Carolina’s burn center brings comprehensive care to the people of the state and beyond
Bruce Cairns arrives at the North Carolina Jaycee Burn Center each day with one primary concern: He wants to shut it down.
“My mission here is to put us out of business,” he said.
Cairns, medical director of the 21-bed center at UNC Hospitals and John Stackhouse Distinguished Professor of Surgery, would love to see the day when there are no burn injuries.
Until then, the center serves as a hospital-within-a-hospital where burn survivors of all ages are cared for by a cadre of staff: burn surgeons, nurses, social workers, occupational therapists, rehabilitation counselors, physical therapists, aftercare specialists and other disciplines who treat burns and help survivors and families adapt to new realities.
Students from UNC and surrounding schools volunteer and intern at the center to get an education they can get nowhere else, and Special Forces at Fort Bragg are trained to address wounds they may see in combat.
Staff partner with firefighters throughout the U.S., circulate smoke alarms and present on fire safety and burn prevention to anyone who will listen. Researchers break new scientific ground on smoke inhalation, immunology and spray-on skin, and computer scientists discover new ways to monitor patients.
That such a comprehensive center of healing, teaching and learning exists at Carolina is no coincidence, Cairns said.
“If you take the priorities of this institution and align yourself with them, everything else will fall into place,” he said. “We have to make a difference. The University requires that of us.”
‘One big family’
Burns leave the visible marks of a tragic, life-changing event, and their healing requires many resources. Caring for these patients is not for everyone, but for some, it is everything.
When Anita Fields was a student at Carolina’s School of Nursing in the 1980s, she did not predict a lifelong career with burn survivors. Fields, now program manager for burn aftercare, has been at the center for more than 25 years.
“You don’t expect to hear anyone say, ‘When I grow up, I want to work at the burn center,’” she said.
But it’s a place where signs of healing abound – a woman laughing with her occupational therapist as she waves a bandaged palm back and forth, a child playing with a therapist who can see past scars, a social worker who understands the emotional pain that will outlast the physical, group photos from camps that nurture survivors and parents at every stage of recovery.
There’s a waitlist of nurses who want to work there, Fields said. Some leave and come back. Some, like Fields, never leave. “The burn center is one big family,” she said.
The patients know that, too. “Burns is a field where patients can tell immediately if you’re really here for them,” said Cairns. “When it pulls you in, you’re all in.”
Lauren Williams, a master’s student in occupational therapy, rotated through the center last spring. Occupational therapists there focus on hand therapy, self-care retraining and scar massage.
“I saw how dependent the surgeons were on their OTs. Surgeons in the OR will page the therapist when a splint is needed during surgery,” she said. The experience has inspired Williams to seek further fieldwork at a pediatric burn center in Malawi next summer.
Cathy Calvert, a rehabilitation counselor at the center since 1989, said the center easily becomes a passion. Still, she has students shadow her first so they understand all that the work entails.
“Here, students get the full gamut: a hospital base and multidisciplinary team, inpatient and outpatient real-life experiences, and external partners like nurse case managers,” she said. “They see the counselors conferring with OT and PT, and that we are all involved.”
Tanya Thawley, a student in Carolina’s rehabilitation counseling program, is doing her practicum at the burn center this fall, assessing patients’ injuries related to work function and helping them return to and maintain employment.
Though she plans to spend her career working with substance abuse, Thawley chose the burn center because she knew it would stretch her skills. “My passion is not vocational rehabilitation, but when I step back, I realize I’m using all my skills: I’m empathizing, I’m referencing, I’m counseling,” she said.
Cairns said even students with no connection to health affairs leave the center better prepared for work, and with a service state-of-mind.
“When students come here, they have limitations on what they think can happen. But when they see people tackle a problem this big, everything begins to seem possible,” he said.
Some of the most popular student visitors are UNC athletes. In those interactions, both patient and athlete benefit, Cairns said.
“When a patient with burns on more than 40 percent of his body says to an athlete, ‘I hope your knee gets better so you can play this weekend,’ you see that student transformed. And when the athlete leaves, that patient might walk a little bit farther, might eat another spoonful,” he said.
Ernest Grant, outreach coordinator, has worked for more than 30 years to stop burns where they start.
“As a nurse, I was caring for burn patients and noticed how so many burns could be prevented,” Grant said. “So, I challenged myself to do that.”
If there is a prevention angle, the center will find it and put resources toward it, Cairns said.
He described this kind of outreach as an extension of the state motto, Esse quam videri. “To be, rather than to seem,” he said. “We don’t just talk about these things; we really have to do them. It’s the University’s mandate.”
Grant is on the road most of the week, bringing awareness to burn prevention through fire safety seminars, health fairs, visits to civic organizations and coalitions with fire safety professionals at the state, national and international levels. He will be invited to give upwards of 150 presentations this year.
He also reaches out to first responders, paramedics and nurses to teach them how to care for patients who will be transferred to UNC’s burn center.
“We know that early care is essential for a better outcome for the patient,” Grant said.
He works to increase fire safety through legislation and led the effort to pass the Fire-Safe Cigarette Act in 2007, which requires that only “fire-safe” cigarettes be sold in North Carolina. Faculty and staff from the center often provide research and expertise as a basis for new legislation.
The state has seen its fair share of disasters where burns were a prominent injury: the Hamlet chicken processing plant fire in 1991, the West Pharmaceutical fire of 2003, the Pope Air Force Base crash in 1994 and 2009’s ConAgra explosion. As the lead agency in the southeast for burn disaster planning, Carolina’s burn center contributes to disaster preparedness on the state and national levels.
“When you think about the attacks that just happened in Egypt and Libya, you realize, there was a lot of smoke and fire involved,” Cairns said. “Our work is helping to inform how to deal with that kind of disaster.”
Like his co-workers, Grant feels his life’s work is at the center.
“You come in here to learn, wondering what you’re supposed to do for your life, and then you are forever changed,” he said.
“This place will challenge you to be the best nurse, pharmacist, therapist. Whatever you are, this place will make you the best at it.”