The Burn Center at Rhode Island Hospital admits in excess of 150 burn patients per year and has in excess of 1000 patient visits to the pediatric and adult burn clinics.  The trained professionals and top-notch technology provide superior care to each patient that enters our service.  Rhode Island Hospital’s Burn Center is remarkable for its interdisciplinary nature; physicians, nurses and technicians from different disciplines bring their expertise to their dedicated treatment of burn patients.  We are fortunate to have the world class Hasbro Childrens Hospital at our disposal for our burned Children.  They have the special expertise to deal with this specialized patient group, and offer support for children in excess of medical and surgical care.  The Child life Department uses advanced techniques to help children cope in the challenging hospital environment.  Child Life also has credentialed teachers on staff to ensure that children admitted for prolonged periods are able to keep up with their education process.
 
Burn ICU and Pediatric ICU
 Burn and Pediatric ICU nurses participate in the care of burn patients as a member of the critical care team that manages the most critically ill burn patients at our burn center. They are an integral part of the team providing 24 hour assessment and monitoring of critically ill burn patients, as well as providing sophisticated burn wound care. Many of the Burn and Pediatric ICU RNs are certified in Advanced Burn Life Support and also provide ABLS instruction in the hospital. In addition Burn and Pediatric ICU Nurses participate in the rehabilitation process and provide much needed support for patients and families, often in collaboration with social work. The ICU nursing team also provides instruction to and collaborates with the RNs on the general burn unit to educate them on the patient’s case, and specific type of burn dressings in an effort to help make the patients transition as smooth as possible. We have had many patients and their families return after discharge to thank the team and show us their amazing progress that the Burn ICU was a large part of! 
 
Burn Rehabilitation
Starting on day one of a burn, our expectation needs to be that our burn patients will recover and retain excellent function.  To that end we must at onset of treatment undertake a rigorous program to protect range of motion, strength, and flexibility.  There will be times in a patients care regimen when there are opportunities for a patient to build their capacity, and there will be times when a patient will have little opportunity to build or sustain physical activity secondary to surgery.  When there is no contraindication to aggressive therapy the patient must make as much progress as possible so that when the patient is limited in their capacity to participate they will lose as little as possible.  The goal is to provide optimal function.  The initial rehabilitation phase for the burn patient focuses on preservation of range of motion (ROM) and skin integrity.
 
Burn services are provided to patients through all phases of recovery following a burn injury.  Therapy services usually continue after discharge from the hospital.  A therapist experienced in burn care will develop a treatment plan based on a patient’s individual needs.  Physical and Occupational Therapy are initiated as soon as possible during the acute phase of a burn injury. Treatments are focused on preserving joint range of motion and muscle strength through splinting, stretching and exercise.  Treatment plans include education in minimizing scarring and information regarding protecting the skin.  The Rhode Island Burn Center employs the most advanced techniques to minimize and reduce the effect of scarring. Patients set goals with their therapists to maximize performance in ambulation and other aspects of mobility and in activities of daily living i.e. bathing, dressing and returning to community activities. 
 
Scope of Care For Burn Patients                                               
Rhode Island and Hasbro Children’s Hospital admit burn victims. This is accomplished in accordance with recommendations from the American Burn Association. Policies, procedures, and competencies exist within Rhode Island and Hasbro Children’s to make the Rhode Island Burn Center a center of excellence.
 
Rhode Island Burn Center admits all patients in the pediatric and adult population who have suffered an acute burn injury, this includes stabilization and treatment and reconstruction, patients with complicated wound care, and patients with Toxic Epidermal Necrolysis (TEN) syndrome, Stevens-Johnson syndrome, or other exfoliative disorders of the integument.
 
All burn patients 17 and older are admitted to Rhode Island Hospital
All burn patients less than 17 years of age are admitted to Hasbro Children’s Hospital
 
Full time Nursing, OT, PT, Social Services, Case Management, Outpatient Services and Surgical Services attend to patient’s needs using a Family Centered Care approach. Other team members will include Nutritionists, Pharmacists and Respiratory Therapists. Team rounds will be conducted daily between the trauma service and nursing. Multidisciplinary rounds will be conducted as needed to evaluate and adjust the plan of care.
Specialized services offered to burn patients:
Hydrotherapy
Comprehensive wound care
Central line placement, care and monitoring
Post-anesthesia recovery
Multi-system monitoring and intervention
Critical Care procedures
Surgical intervention
Rehabilitation therapy
Comprehensive outpatient follow up
 
Burn Injured Patients:
Criteria for referral and admission to Rhode Island and Hasbro Children’s Hospital for the treatment of burns is in accordance with recommendations from the American Burn Association suggested for Burn Center practice and verification. Any burn injury can be evaluated and treated at the Burn Center.
 
