Calgary Firefighters Burn Treatment Centre Annual Report

2013-2014

Calgary Firefighters Burn Treatment Centre

Annual Report

Report Generated by: Johanna Atienza, CHIM, Burn Analyst Trauma Services

Table of Contents ALBERTA HEALTH SERVICES ...... 4 MEDICAL DIRECTOR’S MESSAGE ...... 5 EXECUTIVE SUMMARY 2013/2014 ANNUAL REPORT ...... 6 SPECIAL ACKNOWLEDGEMENTS ...... 7 WHAT WAS THE BURN TEAM UP TO IN 2013/2014?...... 8 Clinical ...... 8 Education ...... 8 Quality Assurance/Improvement ...... 8 Burn Survivor Support ...... 8 Administration ...... 9 Research ...... 9 HOW DO WE COLLECT OUR DATA? ...... 10 What is the Burn Registry? ...... 10 Who qualifies for the Burn Registry? ...... 10 How do you identify a burn patient? ...... 10 What data is collected? ...... 10 Why is this data collected? ...... 10 How good is the quality of the data? ...... 11 STATISTICS AND OUTCOME DATA ...... 12 WHO EXPERIENCED BURN INJURY & NON-BURN RELATED INJURIES IN 2013/2014?...... 13 Admissions ...... 13 Admission Source ...... 17 Admission Status ...... 18 ICU Admissions ...... 18 HOW DID THE PATIENTS GET TO THE FOOTHILLS MEDICAL CENTRE? ...... 21 Mode of Transportation ...... 22 WERE ANY PATIENTS UNDER ANY INFLUENCE OF ALCOHOL OR DRUGS? ...... 23 ETOH ...... 23 Drug Use ...... 24 HOW LONG DID THE PATIENTS STAY IN FMC? ...... 24 Total Hospital Days (LOS) ...... 24 WHAT INJURIES DID THE PATIENTS SUSTAIN? ...... 25 Diagnoses ...... 25 Inhalation Injury ...... 26 3

HOW WERE THE PATIENTS’ INJURIES TREATED? ...... 27 Operative Interventions ...... 27 HOW DID THESE INJURIES OCCUR? ...... 29 Etiology of Injury ...... 29 External Cause of Injury ...... 30 WHERE DID THE INJURIES OCCUR? ...... 31 Place of Occurrence ...... 31 WHERE WERE OUR PATIENTS DISCHARGED TO? ...... 32 Discharge Disposition ...... 32 Mortality ...... 33 Resource Utilization ...... 35 Insurance ...... 37 OUTPATIENT BURN TREATMENT SERVICES ...... 38 APPENDIX A ...... 39 APPENDIX B ...... 42 APPENDIX C ...... 43

ALBERTA HEALTH SERVICES

Vision Our Vision, Mission and Values are core statements describing the overall purpose of our organization, how we operate, and what keeps us moving forward. It clarifies what we do, who we do it for and why we do it.

Our Mission To provide a patient focused, quality health system that is accessible and sustainable for all Albertans.

Our Values Our seven values reflect the essence of our culture and help define what we believe in and what we stand for. They provide us with a common understanding of what’s important, anchor our thinking and provide a framework for our actions.

MEDICAL DIRECTOR’S MESSAGE

2013-2014 was very much a year of “works in progress”. While continuing to strive for excellence in burn care at the Calgary Firefighters’ Burn Treatment Centre, we worked towards several projects that we should be able to announce have come to fruition in next year’s report.

Specifically, we continued to work with the Calgary Firefighters’ Burn Treatment Society on the framework of an agreement that will see the CFBTS fund a University Professorship in Wound Healing and Skin Regeneration, with the over-arching goal of improving quality of life for burn survivors.

Also, plans were drawn-up and funding secured for a much-needed renovation of the shower cart room, while at the same time maximizing use of the former tub room. Immersion hydrotherapy is no longer considered standard of care, and accordingly, the tub room will be re-purposed to create a team office with three work spaces for members of the multi-disciplinary burn team, as well as a private, quiet family room for use of patient families.

Furthermore, plans are afoot through the Canadian Burn Network to secure more funding to support our burn database initiative.

So…stay tuned for the 2014- 2015 Annual Report!

