What is a burn?
Burns are physical injuries that occur when the human skin comes in contact with heat, radiation, electricity or certain chemicals. Burns are extremely dangerous and excruciatingly painful. Even a minor burn can be extremely painful.
They can cause a severe damage to the skin and in some cases also to some internal organs of the body. They form permanent or temporary marks on the skin and involve the damage of the layers of skin.
Basically burns are caused by any hot object or a chemical. Usually the most common agent causing burns is the fire. Other agents are hot liquids, electricity and chemicals and gas.
Each year, over 200,000 Canadians receive medical care for burn injuries.
More than 5000 of these are hospitalized for an average of two weeks, and of these, four percent will die from their injuries.
How many of you have had a burn?
How many of you have had, or ever had a loved one have a burn so severe that they had to go to a burn ward for treatment?

I’d like to take this opportunity to give you a little history on the creation of burn wards in Canada, specifically Winnipeg, Regina (my own personal experience with my brother) and Toronto, the costs of these services, the leadership required to make these services a reality, and the important role these services play in the welfare of injured Canadians as a whole.

Prior to the 1960s, burn victims were treated in general surgical wards. There were no specialized facilities for treating burn victims. This all changed with the creation of two of the first specialized wards in Canada; Vancouver in 1969 under the leadership of Dr. Doughlas Courtemance and St. Joseph’s Hospital in Victoria of 1970.
It was the vision and persistence of Executive Medical Director Dr. Ralph Adams and Dr. Embert Van Tilberg that made this dedicated burn ward in Victoria a reality. The cost of the project was originally $168,000, but by changing the site to a newer building instead of renovating the existing hospital, the project was completed for $73,000, due to the help of $27000 that was raised through private donations and grants. The new facility had ceiling tracking systems to assist in transferring patients, customized bath tanks to assist in cleaning and removal of dressings from burn victims, and specialized air exchange systems to minimize the risk of infection.

With the success of the burn wards in Vancouver and Victoria, the rest of the country soon followed. Today, there are over 20 dedicated burn wards throughout the country.

Burn centers typically cover a considerably larger population base than trauma centers and therefore require coordinated communication links among emergency medical services, transportation networks and referral hospitals across tremendous distances. In 2010, the ratio of designated adult level 1 and level 2 trauma centers to burn centers in Canada was about 3:1. For example, In British Columbia, about 60% of the province’s 4 million residents live in the same census metropolitan area as the province’s 2 designated adult burn centers in Vancouver and Victoria. Nearly 40% of the population will require transport over hundreds or thousands of kilometers before arrival to either centre. This can be very costly to families who have to travel to the larger cities and have to stay in hotels while their loved ones receive treatments.
Minimum population of around 200,000 is required for a standard burn unit to be established in a city. More advanced specialized wards are stationed in larger cities; such as Toronto. The only exception to this rule is St John, New Brunswick which has a burn ward with a population fewer than 100,000.

Burn Unit Costs/ General Information * It costs around $2.4 million per year to run a 12 bed burn unit * It cost approximately $1800 per day, per patient * Average length of stay is 10 days to 2 weeks * Patients who receive burns over 50% of their body remain inpatients can remain in hospital up to 6 months.

Burn units would not be able to operate to their full potential without the support and fundraising efforts provided by the Firefighters of Canada. To firefighters, there is no greater measure of courage than burn patients struggling to survive devastating injuries. Burn survivors inspired men and women of the Fire Departments to volunteer their time and effort in raising funds to support burn care, treatments, education awareness, rehabilitation and rehab.

Here in Winnipeg, in 1978, the Firefighters Burn Fund was established by the visionary leadership of Martin Johnson and Gary MacDonald, two firefighters who spearheaded efforts to improve burn treatments and to develop actual burn programs at local Winnipeg hospitals. Currently, there are two burn wards that cater to the specific needs of burn victims. The Health Sciences Center Burn Unit was opened in April of 2007. This state-of-the-art 8,000 square foot unit was established under Premier Gary Doer at a cost of $135 million, the most expensive capital health project in Manitoba’s history.
In Manitoba alone, anywhere from 4,000 to 6,000 people are treated for burns each year. Martin Johnson, who is still chairman of the Firefighters Burn Fund, said at the time, that the opening of the unit is the culmination of a promise Gary Doer made him four years before, and 30 years of his own work with the Burn Fund. As I mentioned earlier, the estimated cost of an average burn unit bed in Canada is about $1800 per day. Expenditures of approximately $117 million are incurred for the 5000 patients that are hospitalized every year in Canada. Happily, cost efficiencies can be realized as well, mainly from proper planning of the placement of facilities. The central location of the Winnipeg Burn Ward makes it a cost-effective solution for government, as it is able to service burn victims from not only in Manitoba, but Northeastern Ontario and Nunavut as well.

