«I perfectly remember years ago a patient who, after being discharged, came looking for me to give me some chocolates and I didn’t recognize him. He gave me a lot of tenderness because he told me: ‘I didn’t know your face either because was intubated and with his eyes sewn shut, but You came in every day and you talked to me and you talked to me and I heard people calling you Claudia. That’s why I looked for you.” This anecdote, which Claudia Dobre, nursing supervisor at the Major Burns Unit and ICU of the Getafe Hospitalperfectly exemplifies the relationship established between healthcare workers and patients in this complex unit where coordination has an almost military character, but humanity is an essential ingredient. And hence its excellent results.
«We all aim to obtain the best results for patients and that includes improving survival, first of all, and that all treatment is aimed at promoting reintegration into normal life with the best possible functionality. That requires the coordination of different specialistsespecially plastic surgeons, intensivists and specialized nurses. It is a coordination that in few organizations is achieved in such a close and effective way,” explains Dr. José Ángel Lorente, head of the Intensive Care Medicine and Large Burns Service at the same hospital.
Furthermore, the patient in this Unit is different from other ICUs because here the patient can be awake, eating and watching TV, but they have to be there because they need daily treatment. And the stay can extend even more than six months. «The knowledge required is very high. The nurse is at the bedside 24 hours a day and it is addressed giving great importance to humanization. They are patients who spend a lot of time hospitalized and a very big bond is created», says Ana Saiz, Nursing Supervisor of the Major Burns Unit and ICU.
The members of the Major Burns Unit at the Getafe Hospital work with close and effective coordination to move forward patients who remain at risk for weeks.
In this edition, the jury of the ABC Salud awards has rewarded the trajectory of this Unit for being a national and international reference in the treatment of critically burned patients. He began his career in 1991 as heir to the Red Cross Burn Center, which was located on Lisbon Street in Madrid. More than 30 years later, it not only treats patients from all parts of the country, especially from the central zone, but has even received international patients, such as those from the Bent Bayah accident in Libya in 2022.
The Unit is made up of plastic surgeons, intensivists, psychiatrists/psychologists, rehabilitators and physiotherapists and nursing professionals with extensive experience in this field. In addition, it has the close collaboration of ophthalmologists, dermatologists, anesthetists as well as the members of the Tissue Bank. Sometimes, the intervention of otorhinolaryngologists, dermatologists, general surgeons, vascular surgeons, traumatologists, nephrologists, pulmonologists, among other health professionals, is also necessary.
The importance of a burn
Burns are, in the words of Dr. Purificación Holguín, head of the Plastic and Reconstructive Surgery service at the Getafe University Hospital, “injuries that are very unknown to the general public.” «Everyone trivializes burns a lot and You cannot imagine how serious they are and what they affect once they occur in a certain magnitude,” he warns. It is not just an aesthetic issue. The skin, which is the largest organ in the human body, “regulates temperature, fluid loss and is the first barrier that protects us from any contamination,” recalls Dr. Holguín. In a fire, patients have a period of initial mortality from carbon monoxide poisoning. But once this phase is over, the risk of death is related to the infections that the patient can contract from skin burns.
Another of the peculiarities of these patients is that «the risk lasts for weeks, not just the first 24-48 hours. The severity persists for weeks. We have to be vigilant against the appearance of complications of infectious origin, organ dysfunction (heart, lung or kidney). And the challenge it represents is very important for the intensivist. It requires very specialized treatment and coordination with other specialists is crucial to obtain good results,” adds Dr. Lorente.
They manage patients who may have a greater than 50% chance of death.
A small but deep burn can pose a high risk, as can a superficial but very extensive burn. «Even burns that do not initially seem like a particularly serious situation, because the patient is conscious and talking, but that affect a significant body surface, such as burning the legs, They have a high mortality in relation to the response that the body produces to these burns, inflammation, etc. These are patients with a high probability of complications and an unfavorable outcome if adequate intervention is not performed. We drive patients who may have a greater than 50% chance of death. And in this Unit the results are really good. We feel proud,” highlights Dr. Demetrio Carriedo, associate physician in Intensive Medicine in the Major Burns Unit.
“We have had patients with burns on 80% of their bodies with a very high probability of death, 80-90%, and we have pulled them through,” adds Dr. Holguín.
Domestic accidents
Although adults of all ages have passed through the Unit, the profile that is most repeated in recent times is that of the elderly. There are fewer and fewer workplace accidents because risk prevention services in companies have improved a lot, but there are more domestic cases due to imprudence such as stoking a fireplace with alcohol or gasolineuse flammable liquids when burning stubble or in barbecuescarrying gasoline in the trunk of a car, smoking in closed spaces with supplemental oxygen or opening a pot before all the pressure has been released. Also due to electrical accidents in people who try to steal copper in high voltage cables.
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