D.A. Nickerson, BSc, MD, FRCSC, FACS Medical Director, Calgary Firefighters’ Burn Treatment Centre

EXECUTIVE SUMMARY 2013/2014 ANNUAL REPORT

The Calgary Firefighters Burn Treatment Centre at the Foothills Medical Centre was established in 1978 and is dedicated to serve those adults that sustain burn injuries from across Southern Alberta, Southwestern Saskatchewan and Southeast British Columbia. The eight-bed unit is designed to provide comprehensive burn care by a specialized team for the acutely burned, non-ventilator dependent adult burn patient.

A multidisciplinary team consisting of plastics surgeons, a burn physiatrist, physician residents, a psychologist, nurses, physiotherapists, occupational therapists and a social worker, provide care to meet the complex needs of burn patients and families. The team meets weekly in burn rounds to discuss the patients’ progress and clinical goals. Upon discharge, rehabilitation continues at the outpatient burn clinic within the Rehabilitation Department at the Foothills Medical Centre.

The Burn Unit has been shaped to what it is today because of the strong partnership with the Calgary Firefighters Burn Treatment Society (CFBTS). Since 1978 firefighters have volunteered countless hours to raise annual funds to support burn treatment, equipment, research, and education. A recognition event was held in November to honor and express our gratitude to the CFBTS for their 35 years of commitment.

During the 2013-2014 year we have cared for an increased number of burn patients including those patients requiring admission to the intensive care unit. To improve outcomes of the critically injured burn patient, this year we established a Burn Care Committee. The membership includes providers from the ICU, burn unit, burn clinic, and infection prevention and control that focus on reviewing and implementing best practices and providing ongoing staff education.

The burn survivor support group had a busy year with the increase in burn patients. Burn survivors trained as peer supporters had an increase in visits, as well as attendance at monthly meetings, social outings, and burn survivor conferences. This group is devoted to ensuring the successful reintegration back to the community after a burn injury.

Thank you to the team and our strong partnerships for their dedication and efforts that promote excellence in burn care.

Tanya Miller BN, RN Unit Manager PCU 30/31 Foothills Medical Centre Alberta Health Services

SPECIAL ACKNOWLEDGEMENTS

Dr. Duncan Nickerson, Medical Director, Plastic Surgery Dr. Vincent Gabriel, Physical Medicine and Burn Rehabilitation Ms. Judy Walker, Manager, U42 & U30/31 Ms. Christine Vis, Manager, Trauma Services and Unit 44 Ms. Tanya Miller, Unit Manager, U30/31 Ms. Lindsay Burnett, Clinical Nurse Educator, U30/31 Ms. Johanna Atienza, Burn Analyst, Trauma Services

WHAT WAS THE BURN TEAM UP TO IN 2013/2014?

Clinical • Provided clinical care to 112 patients whom met the burn registry criteria; this is a 14.7% increase from the previous fiscal year • The length of stay ranged from 1-138 days, with an average of 20.1 days • Physician led outpatient burn clinic every Tuesday and Wednesday morning, with therapy and wound care coverage 7 days a week • Implemented photography of burn wounds in the electronic health record with the objective to document wound status and treatment response

Education

• Weekly multidisciplinary burn rounds that includes educational presentations • Annual burn unit orientation consisted of 3 days of classroom education by the multidisciplinary burn team for nurses and therapists • Six nurses attended the Canada Association of Burn Nurses (CABN) biennial conference held in Montreal, Quebec in September 2013 • Several burn unit staff attended the American Burn Association Annual Meeting in Palm Springs, CA in April 2013 and Boston, MA in March 2014 • Advanced Burn Life Support Certification for 6 Registered Nurses and 2 Physician Residents • Trauma Orientation for unit 44 includes a session on burn care presented by the burn unit clinical nurse educator • Cross training of therapists to support both inpatient and outpatient burns

Quality Assurance/Improvement

Data Management

• Adult Burn Treatment History Form (Appendix A) is now being completed in U30/31, Emergency Department and also the Burn Outpatient Clinic by Plastics Attending and Residents • Networking and brainstorming new initiatives with burn registry users across Canada • Data requests initiated this fiscal year for internal quality purposes only

