ISYSEd Sponsors Extraordinary Educational Seminar On Burn Injuries At Anaheim Crowne Plaza
By Lonce LaMon - April 2, 2012
ISYSEd hosted the Acute and Post-Acute Burn Injuries seminar for the workers’ compensation claims professional industry on Tuesday, March 27th, at the Anaheim Crowne Plaza Hotel. The seminar room was filled beyond capacity with workers’ compensation claims adjusters, nurse case managers, vendor companies, and other workers’ compensation and medical professionals.
An extraordinary father- son team—Dr. Richard Grossman and Dr. Peter Grossman—were the lead members of the panel, together with their other two associates from their Grossman Burn Center: Dr. Jonathan Simons, a psychologist, and Alejandro Joseph Freire, a prosthetics expert and provider for burn-injury patients.
Dr. Richard Grossman, a mature veteran doctor and the father of Peter, told of how he went to Medical School at the University of Tennessee. Then, there was a fire. Many people died. Some survived. And they were taken to a hospital. At that hospital he requested that some beds be set up separately for the burn patients. That was the beginning of his burn center.
Alysha Loumakis-Calderon, the Director of ISYSEd, smiles as she walks behind her fine group of panelists at her burn injury seminar at the Anaheim Crowne Plaza last Tuesday.
There are five Grossman Burn Center locations. One is in West Hills (the San Fernando Valley in Southern California), another is in Santa Ana (Orange County); then there is one in Bakersfield, California; Lafayette, Louisiana; and Phoenix, Arizona.
Dr. Peter Grossman is a board certified plastic surgeon and the co-director of Grossman Burn Center with his father. He is the author of numerous articles and has lectured around the United States.
“Burns can be very difficult to look at,” he told the audience. “You need to know that these visuals are extremely difficult to look at. We hope that everybody that comes into our centers will survive.”
Dr. Peter Grossman speaks to his audience while seated next to his father, Dr. Richard Grossman, who is on Peter's right.
The state of burn care has advanced tremendously over the past fifty years. When a patient does survive, the first thing that comes next is functionality. The task immediately at hand is to get the patient functional. They need to be able to hold a tool in their hands. To function. Then, next, after functionality it’s about appearance.
Appearance can impair a person from being able to get a job, to interact socially. What the body does after a severe burn is it goes into overdrive and then over-heals. Then scar tissue forms that does not have the same elasticity that the rest of the normal skin of the body has. Scar tissue locks into place and disallows the body to function. The task is then to remove the unhealthy scar tissue and replace it with the patient’s healthy skin. So, immediate treatment of burns must happen quickly in order to prevent scarring. If skin is burned, it can’t replace itself.
“I’m going to talk to you about the negativity of scar tissue,” Dr. Peter Grossman continued.
A first degree burn just involves the epidermis. The epidermis protects the dermis from the outer environment. The dermis is where the nerve endings and the sweat glands are. That’s where there are regenerate cells. But if a burn comes down further and deeper, underneath the dermis, most of the regenerate cells have been destroyed.
“Every one of us here in this room is susceptible to burn injury. It does not discriminate,” Peter Grossman said. “How will I be able to have a job? Will someone love me?”
An audience member addresses a question to Dr. Peter Grossman of the Grossman Burn Center.
A first degree burn usually goes away in seven to ten days. It’s like a bad sunburn. But with a second degree burn there’s a blistering area. It is weepy. If it’s a deeper second degree burn and the regenerative cells are destroyed, there is going to be scarring. There will be a red, angry looking area with blistering.
“Burns are progressive and dynamic by their nature. Burns change.” That’s why the treatment of them needs to start right away.
With industrial injuries, fires are a very common cause. And also hot water. And electrical injuries. With electrical injuries the voltage always grounds itself. It travels through the body and exits.
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Alysha Loumakis-Calderon, Director of ISYSEd, presided over the entire two-and-a-half hour lunch-time seminar.
“So, what’s the big deal about scarring?” Peter continued. “The problem with scarring is it gives us an abnormal architecture of the tissue. It pulls and doesn’t allow the body to separate it. The hand, for example, can’t open up because the scar tissue has over-healed. A child can’t lift his arm away from his chest. Can’t separate it from the upper and lower arm. Here’s why scarring is problematic.
“If you have a second degree burn, it can convert to a third degree burn. So, it’s better to be more aggressive than necessary than less aggressive than necessary. If it heals like this (shows a photo) you’re going to be behind the eight ball because no matter how much surgery is done we’re not going to be able to make this go away. And this could not have existed. You don’t want to have this happen. So, the faster it heals, the better chance of less scarring.”
But if it does happen, however, and bad scarring does occur, there are some extraordinary surgery techniques that Peter Grossman explained. “We can’t perfectly fix it but we can make it better.”
There was a patient illustrated who had her chin literally melted into her chest, preventing her from lifting her head that visually was absolutely heart-rending. But then the after-picture of this same patient was stunningly miraculous.
A surgery technique called Z-Plasty literally cuts a Z through the tethered scar tissue and spreads it out, and then uses grafted skin to fill in the gaps created. That’s what scar tissue does: it pulls and tethers the skin. And this tethering has to be undone.
This center photo on the poster shows a burn victim face forward after surgery by the Grossman Burn Center. She had had her lower face and chin melted into her chest in a manner which was visually heart wrenching. The before-photo is not shown here.
Another technique for creating new skin for grafting is “ballooning”. A balloon is slipped under good skin through a surgical incision and then filled with water. Over time the skin stretches and creates a much larger area of usable skin. The patient can look freakish during this ballooning period, but fortunately it is only temporary. When the balloons are removed the new skin is available, and then the scar tissue can be scrapped away or cut away, and that area grafted with the new skin.
Dr. Jonathon Simons is the director of social and psyche services at the Grossman Burn Center. He deals with the psychological trauma and recovery of the burn victims.
When he got to the podium he expressed how we all most likely drove to the seminar by taking the reasonable risk of driving there in an automobile. But burns are not something we consider a reasonable risk. They are something we never bargain for in our daily risk taking. Thus, getting badly burned is to experience something profoundly traumatic.
Post Traumatic Stress Disorder often occurs with burn victims and causes flash- backs. Everything the burn victim experienced gets taken in. The dreams are particularly distressing. They are re-experiencing. They are reliving. The event is playing over and over again. They are caught in this continual feed-back loop. The memory of what happened takes control.
“We don’t get to press a button and erase these memories,” Dr. Simons said.
Dr. Simons went on to state that it’s normal for these patients to then get into avoidance behaviors. The hallmark of Post Traumatic Stress Disorder and depression is diminished interest in ones usual and customary activities.
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Dr. Jonathon Simons spoke about the psychological trauma and recovery process for burn victims.
Thus, the emotional trauma that develops in these patients needs to be handled very early on after the accident; not only in the patient, but with the patient’s spouse and other family members.
The physical burn injury itself, like the emotional injury, also needs to be treated early. That is highly important in order to avoid the scarring that is far more problematic to treat at a later date, and far more costly not only in human terms, but in actual dollars when involving workers’ compensation claims.
ISYSEd, based in Anaheim, California, provides continuing education for nurse case managers, counselors, disability specialists, and workers' compensation claims professionals. For more information and to find online courses as well as upcoming live course events, go to www.ISYSEd.com.
lonce@adjustercom.com
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