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Page last updated 8-04-04

© COPYRIGHT 2004 ALL RIGHTS RESERVED TOTALBURNCARE.COM

TOTAL BURN CARE  2nd edition
Copyright© 2001 Elsevier Science
Edited by Dr. David N. Herndon

Reprinted with permission of Elsevier

(excerpt from chapter 1, pages 11 and 13)

Teamwork for total burn care: achievements, directions and hopes
David N Herndon, Patricia E Blakeney

Introduction

   Major burn injury evokes strong emotional responses in most lay persons and health professionals who are confronted by the spectre of pain, deformity and potential death associated with significant burns.  Severe pain and repeated episodes of sepsis followed by predictable outcomes of either death or a survival encumbered by pronounced disfigurement and disability has been the expected pattern of sequelae to serious burn injury for most of mankind's history.¹  However, these dire consequences have, over time, been ameliorated so that, while burn injury is still intensely painful and sad, the probability of resultant death has been significantly diminished.  During the decade prior to 1952, a 50% mortality rate occurred in young adults (15-44 years of age) with total body surface area (TBSA) burns of 46% or greater^².  Forty years later, statistics from the pediatric and adult burn units in Galveston, Texas indicated that the 50% mortality rate accompanied a 70% or greater TBSA for the same age group.  Improved survival has been the primary focus of burn treatment advancement in the past few decades.

   Findings of the group at the Army Surgical Research Institute pointed out the necessity of involving many disciplines in the treatment of patients with major burn injuries and stressed the utility of a team concept.¹  The International Society of Burn Injuries and its journal, Burns, and the American Burn Association with its publication, Journal of Burn Care and Rehabilitation, have publicized to widespread audiences the notion of successful multidisciplinary work by burn teams.

Functioning of a burn team

   Gathering together a group of experts from diverse disciplines will not constitute a team.⁴³  In fact, the diversity of the disciplines, in addition to individual differences of gender, ethnicity, values, professional experience and professional status render such teamwork a process fraught with opportunities for disagreements, jealousies and confusion.⁴⁴  The process of working together to accomplish the primary goal, i.e. a burn survivor who returns to a normally functional life, is further is complicated by the requirement that the patient, and family of the patient, collaborate with the professionals.  It is not unusual for the patient to attempt to diminish his immediate discomfort by pitting one team member against another or 'splitting' the team.  Much as young children will try to manipulate parents by going first to one and then to the other, patients, too, will complain about one staff member to another or assert to one staff member that another staff member allows less demanding rehabilitation exercises or some special privilege.⁴⁵  Time must be devoted to a process of trust-building among the team members.  It is imperative that the team communicate - openly and frequently - or the group will lose effectiveness.

References
1.  Artz CP, Moncrief JA.  The Burn Problem. In: Artz CP, Moncrief JA eds.
The Treatment of Burns, 2nd ed. Philadelphia, PA: WB Saunders Co., 1969: 1-21

2.  Bull JP, Fisher AJ. A study of mortality in a burns unit: a revised estimate.
Annals of Surgery 1954; 139: 269-274

43.  Schofield RF, Amodeo M. Interdisciplinary teams in health care and human services settings: are they effective. Health and Social Work 1999; 24(3): 210

44.  Fallowfield L, Jenkins V. Effective communication skills are the key to good cancer care.
Eur Journal Cancer 1999; 35(11): 1592-1597

45.  Perl E. Treatment team in conflict: the wishes for and risks of consensus. Psychiatry 1997; 60(2): 182.

This article was excerpted from the book Total Burn Care, 2nd edition (2001), edited by David N. Herndon, M.D. and is posted with permission from Elsevier.
Single copies of this article may be downloaded or copied only for the reader's personal research and study.

(This link takes you to the "Total Burn Care" page at the publishers web site.)
TOTAL BURN CARE  2nd ed.

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