Burn Survivor Support

• Active burn survivor support group with various social activities and monthly support group meetings • 6 burn survivors and 2 burn unit staff attended the annual World Burn Congress in Providence, RI in October 2014 • Offer peer support through the Phoenix Society SOAR program (Survivors Offering Assistance Recovery). 2 additional survivors were trained as peer supporters and both burn 9

unit staff were trained as peer support coordinators during the World Burn Congress in Rhode Island • There has been an increase in peer support visits with the increase in burn volume • Several burn survivors, family members, and burn unit staff attended the “Spencer Speaks” 10 year anniversary event, which was a motivational speech by a burn survivor

Administration

• The CFBTS continues to raise funds and awareness for burn survivors. On November 21, the Calgary Health Trust held an appreciation breakfast to honor 35 years of the CFBTS’s dedication to the burn unit. In total they have raised $7 million that has been used to fund equipment, staff education, burn survivor support, and research to keep us in the forefront of burn care and innovation. The firefighters ended the event meant to celebrate them by presenting a cheque for $1.35 million to the burn unit. • Calgary is actively involved with the CABN, representing the President of the association and 4 nurses on Executive and Council

Research

• Improving outcomes for burn survivors remains the priority in current research. The burn team at the Calgary Firefighters Burn Treatment Centre collaborates with a multidisciplinary team of experts. The collaboration includes a team of researchers led by burn physiatrist Dr. Vince Gabriel and cell biologist Dr. Jeff Biernaskie with members from the Faculties of Medicine, Nursing, Engineering, and Clinical Psychology. The collaboration also engages burn patients and firefighters. The main focus of the research is to improve the outcomes of split thickness skin grafts through the use of autologous adult stem cells. Progress continues to be made on the project.

HOW DO WE COLLECT OUR DATA?

What is the Burn Registry? The Burn Registry is an electronic database system based on the American Burn Association NTRACS Version 5 Data Dictionary. The registry contains information of all burn patients admitted to the Foothills Medical Centre. The information is collected and analyzed for internal reporting and will eventually be used for future research purposes.

Who qualifies for the Burn Registry? To qualify for the Burn Registry, a patient must be admitted as an inpatient to the Foothills Medical Centre with a diagnosis of a burn injury or a burn related injury. Patients who have sustained inhalation injuries, with or without burn injuries, are also qualified. Other non-burn injuries are also captured in the registry, by virtue of having a diagnosis that requires the specialized care available in the burn treatment centre, including the following: • TENS (toxic epidermal necrolysis) • SJS (Steven Johnson Syndrome) • Purpura fulminans • Friction/Degloving injuries • Acute soft tissue infections (i.e. Necrotizing Fasciitis, Fournier’s Gangrene, etc.) • IV infiltration • Calciphylaxis, and • Other qualifying non-burn injuries primarily treated by the burns/plastics service

Patients who are readmitted – planned or unplanned – are also captured in the Burn Registry.

How do you identify a burn patient? A burn patient is a patient who has sustained an injury caused by fire/flame, scalding, contact with hot object, electrical burns, chemicals, radiation, friction and other mechanisms such as hot steam or gas. Burn injuries are determined by size and severity using the Lund and Browder chart. The size of a burn is measured as a percentage of the total body surface area (TBSA). Assessment of the depth of a burn injury is dependent on the temperature of exposure and the duration of exposure. Burns are classified as epidermal (superficial), partial thickness (superficial partial thickness or deep partial thickness), and full thickness injuries. Indeterminate burn injuries are burns that are yet to be determined to be deep partial thickness or full thickness burns. Indeterminate burns are continuously assessed during the patient’s admission to determine its depth and course of care.

What data is collected? Data collected includes patient demographics, admission information, burn injury data including the mechanism and circumstances of injury, ICD-9 diagnosis and intervention, Lund & Browder chart, complications and hospital outcomes.

Why is this data collected? The information collected for the Burn Registry is retrieved for analysis and internal quality improvement initiatives within the unit and Trauma services, solely for the purpose of providing the highest standard of care of the patient.

How good is the quality of the data? Reports and queries generated from the Burn Registry and Data Integration, Measurement and Reporting (DIMR) are examined by the analyst to identify any discrepancies in the data. Any errors are corrected in the registry to ensure data quality and consistency. Burn Admission data is dependent on the integrity of the information captured on the Burn Admission Form and the patient’s health record. The role of the burn data analyst is to ensure that the quality of burn data is accurate and consistency and reflects ABA reporting.

