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Pediatric Burns By Bradley J. Phillips

Chapter 1:  Historical Perspective and the Development of Modern Burn Care
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Pediatric Burns

Chapter 1

Historical Perspective and the Development of Modern Burn Care

Leopoldo C. Cancio, MD, FACS Colonel, Medical Corps, US Army, US Army Institute of Surgical Research

Basil A. Pruitt Jr, MD, FACS Clinical Professor of Surgery, University of Texas Health Sciences Center at San Antonio

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense.

Outline

1. Introduction

2. Organizational Landmarks

a. The World Wars and Fire Disasters

b. Organization of the Burn Unit

c. National and International Burn Associations

3. Milestones in Research and Clinical Care

a. Fluid Resuscitation

b. The Burn Wound: Topical Treatment

c. The Burn Wound: Surgical Treatment

d. Inhalation Injury

e. Metabolism and Nutrition

f. Rehabilitation

4. Conclusion

5. Key Points

6. Acknowledgments

7. Table

8. References

Introduction

Before WWII and the creation of specialized units for the care of thermally injured patients, deep burns in excess of 30% were almost invariably fatal1; the pathophysiology of death following thermal injury was misunderstood, and effective options for resuscitation, wound care, and surgical closure did not exist. What conditions made possible the extraordinary revolution of the last 60 years? Answering this question is important in order to continue to progress in addressing the unsolved problems in burn care and to make our most lifesaving advances available to the rest of the world.

Organizational Landmarks

Of the various innovations which led to the marked reduction in postburn mortality of the last 60 years, no technology or surgical technique has been more important than the burn center concept itself, which involves the institutional commitment to excellence in research, teaching, and clinical care. Several landmarks in the history of the burn center are provided in the Table. The first burn hospital was established in 1843 by James Syme in Edinburgh, who felt that mixing burn and other surgical patients would represent “the highest degree of culpable recklessness.” Subsequently, space was created in a former workshop. Five years later, however, the burn patients were transferred in order to accommodate an increased number of patients from railway and other accidents.2

The World Wars and Fire Disasters

Subsequent developments in burn care, as in trauma care generally, were clearly given impetus by the world wars