It truly takes a village — health care professionals from many different disciplines working as a team — to provide exceptional care for pediatric patients with burns.
That powerful approach is key to the care provided by the Pediatric Burn Program at Johns Hopkins Children’s Center. And it was one of the things that most impressed a team from the American Burn Association and the Maryland Institute for Emergency Medical Services Systems, which recently conducted an intensive two-day survey and recommended the program’s “full re-verification without any deficiencies” as the designated pediatric burn program for the state of Maryland and one of the top children’s burn programs in the United States. The designation means that the Children’s Center will continue to care for children with burns under the age of 15 in the state of Maryland and surrounding states.
“We passed with flying colors, and I think what impressed them is not only our amazing team, but also that we do a lot of research, and perhaps even more important, a lot of burn prevention outreach and education,” says Alejandro Vera Garcia, a pediatric surgeon who serves as the program’s director.
The reverification process is stressful, takes a lot of time, and wasn’t a slam-dunk, says Erica Hodgman, pediatric surgeon and the program’s assistant director. “Between COVID-19 and the ongoing shortage of medical professionals, it has been a tough couple of years” since the last reverification in 2018, she says. “Fortunately, they were very impressed with everything we’ve accomplished.”
Among those accomplishments is the use of new burn dressings that are less painful than traditional dressings and don’t need to be changed as often, as well as novel wound care technology. “We’ve had great success with a product that creates spray-on skin from the patient’s own cells, which means we’re getting wounds to close faster and don’t have to take as much skin from other sites on the patient’s body for skin grafts,” Hodgman says.
“We’re also doing more to manage smaller burns on an outpatient basis. And we’re working on more streamlined access to physical and occupational therapy, including having our physical therapy and occupational therapy staff members automatically see young patients in the emergency department so they can go home with exercises and not have to wait for an appointment to get started doing rehab at home.”
The Pediatric Burn Program at Johns Hopkins Children’s Center treats some 300 patients a year, including about 100–120 who are admitted to the hospital. The burns range from less serious cases, like kids who touch a hot stove with a fingertip, to serious burns related to house fires, fire pits and hot liquids pulled from countertops.
“We are doing a lot of research to improve treatment, and the great thing about Johns Hopkins is that we have access to so many different areas of expertise,” Hodgman says. “I saw recently that the engineering program is looking for projects for their students to work on, and I’d love to collaborate with them on novel splints and dressings and maybe even a safer cup to prevent injuries from hot food spills.”
The Burn Program was first designated a regional pediatric burn center by the Maryland Institute for Emergency Medical Services Systems in 2006, and made independent from the adult burn center at Johns Hopkins Bayview Medical Center because it was recognized that children’s developmental, psychological and physiological needs are unique. In 2018, it was for the first time designated by the American Burn Association as one of just a dozen or so burn programs providing the highest level of burn care for children in the U.S.
“Pediatrics is complex, and we offer a full range of care to get kids back into school and their normal activities as quickly as possible,” Garcia says.
Doctors and nurses representing a wide range of specialties are key. But so are professionals in child life, nutrition, physical and occupational therapy, social work and mental health, and even injury prevention. “The entire hospital is committed to the excellence of this, and I feel fortunate to be a part of it,” Hodgman says.
Garcia, who has been director of the program for three years, says one of the things that attracted him was the public health aspect of pediatric burn care. “All of these burns are preventable,” he says. “It’s just a matter of education. We have injury prevention specialists who go out into the community, and we do news stories on fire prevention, fireworks safety and the like. If we are now seeing 300 patients a year, I would love it if in a year or two we were seeing only 200.”
The reverification process is difficult, but well worth the effort, he says. “It’s worth it because it is hard. It’s reassuring for parents and the pediatricians and ED doctors who refer their children to us. But more important, it forces us to stop and look at everything we do and ask ourselves how we can do it better.”