Calgary Firefighter’s Burn Treatment Unit Foothills Medical Centre

STATISTICS AND OUTCOME DATA 2013- 2014

WHO EXPERIENCED BURN INJURY & NON-BURN RELATED INJURIES IN 2013/2014?

Admissions Admissions include all patients who have experienced burn injuries or non-burn related injuries admitted at the Foothills Medical Centre (FMC) from April 1, 2013 to March 31, 2014. The following chart presents the number of patients who were qualified for the burn registry by month.

A total number of 112 patients were qualified for the burn registry this fiscal year.

Burn Admissions by Month

2012-2013 2013-2014 14

12 12 11 11 10 10 9 9 9 8 8 7 7 7 7 7 6 6 6 6 6 5 4 4 3 3 3 3 2 2

0 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

*Includes 2 smoke inhalation patients.

There are a total number of 86 burn patients admitted to the Foothills Medical Centre- A 14.7% increase from the previous fiscal year. 14

Non- Burn Admissions by Month

2012-2013 2013-2014 6

5 5

4 4 4 4

3 3 3 3

1 1 1 1 1 1 1 1 1 1 1 1 1 1

0 0 0 0 0 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

There are a total number of 26 non-burn patients admitted to the Foothills Medical Centre- a 50% increase from the previous fiscal year.

By Gender The following table shows the number of admissions by gender. Males outnumber females in burn and non burn cases by approximately 2:1.

Admissions by Gender

Burns Non-burns 100 86 80 61 60

40 25 26 17 20 9

0 Male Female Total

Age Distribution by Gender Age Distribution by Gender 25

The average age admitted to Foothills Medical Centre is 41.6 years old. The largest age groups are within the 21-30 and 41-50 age range.

By Condition There are specific non-burn diagnoses that are captured into the burn registry. These conditions include specified diagnoses determined by the ABA data dictionary (i.e. Toxic epidermal necrolysis, Steven Johnson syndrome, Purpura fulminans, Friction/ Degloving injuries, acute soft tissue infections such as Necrotizing fasciitis and Fournier’s gangrene, Calciphylaxis) as well as other specified conditions treated by the Plastic Surgery service. Admissions for frostbite injuries and scar conditions are also captured in the registry.

Non-Burn Admissions by Condition Post Operative Wound Failed Graft, 1, 4% Infection, 1, 4%

Scar Management, 5, 19% Necrotizing fasciitis, 4, 15%

Friction burn , 5, 19% Frostbite, 9, 35%

Degloving Injury, 1, 4%

There were no admissions for Fournier’s Gangrene and Steven Johnson Syndrome this fiscal year. Admissions for scar management include burn and non-burn scar conditions.

Number of Readmissions There were a total of 5 readmissions captured in this reporting fiscal year.

Reason for Readmission Planned Unplanned Scar Management 3 0 Failed Graft 0 1 Post operative infection 0 1 TOTAL 3 2

Admission Source This refers to where the patient came from prior to arriving to the Foothills Medical Centre. Internal sources include patients who have been referred from another service or outpatient clinic within the hospital. External sources include patients who have been transferred from another facility after being seen in an emergency department. Unreferred sources include patients who arrived at the emergency department via private vehicle or ambulance from the scene of injury.

Admission Source: Burns

2012-2013 2013-2014

100 86 90 75 80 70 60 50 28 40 30 33 23 23 24 30 20 10 0 Internal External Unreferred Total

Admission Source: Non- Burns

2012-2013 2013-2014

30 26

13 15 11 12 10 7 3 3 3 5

0 Internal External Unreferred Total

Admission Status The following table presents the admission status of the patient upon arrival to the Foothills Medical Centre (FMC). Only one admission status is possible per patient admission.

Initial Admission 2012-2013 2013-2014 Burn Injury Related 75 86 Not burn injury related 12 20 Readmission planned burns 0 0 non-burns 1 3 unplanned burns 0 0 non-burns 0 2 Reconstructive surgery admission 0 1 TOTAL 88 112

ICU Admissions ICU Admissions: Burns 200 180 160 140 120 100 80 60 40 20 0 ICU Admissions ICU Days Ventilator Days 2012-2013 11 95 77 2013-2014 18 183 156

Burns: Average ICU days: 10.2 days ICU days range: 1-30

ICU Admissions: Non-Burns 25

0 ICU Admissions ICU Days Ventilator Days 2012-2013 6 22 18 2013-2014 2 13 9

Non-burns:

