Burn Center

Cautionary Tales From The Burn Center

By Dr. James Holmes, FACS

Here’s a story I hear too many times from my burn center patients.

“I finally finished raking up all the leaves and trimming the bushes. I always burn the brush out back, a good distance from the house, you know, for safety. So I went out to the shed and got the gas can and came back, poured it out and lit a match. The next thing I knew, the flames were up in my face.”

More than half my burn center patients are burned because they make the mistake of using gasoline to start a fire. Gasoline is the most dangerous starter because its vapors are so flammable – even explosive. If you must use a fire starter – and I’d prefer you don’t – use diesel, kerosene or charcoal lighter. They’ll start a fire just fine and they’re safer than gasoline because their vapors aren’t flammable.

“But gasoline is so handy,” my patients tell me. “The can is right there in the garage. Anyway, that’s how my daddy taught me to burn the trash, and I’ve always done it this way.”

Could be. But half the admissions to the Burn Center here at Wake Forest Baptist Medical Center are patients burned when a trash or brush fire started with gasoline exploded on them. Those who survive spend months recovering, undergoing repeated skin grafts and the slow healing that follows.

North Carolina has only two burn centers, one here at Wake Forest Baptist and the Jaycee Burn Center at UNC Chapel Hill Medical Center. That means we treat burns in our center from the central Piedmont, west to the mountains and south to Charlotte. We’re also the closest burn center for patients in southern Virginia and eastern Tennessee. Local community hospitals can treat first-degree burns and some second-degree burns – but third-degree burns require the kind of expertise only found at a burn center. [What's the difference between the three levels of burns?]

I love my work – and the research that goes with it – but trust me: you’d be better off staying as far from the burn center as you can. The burns that require my care are almost always preventable. So here’s a dose of fire prevention:

  • Make sure your home is equipped with working smoke detectors. Fire departments generally recommend one on each floor. A new ordinance in Winston-Salem requires one in every bedroom. I wish that were the case everywhere.
  • Practice an exit plan with your family. When you were a kid, fire drills at school probably seemed like nothing more than an excuse to get out of school for a while. They’re not silly. Practice at home, just in case.
  • Set the temperature on your water tank at 120 degrees or less. I can’t tell you how many children and elderly people I’ve taken care of with third-degree burns from scalding water.
  • Teach your children to stay away from the stove, the fireplace and the barbecue grill. Keep a safe zone around them. Turn pot handles towards the wall.
  • Never use a kerosene heater inside a home.
  • If you work with flammable chemicals, use them safely. And if you’re in charge of any workplace, follow the rules. Too many people in North Carolina have died in industrial fires that could have been prevented.

Most first-and-second-degree burns heal with simple wound care. But a third-degree burn requires skin grafts and expert emergency care from a burn center. That’s where I come in. We treat about 250 patients a year from the entire region; Brenner Children’s Hospital treats about 75 children for serious burns. Most of these patients require skin grafts because third-degree burns affect the inner layers of skin that don’t repair themselves naturally. Patients burned over large parts of their bodies require extensive skin grafts that can leave healthy parts of their bodies scarred. Pain management has improved, but the basic surgical techniques we use to remove healthy skin from one part of the body and graft it to the injured area haven’t changed much in the last 30 years. And recovery still requires constant nursing care, expert rehabilitation therapy, and patience.

I am excited to be working on research into new technologies for grafting burns from cells that have been harvested from the patient’s healthy skin. The Burn Center here is part of a multi-center clinical trial sponsored by the Department of Defense to test technology that allows us to apply skin cells during surgery with an aerosol spray. So far, six patients here are enrolled in the study. If they do well, as I expect they will, the technology can be used for soldiers burned on the battlefield and patients injured here at home.

We don’t live in a risk-free world. I like nothing more than grilling a steak at home, but my daughters know to stay far away from the grill. And I know it’s not reasonable to ban outdoor trash fires, especially in a rural state. But think about what you’re doing. Don’t ever use gasoline to start the fire, regardless of what your father did or his father before him. Even a cup can cause an explosion. In spite of the miracles we work here, you don’t want to be my patient.

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James Hill Holmes IV, M.D.

James Hill Holmes IV, M.D.

James Hill Holmes IV, M.D., Associate Professor Surgical Sciences-General Surgery at Wake Forest Baptist Medical Center

Last Updated: 03-21-2014
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