Ross Tilley Burn Centre – Toronto Ontario

Dr. Ross Tilley was born in 1904 in Bowmanville, Ontario. He attended medical school at the University of Toronto and graduated1929. He trained in surgery in Toronto, New York and Edinburgh and finally opened a private practice at the Toronto Western and The Wellesley hospitals in 1935.
During World War II, Dr. Tilley served in the Royal Canadian Air Force (RCAF) medical service as Principal Medical Officer and spent most of his time at the RCAF Headquarters in the United Kingdom. In 1942, Dr. Tilley transferred to Queen Victoria Hospital in East Grinstead, Sussex where he worked alongside Sir Archibald McIndoe, another surgical pioneer. Due to the increased number of Canadian casualties, a Canadian wing was built. Dr. Tilley was a leader in planning of the wing. In 1944, he was made an Officer of the Order of the British Empire for his leadership in pioneering new techniques for treating burns. He became known as an innovative surgeon, was revered as a humanitarian and a great teacher. In 1982, he was honored with the Order of Canada for his leadership and contributions to Canadian plastic surgery. Dr. Ross Tilley envisioned an adult burn treatment centre in the Toronto area and launched an intensive campaign, led by Drs. W.R.N. Lindsay, Leith Douglas and Tilley himself in the late 1970’s and early 1980’s. Their efforts, combined with the enthusiastic committee of the board of Wellesley Hospital, convinced the Ministry of Health that the concept was valid. Their successful campaign led to the building of the original burn centre in The Wellesley Hospital, which was named in honour of Dr. Ross Tilley for his work and dedication in this field. The Centre officially opened on April 18, 1984.
The centre is Canada’s largest burn unit and the only centre to be verified by the American Burn Association. The Ross Tilley Burn Centre admits patients over 16 years of age, 70% of whom have burns with greater than 20% total body surface area involvement.

Regina’s Fire Fighter Burn Unit
In the 1950’s burn victims at the Regina General Hospital were admitted to a general unit; 3-2 unit. The unit had mostly single rooms with five of these rooms having bath tubs. These rooms were necessary for burn victims who required protective isolation and to receive the required bathing and cleansing. There was no “burn team” at this time as it was not recognized as a specialized area and nurse received no special training nor had any specialized equipment. The small household type bathtubs and narrow doorways proved backbreaking for the nurses and torture for the patients. By the mid 1970’s, a decision was made to provide more adequate care for burn victims.
In 1974 the Saskatchewan Fire Fighters came on the scene and part of the 3-2 unit became officially known as the Burn Unit. Not only did the unit have an official name, but specialized equipment also began to materialize.

The first piece of equipment brought in was a stainless steel therapy bathtub (Hubbard Tank) complete with hydraulic lift. Not only did this equipment make a significant difference for the staff but also to patient. Baths and debridement were now carried out more efficiently and with less painful contact.
A burn team was also beginning to evolve. It was recognized that social workers, dietician and many other support members could make a valuable contribution to burn care in addition to the already skilled doctors and nurses. Specialized training for staff was also recognized as a necessity.
In February 1985, the health minister announced a $670,000 provincial grant to provide a new burn unit at Regina’s General Hospital. Negotiations for the burn unit were truly a cooperative effort between the hospital board and fire fighters committee. On May 23rr 1996 at the official opening the fire fighters presented a cheque for $290,000 to the hospital and pledged their continuing support to their community burn unit for education and equipment needs in the future.
An updated family room was renovated to provide a comfortable environment for the families who would spend endless hours with their loved ones. Couches, rocking chairs, tv’s and other amenities like a kitchen were provided to make the hospital feel more like home.
Since then the Saskatchewan’s Professional Fire Fighters Burn Fund has kept up with changes in both equipment and technology changes. Equipment like the Zieiss operating micorsosope will provide a significant advantage to surgeons delivering microsurgical care to burn victims and its use will benefit patient care for next 2 decades.

Did you know that the burn fund provides continuing education for doctors and nurse in burn care and treatment, along with funding public awareness videos on burn prevention and safety along with sending children to burn camp on a yearly basis…

In 1998 the Regina General Hospital underwent a renovation and expansion, which saw the burn unit move to the sixth floor in the new hospital wing and was renamed “The Fire Fighters Burn Unit”

Dedicated burn wards have evolved since the first ones started up in Vancouver and Victoria all those years ago. Specialized teams of nurses, physicians, specialists, plastic surgeons, dietitians, therapists and psychologists along with newer technologies can now offer personalized treatments for burn victims. Their dedication and the commitment means that survivors now receive the finest medical care possible. Specialized equipments such as therapy bathtubs like the Butterfly Burn tub and Hubbard tank are essential in for the treatment and quick recovery for these patients. These units also require specialties beds, whirlpool and hydraulic lifts, pediatric tub, skin replacements, monitoring devices, exercise equipment and other amenities to help in the burn patients.

Hospital treatment
Healthy skin prevents loss of fluid from the tissues underneath and is also a very effective barrier to infection. These functions are lost when the skin is burned. After severe burns, large quantities of fluid can be lost through the skin. This can have a serious affect on the heart and circulation. This is why people with serious burns need to be closely monitored and often require intravenous fluids to help their circulation.
People with severe burns need to be cared for in specialist burns units where other specialist treatments can be given to help look after them.
Burns may become infected because the skin is less able to protect itself from infection by bacteria. That is why more serious burns need to be dressed and kept clean to help prevent this while the skin heals. If infection is suspected, treatment with antibiotics may be needed.
Most recently, major advances have been realized using the new super-oxidized water technology called Microcyn® to clean and debride the wound while minimizing the pain traditionally experienced by burn victims.