Average ICU days: 8.7 days

ICU days range: 1-19

Admissions by Occupation Occupation Burns Non- Burns Architecture/ Engineering - - Arts/ Design/ Entertainment/ Sports/ Media 1 1 Building/ Ground/ Cleaning/ Maintenance 1 - Business/ Financial - - Community/ Social Services - - Computer/ Mathematics 1 - Construction/ Extraction 13 1 Education/ Training/ Library - - Farm/ Fish/ Forestry 2 1 Food Prep/ Service 5 1 Healthcare Support 1 1 Health Practitioners/ Technician - - Installation/ Maintenance/ Repair 6 - Legal - - Life/ Physical / Social Sciences 1 - Management 1 - Military Specific - - Oil & Gas Industry 5 1 Personal Care & Service 2 - Production 1 1 Protective Services 2 - Sales and Related 6 1 Student 4 2 Transportation/ Material Moving 1 1 Unemployed (Disabled, Retired, Below School Age) 15 5 Other 2 1 Unknown 16 9 TOTAL 86 26

HOW DID THE PATIENTS GET TO THE FOOTHILLS MEDICAL CENTRE?

Hospital Transfers Patients who are transferred to the Foothills Medical Centre are referred by another hospital either within the province or outside of the province.

REFERRING HOSPITAL and Fixed-wing Ground Helicopter Private/Public Police/Fire MODE OF TRANSPORT Ambulance Ambulance Ambulance Vehicle/Walk-in Dept. No Referring Hospital 40 0 36 2 WITHIN ALBERTA Airdrie Regional Health Centre Banff Mineral Springs Hospital Brooks Health Centre 3 1 Cardston Health Centre 1 Chinook Regional Hospital 4 Cochrane Urgent Care Centre Fort Macleod Health Centre High River General Hospital Innisfail Health Centre 3 Medicine Hat Regional Hospital Oilfields General Hospital Olds Health Care Centre Peter Lougheed Centre 6 1 Pincher Creek Health Centre Red Deer Regional Centre 1 Rocky Mountain House Health Centre Rockyview General Hospital 3 Sheldon M. Chumir Health 1 1 Centre South Calgary Urgent Care 1 Centre Strathmore District Health Services Taber and District Health Centre 1 University of Alberta Hospital 1 Vulcan Community Health Centre OUT OF PROVINCE British Columbia East Kootenay Regional Hospital 1 Elk Valley Hospital 2 Invermere and District Hospital 1 Queen Victoria Hospital 1 Sparwood Health Centre 1 GRAND TOTAL 66 4 39 2

Mode of Transportation Emergency transport to the Foothills Medical Centre can arrive via ‘ground’ or ‘air’. In cases where multiple modes of transportation were used, the last mode used was documented.

Mode of Transportation 60

0 Fixed wing Ground Helicopter Private/Walk-in Police/Fire Dept. Burns 1 53 4 27 1 Non-burns 0 13 0 12 1

WERE ANY PATIENTS UNDER ANY INFLUENCE OF ALCOHOL OR DRUGS?

ETOH The following chart presents how many patients were tested positive for ETOH use upon admission.

ETOH Use by Month

Burns Non-Burns 6 5

5 4 4 3 3 3 3 3 2 2 2 2 2 2

# of of # patients 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

The chart below presents the number of patients that exceeded the Alberta alcohol legal limit upon admission.

*The Alberta limit for ETOH consumption is 80 mg/dL (17 mmol/L).

# of Patients > Alberta ETOH Legal Limit

Burns Non-burns 3

1 # of of # patients

*Based on: https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=hw3564&#hw3588 24

Drug Use This field indicates if any drug use may have occurred prior to the injury. Laboratory results were obtained from Sunrise Clinical Manager and patient chart documentation. Burns Non burns How many tested positive? 2 1

HOW LONG DID THE PATIENTS STAY IN FMC?

Total Hospital Days (LOS)

BURNS NON BURNS TOTAL TOTAL GRAND TOTAL Total Hospital Days 1684 Total Hospital Days 570 2254 Average Length of Stay 19.6 Average Length of Stay 21.9 20.1 Range 1-138 Range 1-87 1-138

WHAT INJURIES DID THE PATIENTS SUSTAIN?

