the dog had seen better days. We got the patient with an IV, a catheter and wrapped in a space blanket for travel - what else should they have done??? She haughtily replied that they should have dressed the burn with SSD I have worked rural hospitals - one small tube of cream is all they carry.

We have worked on adressing the gulf in knowledge between city and country with the Rural Health Education centres - do you have anything similar???

[canoehead]

Why not videotape an inservice on initial burn treatment that you can give to the folks at your hospital, and offer free copies of it to all outlying hospitals, along with a packet of policies and articles? I work at a small hospital and we just love that kind of thing. Plus the nearest large facility comes once a year to do a case review of all the transfers they have gotten from us, and all the docs and nurses attend. Sometimes there was a debate on our end as to what should have been done and we can get clarification from them on the latest thinking. It's a great experience.

[elkpark]

I, also, have worked in a small, rural hospital where people meant well and tried to do the right thing, but just plain didn't know a lot of the newer stuff. People there were v. appreciative of assistance and inservices to be able to do a better job for people in their community ... Perhaps your center could reach out in some way to the smaller, referral institutions with which you work -- invite them for tour/inservice programs (with lunch, of course!! ) at your facility, offer presentations at their facilities, etc. Work to establish an ongoing relationship and the idea that "we're all on the same team." I know that the big burn center in my state does a LOT of outreach and education around the state. If money is an issue, perhaps there is state grant money available -- it would be easy to make the case that an effort like that would benefit all the citizens of the state.

I'm v. sure that those other folks want to do the best thing for people, and would be happy for any assistance in that direction.

[prmenrs]

Education would be the key, along with realistic expectations for what an outlying hospital/practitioner can do. Maybe one of the 1st things you could do would be to install dedicated phone lines @ the referring facilities, when they get a burn pt., all they have to do is pick up the phone to speak to the burn center for assistance in dealing w/a major injury. Reference guidelines on a website is another idea.

It's extremely important NOT to be patronizing when dealing w/outside agencies--no one likes being told they're an idiot, even if they are. And most 1st responders don't see a pt and think to themselves, "Hmm--how can I screw this one up?". People generally do the best they can w/the knowledge they have @ the time.

Education and availability, presented in colleagial (sp?) fashion.

[gwenith]

We actually have video conferences once a month linking 5 - 6 ICU's statewide each unit takes turn at presenting a topic for discussion - these are usually extremely helpful and amazingly good. Some of the best researched presentations are from the smaller "rural" hospitals.

One of the reasons why I spent hours putting together the sticky threads (Yes I know they are not finished yet ) is for some of the smaller hospitals and members such as Nekhismom who was asking for guidance because her brother was burnt.

We did not mean this thread to turn into a flame and please do not feel uncomfortable for your original post. I know that what you were looking for was probably some of the myths of burns nursing that still survive. You just hit a raw nerve from those of us who have worked in rural and remote area hospitals who have done the best we possibly could in an impossible situation only to have the Flight team/retrieval team walk in and rip a new one for what we have not done - which we would have if we could have.

Within your original post was a very good premise.

What is being done that should not be.

The difficulty arises from getting that question answered. What would be good would be to start a thread on burns questions. Let anyone ask anything - no matter how "basic" or simple and have it answered by those of you who are experts working within the larger centres.

[clgmezzo]

We offer extensive outreach to all the hospitals in our 17 county area along with inservices for ER staff residents and anyone willing to listen. We also send out materials, and offer an "open door" policy in regards to consultation from pts in their own homes, ER's offices, and immediate care services. I wasnt trying to beat down the other hospitals as much as i was thinking of things that make me shake my head.

[clgmezzo]

gwenith, lol, i understand completely, before i got to my present center i worked in a Tiny little rural hospital in ohio

[critcarenurse16]

I work in a rural outlying hosptial. Our care in my opinion is top notch for what we have to work with. Most trauma is shipped out but one thing larger facilities need to keep in mind-- we MUST stabalize before transfer. Transfering physicians must consult with an accepting physician who typically recommends treatment in how to stabalize for transfer. Give us a break-- we're all on the same team after all. Just my $0.02

[gwenith]

As always the operative word when it comes to small rural hospitals is "until". What many metropolitan hospitals do not realise ( and I am assuming this is a world-wide phenomena) is that "until" can be a huge word.

"Until" means that you are dealing with the "golden hour" the first and most critical time frame for trauma.

"Until" means trying to do the job of a major center without the equipment of personnel

"Until" may mean 15 minutes or if the weather is bad or the careflight team are tied up elsewhere 3-4 hours (Okay our remote is REMOTE!!)

Until can be a big word.