The Vanderbilt Regional Burn Center was developed in the wake of the Waverly train disaster in February 1978. In the aftermath of a 24-car derailment, a vapor leak occurred. Within minutes of the discovery –– before the cleanup crew had time to react –– the tanker exploded.

 

Although initially transported to Nashville for treatment, the victims ultimately had to be airlifted to burn centers in Louisville, Birmingham and Cincinnati. A total of 16 people died as a result of the fire with more than 40 others injured. Before the end of that year, the Vanderbilt Regional Burn Center was launched to ensure expert care would be available closer to home in the future.

 

Today, the center has risen to national prominence and is widely recognized for its broad clinical expertise and depth of research as one of the country's premier trauma centers specializing in burn care.

 

At the helm is Jeffrey S. Guy, MD, MsC, FACS, who has been with the burn center for one of its three decades. Named to the director's position in 2004, Guy noted, "We're one of the busiest burn centers in the country. This year we're on track to see 800 inpatients and about three-and-a-half thousand outpatients. Ten years ago, we did about 100 inpatients, and we didn't have an outpatient clinic at all … we've had monumental growth."

 

In the past decade, Vanderbilt has also added a pediatric burn program. Prior to the addition, a mother and child critically injured in a fire would have been separated and sent to two different centers, adding to the stress of both patients and family members. Currently, inpatient admissions are approximately 80 percent adult and 20 percent children. Of the pediatric patients, about 20 percent of those are victims of abuse or neglect.

 

With the closure of the burn center at Erlanger in Chattanooga last July, Vanderbilt has seen an increase in referrals from East Tennessee. Currently, the only two burn centers in the state are the 26 beds at Vanderbilt and 14 beds at the financially strapped Regional Medical Center in Memphis.

 

Guy noted patients arrive in Nashville from all eight surrounding states and from other burn centers around the nation when they hit capacity overload. "Right now, we're the burn center for nine Level I trauma centers," he said. "We've demonstrated that we can take on a large number of patients. We have a reputation of never turning patients away."

 

Furthermore, the center is nationally noted for being able to effectively treat the various types of burns with which patients present from chemical to radiation to flame burns. Some burns are seasonal in the sense that there is an upsurge in burns from space heaters in the winter and grilling burns in the summer.

 

Unfortunately, Guy has begun seeing an increase year-round in burns from methamphetamine labs. After tougher Tennessee laws limited access to necessary components, these types of burns decreased for a time. However, a new "recipe" has resulted in an increase in labs … and in turn, a surge in burns as people handle the unstable and highly combustible ingredients.

 

Vanderbilt is also a hub for burn research. Recently, Vanderbilt was designated as one of three sites testing novel products for skin replacement through a federal grant administered by the Armed Forces Institute of Regenerative Medicine. While the basis of the research is to help wounded soldiers, the resulting technology should be broadly applicable to anyone who has been burned.

 

Guy said the burn center is really unique in how it is set up. "Vanderbilt really let us think outside the box," he noted of the design for patient flow and care. In Nashville, the Intensive Care Unit, rehabilitation services and outpatient clinic are all on the same floor instead of spread out as in most centers. The layout lets a patient move seamlessly between care levels while being surrounded by the same physicians, nurses and technicians.

 

 "It creates a continuity of care and concentrates the expertise, which is really unique," Guy said. "It has the added benefit of keeping our costs down because we are not duplicating services." This is important, he noted, as "more than two-thirds of our patients have no insurance."

 

He added, "It's very much a socioeconomic disease." Guy pointed out that in many cases victims were already struggling financially, without insurance, and then lost everything they did have in a fire. "From a social standpoint, it's a very complicated problem. In essence, it's a chronic disease when you talk about larger burns," he added of the ongoing care required.

 

Ultimately, maximizing outcomes takes an interdisciplinary team and commitment on the part of patients and families. With the improvements that have occurred in acute care, burn specialists now take a longer viewpoint.

 

"We don't measure success on whether they live or die but instead on whether we can get them to a functional recovery," explained Guy. "That's why the rehabilitation function is so important. I may help them survive, but I sometimes think that's the easy part," he said, adding the importance of nurses, therapists, technicians, counselors and family members cannot be emphasized enough.

 

Although the work is physically and emotionally draining, Guy said it is also uplifting. "You leave here every day and know you're making a difference, and that's wonderful."

 

He added that providers specializing in burn care develop close relationships with the patients and families with which they work. "Burn patients are kind of like transplant patients. We make it clear that once you are our patient, you're always our patient," he said. "When you are a burn survivor, a lot of local providers are not comfortable working with them so they often are sent back to see us … which is not bad, it's what we want."

 

He would also like to see more patients referred to Vanderbilt for initial treatment. "As part of our business plan, we try to capture and take care of as many routine burns as we can," he said. "Taking care of those kinds of patients helps offset taking care of high-end, big burns."

 

Referring/Transferring Patients

The concern, however, is by no means merely financial. Guy said that burn care dispensed in most emergency departments is "circa 1970" and doesn't employ many of the new technologies that can diminish pain and improve functionality. Guy said he doesn't want a physician to ever hesitate to refer someone with a "small" burn. He pointed out that a burn the size of a quarter could cause a significant loss of functionality.