Diagnoses The depth of a burn injury declares itself over time. The following table presents the final diagnoses captured within the patient’s health record. The burn injuries are classified as superficial burns, superficial partial/deep partial thickness burns and full thickness burns. Burn injuries classified in the ‘Other’ category includes injuries where the location of the injury does not further determine the depth of the injury.

By Depth & Location The following table presents the depth and location of a burn injury based on the Most Responsible Diagnosis (MRDx). MRDx is the diagnosis or condition that can be described as being most responsible for the patient’s stay in hospital. Burn depth is captured from the deepest to superficial burn injuries. Partial Thickness Superficial Full Thickness Other TOTAL (Superficial/ Deep) Eye & Adnexa - - - 1 1 (940.*) Face, Head, Neck 18 2 7 9 - (941.*) Trunk - - 4 6 10 (942.*) Upper limb - - 9 7 16 (943.*) Wrists & Hands - - 6 6 12 (944.*) Lower limbs - - 12 15 27 (945.*) Internal organs - - - 2 2 (947.*) TOTAL 2 38 43 2 86

Note: Each patient may have one or more burn depth and location per admission. Not presented in the above table. 26

By TBSA Burn Diagnoses by Total Body Surface Area (TBSA)

2012-2013 2013-2014 60 54

20 15

10 4 1 0 0 1 0 0 0 0 <10% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79% 80-89% >90

Note: The above table does not include patients with smoke inhalation, eye burn and superficial burn injuries.

The average total body surface area (TBSA) this fiscal year is . 10.9%

Inhalation Injury Patients who sustained an inhalation injury with or without burn injury captured in the burn registry.

Inhalation Injury # of Burn Patients 2012-2013 2013-2014 Yes with burn injury 5 10 without burn injury 0 2 No 70 74 TOTAL 75 86

HOW WERE THE PATIENTS’ INJURIES TREATED?

Operative Interventions

INTERVENTIONS PERFORMED IN BURN PATIENTS Total # Patients with OR Procedures 62 Total # of OR visits 128 Intervention Codes # of occurrence 31.1* Temporary tracheostomy 1 39.4* Revision of vascular procedure 1 46.7* Other repair of intestine 1 54.1* Laparotomy 2 54.2* Diagnostic procedures of abdominal region 7 79.3* Open reduction of fracture with internal fixation 4 79.6* Debridement of open fracture site 1 83.1* Division of muscle, tendon and fascia 2 84.1* Amputation of lower limb 4 86.0* Incision of skin and subcutaneous tissue 7 86.2* Excision or destruction of lesion or tissue of skin and subcutaneous tissue 21 86.6* Free skin graft 96 86.7* Pedicle grafts or flaps 5 86.9* Other operations on skin and subcutaneous skin tissue 86 93.1* Physical therapy exercises 1 93.5* Other immobilization, pressure and attention to wound 15 TOTAL 254

There were 62 burn related visits to the OR this fiscal year; however, each visit may have had more than one procedure.

INTERVENTIONS PERFORMED IN NON BURN PATIENTS Total # of OR visits 20 Total # of OR Procedures 38 Intervention Codes # of occurrence 04.1* Diagnostic procedures on peripheral nervous system 1 46.0* Exteriorization of intestine 1 79.8* Open reduction of dislocation 1 84.0* Amputation of upper limb 3 84.1* Amputation of lower limb 3 85.3* Reduction mammoplasty and subcutaneous mammectomy 1 86.0* Incision of skin and subcutaneous tissue 1 86.2* Excision or destruction of lesion or tissue of skin and subcutaneous tissue 16 86.6* Free skin graft 14 86.7* Pedicle grafts or flaps 4 86.8* Other repair and reconstruction of skin and subcutaneous tissue 4 86.9* Other operations on skin and subcutaneous tissue 11 93.5* Other immobilization, pressure and attention to wound 6 96.0* Nonoperative intubation of gastrointestinal and respiratory tracts 1 TOTAL 67

There were 20 non-burn related visits to the OR this fiscal year; however, each visit may have had more than one procedure.

HOW DID THESE INJURIES OCCUR?

Etiology of Injury The mechanism of injury is divided into the following categories: fire/flame, scald, contact with hot object, chemical, electrical injury, skin disease, other burn and other non-burn injuries. Skin disease refers to any skin related condition which includes Necrotizing Fasciitis, Fournier’s Gangrene and Steven Johnson syndrome. ‘Other burn’ consists of other forms of burn injuries not classified elsewhere including injuries with multiple etiologies. ‘Other non-burn’ includes friction burns and degloving injuries as classified by the ABA.