 
Speech and Language Pathology
Speech-language pathologists (SLPs) evaluate and treat speech, language, cognitive-communication, voice and swallowing disorders in individuals of all ages.  As a member of the burn team, the speech-language pathologist is consulted when there are concerns regarding swallowing, voice, and/or communications-cognition.  If a patient has suffered an inhalation injury or has required long-term intubation and/or tracheotomy, swallowing, voice and communication is almost always affected.
 
The speech language pathologist provides initial clinical consultation within the office or at bedside to evaluate voice, swallowing and communications needs. Based on this initial assessment, further evaluation may be recommended.  This may include instrumental measures of swallowing function such as a Modified Barium Swallow (MBS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES).  Recommendations made by the SLP include the “safest” form of nutrition, that is, the form of nutrition (oral vs. non-oral) that eliminates the risk of aspiration/aspiration risk (food or liquid entering the airway, placing the patient at risk of developing pneumonia).  Patients with swallowing disorders are also at risk for malnutrition or dehydration. Specific recommendations following SLP exams may also include recommended diet consistency (e.g. pureed, thickened liquids, etc), and/or postural changes, safe swallowing strategies, treatment or further testing.
 
A patient’s ability to communicate may be impaired and require evaluation and treatment.  If it is noted during the initial assessment that the patient’s voice is hoarse, the SLP may complete a videostroboscopy, which is an examination to assess the vocal folds.  Voice therapy may be provided by the SLP may evaluate to determine if the patient can utilize a speaking valve or may require another form of communication such as a simple or computerized augmentative/alternative communication device.
 
For further information, please contact the Speech Pathology Department at 444-5485.
 
Respiratory Care Burn Team
The Respiratory team is available to the Burn Team 24 hours per day, 7 days per week. 
The Respiratory team assists with airways, bronchoscopy to determine the severity of inhalation injury, assist with intubations, ventilator management, set-up and implemention of conventional or high frequency ventilation, and assistance with transport. Assist-manage breathing of intubated patients en route to trauma unit or operating room.
 
Non-intubated patients
            -Inhalation therapy, bronchodilators, humidification, airway clearance
            assess patency of airway.  Suction as needed
Intubated patients
            Setup and implement conventional/high frequency ventilation.
            Monitor/document breathing status
based on labs and work of breathing,
report changes to covering physician.
administer inhaled medications as needed
Airway management
Promoted pulmonary hygiene of
intubated and
non-intubated patients
Bronchoscopy assist
Setup and assist with video bronchoscopy. 
Assisting in evaluating condition or airway and performing diagnostic bronchial alveolar lavage.
            Bedside tracheostomy assist
Control endotracheal tube during placement of tracheostomy through use of bronchoscopy and laryngoscopy.
 
Nutrition Services
Because adequate nutrition is crucial to help prevent infection, assist with wound healing, and help maintain energy and strength, Nutrition Services actively participates in the team management of burn patients.  Our nutrition staff determines each patient’s individual nutritional requirements and develops a personalized nutrition care plan.  This includes a high calorie, high-protein diet with nutritional supplements as needed.  The licensed registered dietitian and dietetic technician meet with families for any special food considerations.  Additionally, some patients may require tube feeding or other alternative feeding routes.  The dietitian frequently monitors patient’s progress and makes adjustments in a patient’s diet.
 
Nutrition Services actively participates in the team management of burn patients admitted to Rhode Island or Hasbro Children’s Hospital.  The goals of the nutrition staff are to meet your unique nutritional requirements and to help you meet these goals in order to optimize your recovery.  Our nutrition team develops a personalized plan for you to prevent nutritional deficiencies, preserve body mass, enhance healing, reduce infection and minimize losses of energy and strength.
 
Our staff has advanced training, specialized certification and extensive experience in the nutritional management of a burned patient. 
 
Partnerships with outside organizations
Since 2008 the Rhode Island Burn Center has been partnered with The Phoenix Society For Burn Survivors.  The Phoenix Society has a patient and family support program know as Survivors Offering Assistance in Recovery (SOAR). 
 
Educational Outreach
The Burn Center has established an outreach program intended to educate the public to the potential disaster that can be realized from even a small burn. The outreach program outlines a series of precautions that can be taken to avoid burns.
 
Professional Outreach
The Rhode Island Burn Center educates medical professionals in the area through a series of Grand Rounds, talks to professional groups, and through the development of burn symposiums.  This year the Rhode Island Burn Center at Rhode Island hospital has been selected by the American Burn Association to host the prestigious Northeast Region Burn Symposium.  This symposium attracts members of the burn care community from Canada to as far south as Washington, DC, and as far west as the Mississippi River The Rhode Island Burn Center also produces durable educational materials such as the Rhode Island Burn Center Manual.
 
Burn Center Disaster Plan:
The hospital disaster plan is set up to respond to multiple different types of disasters including a burn mass casualty. The Hospital Incident Emergency Command System-(HEICS) has a thorough organizational structure that allows for mobilization of personnel, material and structural resources. This plan has been tested through multiple disaster drills over the last several years and has been activated several times for trauma and burn disasters in our local area.