Etiology of Injury for Burns

Electrical , 2, 2%

Chemical, 2, 3% Flame/Fire, 57, 66%

Contact with Hot Object, 8, 9%

Scald, 17, 20%

Etiology of Injury for Non- Burns

Flame/Fire, 2, Scald, 3, 11% 8%

Skin disease, 6, 23%

Other non- burn, 13, 50%

Other burn, 2, 8%

External Cause of Injury The external causes of injury are classified by E-codes based from the ICD-9 classification system. The E-codes indicate the environmental events, circumstances and conditions of the patient’s injury.

External Cause Code BURN NON BURN 2012- 2013 2013-2014 2012- 2013 2013-2014 E811* Motor vehicle traffic accident involving re-entrant 1 0 0 0 collision with another vehicle E812* Other motor vehicle traffic accident involving 0 2 1 1 collision with motor vehicle E813* Motor vehicle traffic accident involving collision 0 0 0 1 with other vehicle E814* Motor vehicle traffic accident involving collision 0 0 0 1 with pedestrian E816 Motor vehicle traffic accident due to loss of control, 0 0 1 0 without collision on the highway E817* Noncollision motor vehicle traffic accident while 0 0 1 0 boarding or alighting E818 Other noncollision motor vehicle traffic accident 2 0 0 0 E825 Other motor vehicle nontraffic accident of other and 1 3 0 0 unspecified nature E819* Motor vehicle traffic accident of unspecified nature 0 0 0 1 E820* Nontraffic accident involving motor-driven snow 0 0 0 1 vehicle E829* Other road vehicle accidents 1 0 0 0 E878* Surgical operation and other surgical procedures 1 0 0 0 as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at the time of operation E890* Conflagration in private dwelling 4 3 0 0 E891* Conflagration in other and unspecified building or 2 1 0 0 structure E892 Conflagration not in building or structure 2 1 0 E893* Accident caused by ignition of clothing 11 13 0 1 E894 Ignition of highly flammable material 10 10 0 1 E895 Accident caused by controlled fire in private 3 1 0 0 dwelling E897 Accident caused by controlled fire not in building or 4 5 0 0 structure E898* Accident caused by other specified fire and flames 3 4 0 E901* Excessive cold 0 0 4 9 E919* Accident caused by machinery 3 0 0 1 E921* Accident caused by explosion of pressure vessel 0 1 0 E923* Accident caused by explosive material 4 14 0 0 E924* Accident caused by hot substance or object, 21 26 0 3 caustic or corrosive material and steam E925* Accident caused by electric current 2 2 0 0 E944* Water, mineral, uric acid metabolism drugs 0 0 1 0 N/A 0 0 5 0 TOTAL 75 86 13 26

WHERE DID THE INJURIES OCCUR?

Place of Occurrence It is important to review a breakdown of where burn and non-burn injuries occurred as it gives an area of where an increase of awareness for prevention is needed.

Place of Occurrence: Burns

2012-2013 2013-2014

60 54

46 45

13 15 7 6 6 4 4 4 4 3 2 3 3 0 1 0 0 0 1 0 Home Farm Quarry or Industrial Place for Street and Public Residential Other Unknown Mine Places and Recreation Highway Building Institution Premises or Sport

Place of Occurrence: Non- Burns

2012-2013 2013-2014 15 12

10 8 6 5 4 3 2 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 Home Farm Quarry or Industrial Place for Street and Public Residential Other Unknown Mine Places and Recreation Highway Building Institution Premises or Sport

WHERE WERE OUR PATIENTS DISCHARGED TO?

Discharge Disposition Discharge Disposition: Burns

80 71 2012-2013 2013-2014

70 60

20 3 7 10 0 1 1 5 0 0 1 1 0 Home Home with home Jail or Prison Rehabilitation Transfer to Transfer to health Facility another hospital another service

Discharge Disposition: Non- Burns

2012-2013 2013-2014 25 21 20

15 12

5 1 1 1 1 0 0 0 0 0 0 0 0 0 Home Home with Jail or Prison Nursing Home Rehabilitation Transfer to Transfer to home health Facility another another service hospital

Mortality The mortality data includes all burn patients admitted in the emergency department, outpatient clinic, ICU and U30/31. All non burn patient mortality includes patients who have deceased during their stay under the Plastics Service only.

Mortality by Gender: Burns Male Female

6 4 4 3 2 2 1

0 2012-2013 2013-2014

Mortality by Gender: Non- Burns Male Female

4 2 2 1 0 0 0 2012-2013 2013-2014

Etiology BURN MORTALITY BY ETIOLOGY 2012-2013 2013-2014 Etiology Fire/ Flame 6 4 Total # of deaths 6 4 Total # of patients 75 86 Mortality Rate 8% 4.6%

NON- BURN MORTALITY BY ETIOLOGY 2012-2013 2013-2014 Etiology Other non-burn 1 0 Skin Disease 1 1 Total # of deaths 2 1 Total # of patients 13 26 Mortality Rate 15.4% 3.8%

Cause of Death CAUSE OF DEATH Burn Non- Burn Cause 2012-2013 2013-2014 2012-2013 2013-2014 Burn Shock - 1 - - Cardiovascular - - - - Gastrointestinal - - - - Multisystem Organ Failure 4 2 1 - Neurologic - - - - Pulmonary 1 - - - Renal - - - - Sepsis - 1 1 1 Other 1 - - - Total # of Deaths 6 4 2 1

Resource Utilization Any resource utilized by the patient during his or her stay is documented from a list of common resources. These resources may be completed in the operating room or ICU or at bedside.

BURNS Resource 2012-2013 2013-2014 Advance Directives 1 1 Allograft (Homograft) skin - 2 Anabolic Agent - - Arterial catheter 1 10 Biological wound covering - - Central Venous Catheter 3 12 Dialysis- hemodialysis 1 - Dialysis- peritoneal - - Escharotomies 2 5 Endotracheal intubation 11 19 Enteral feeding tube - 8 Fasciotomies - 3 IGIV - - Integra - - Nitric Oxide - - PA/ Swan Ganz Catheter - - Paracentesis 1 - Plasma exchange/ exchange transfusion - - Total Parenteral Nutrition - - Tracheostomy - 3 Transfusion of blood 11 16 VDR Ventilation - - Xenograft (heterograft) skin - - TOTAL 31 79

A burn patient may have one or more resource utilized during his or her stay.

NON- BURNS Resource 2012-2013 2013-2014 Advance Directives - - Allograft (Homograft) skin 1 - Anabolic Agent - - Arterial catheter - 1 Biological wound covering - - Central Venous Catheter 1 4 Dialysis- hemodialysis - - Dialysis- peritoneal - - Escharotomies - - Endotracheal intubation 4 2 Enteral feeding tube - - Fasciotomies - - IGIV - - Integra - - Nitric Oxide - - PA/ Swan Ganz Catheter - - Paracentesis - - Plasma exchange/ exchange transfusion - - Total Parenteral Nutrition - - Tracheostomy - - Transfusion of blood 3 5 VDR Ventilation - - Xenograft (heterograft) skin - - TOTAL 9 12

A non- burn patient may have one or more resource utilized during his or her stay.

Insurance The primary source responsible for payment of service(s) provided to the patient admitted to the Foothills Medical Centre.

BURNS Insurance # of burn patients Provincial Healthcare Alberta 69 British Columbia 3 Ontario 3 Saskatchewan 1 WCB 10 TOTAL 86

NON BURNS Insurance # of non burn patients Provincial Healthcare Alberta 23 British Columbia 1 WCB 2 TOTAL 26

OUTPATIENT BURN TREATMENT SERVICES

The Outpatient Burn Treatment Clinic provides treatment and rehabilitation of burn injuries including surgical grafting, graft revisions and major plastic repairs. Burn clinic patients are currently not captured in the burn registry.

The following is a brief summary of the burn clinic from the 2013- 2014 fiscal year:

• There were a total of 1417 burn clinic visits which includes readmissions. • A total number of 363 patients were seen at the burn clinic. • Only 4 patients were reported to be admitted from the clinic.

OUTPATIENT BURN CLINIC Age Range TOTAL

Gender TOTAL Male 842 Female 575 TOTAL 1417

APPENDIX A

APPENDIX B

APPENDIX C

Burn Rounds Schedule 2013- 2014