Annals of the MBC - vol. 3 - n' 3 -
IN ESTABLISHING A BURN CARE FACILITY
Reda Mabrouk AW.
Burns and Plastic Surgery Unit, Helipolis, Cairo, Egypt
SUMMARY. The author describes the
three phases of his experience in 25 years of managing burn patients in Military Service
and National Health Organization Hospitals, i.e. the early sixties, the late sixties, and
the early seventies. In this last period it was decided to build a Military Burns Centre
which would also accept civilians and deal with mass casualties. An account is given of
the basic criteria followed in the creation of the Centre, as well as a description of its
Returning from the United Kingdom in 1961
after training with the late Mr A.B. Wallace, I took the responsibility of treating burn
injuries together with plastic surgery problems, both in the Egyptian Armed Forces and in
some civilian hospitals run by the National Health Organization. The study of this
experience of more than twenty-five years may be discussed as three periods in the
development of burn care facilities:
1. The early sixties: during this period
we had to deal with sporadic cases caused by what may be considered as civilian causes.
The management required:
- study of the aetiology, incidence and causes of burn
- personnel training: medical and nursing staff were chosen
from junior staff and had to be honest, energetic, enthusiastic and interested.
Training was encouraged by adopting the
team-work scheme, by giving the trainees the chance to practise plastic reconstructive
surgery as well, and by giving them fulfilled promises for scholarships.
A small Burns Unit was established as a part of a general plastic reconstructive surgery
department. Facilities for work included a separate dressing-room, but the same wards and
the same operating theatre.
A standard treatment programme was agreed upon and adopted for each case.
2. The late sixties: starting from June
1967 a separate Burns Unit was established with:
- four intensive care beds
- four cubicles each of two beds.
Precautions were taken to guard against
infection and cross-infection and to regulate the temperature by separate air-conditioning
units. Facilities also included:
- a small laboratory
- two dressing-rooms: one for major injuries and the other
for minor ones
- a separate theatre for grafting operations.
- Homografts were supplied by volunteers when needed. The
medical staff shared their responsibilities in the management of burns with
responsibilities in plastic reconstructive surgery in a rotatory scheme.
According to military orders injured
soldiers must not leave hospital before complete cure. Patients were thus transferred to
plastic surgery wards during the healing stage.
3. The early and mid-seventies: the mass
casualties dealt with in June 1967 together with the good results achieved from our
management helped us to persuade the authorities to let us have our own Military Burns
The design and study of the Centre took more than two years. The basis of our study was:
- statistical data of aetiology of the burn cases admitted to
the military hospitals during the previous fifteen years. The incidence of burns admitted
to hospitals in the Cairo area was also considered: 13,765 cases were admitted during
- detailed study of different Burns Centres and Units in
other countries. The senior staff were granted scholarships to visit units in the UK,
France, Sweden, Denmark, Belgium, Jugoslavia and the USA;
- social and economical study of the Armed Forces and of our
Purpose of the Centre
- Formation of team that can acquire knowledge and experience
in the treatment of burns.
- Treatment of military personnels, their dependents and
- Education of medical and nursing professions.
- Study of prevention of burns for public information.
- Research work for improvement of management and for
- Fulfilment of the Armed Forces orders in hospitalization of
soldiers during convalescence and in preparedness to deal with mass casualties. This means
having more beds than the internationally accepted numbers.
Disadvantages of Burns Centres
1. Economic problems:
- High cost of establishing a highly sophisticated and
- High expenses of running and maintenance.
2. High possibility of sepsis in the event
of inadequacy of precautions and with the admission of new patients with old septic burns.
3. Psychological Trauma:
- for the patient, who is isolated and allowed only strict
- for doctors, whose work is more or less monotonous. This
could be overcome by their periodical sharing in plastic reconstructive surgery and by
being given facilities for research work.
Principles in Construction and Running the Centre
- The building is isolated, but attached to and dependent on
a general hospital for food supply, laundry, main laboratory and other medical
specialities, such as physiotherapy, orthopaedic surgery, ophthalmology, nephrology, etc.
- The administration should be independent, with a separate
budget. An experimental 6-month period of organization and administration is advised
before establishing the administration rules. It is advisable to have a plastic surgeon as
- The Centre should be a one-floor building, with plenty of
storage places. Disposal of dirty dressing should be by a chute-system.
- The out-patient department should be separate from the
Centre, and facilities for follow-up and reception of old burns can be a part of the
plastic surgery out-patient section.
- The rule is to have one bed per 100,000 inhabitants, with a
maximum of 20 beds. There is no objection to having more beds for convalescents in order
to fulfil military orders. It was therefore agreed to have 4 beds for resuscitation, 10
for intensive care and the rest for convalescent patients (36 beds).
- Air Control: the centre should be air locked. Temperature:
for resuscitation and ICU, 24-30 Humidity: should be reduced to the accepted %. Air
Pressure: highest in resuscitation, ICU and operating theatres. Not so high In isolation
rooms; convalescent wards are not necessarily pressurized but should be air-conditioned.
The Reception Room should be high-pressure with access to Resuscitation.
- The Centre should be equipped with a mobile X-ray
Medic,al Staff, for 50 beds:
2 Plastic surgeons
1 Part-time bacteriologist and physician
Nursing Staff (8-hour shifts):
6-8 for each patient in Resuscitation and ICU
Ideally there should be two operating theatres and 3
dressing-rooms with bathing facilities in two of them.
There should be a separate entrance for personnel, another
for supplies, besides that for the patients' reception room and the visitors' entrance.
Communication with patients: A glass corridor must be built
around the isolation areas for visitors, students and trainees. Communication with the
responsible nurse can be by intercom. Windows are glass-panelled with double glass and
venetian blinds in between.
Size of rooms: Resuscitation 5 x 5 m, Isolation rooms 4 x 4
m, other rooms large enough to take the beds.
Storage of autografts is in an ordinary refrigerator. If
finance allows, a skin bank may be added to the facilities.
6 Nurses for 12 patients in isolation cubicles
3 Nurses for 12 patients in convalescent wards
During our study and construction of the
centre, all the medical staff were granted scholarships abroad for 3-12 months to complete
their training and to visit various Burns Centres and Units. Two senior nurses were each
given the chance to train in France for a year.
Construction of the centre took about 3 years. All the above requirements were fulfilled.
A second floor was added to the bulding to accommodate convalescent patients. The Centre
is equipped with four fluidized beds and a skin bank.
RÉSUMÉ. L'Ameur décrit
les trois phases de ses 25 ans d'expérience dans la gestion des patients brûlés chez
les Hôpitaux du Service Militaire et du Service National de la Santé, c'est-à-dire
pendant les premières années Soixante, les dernières années Soixante, et les
premières années Soixante-dix. Dans cette dernière période, on a décidé de
construire un Centre Militaire des Brûlés qui en outre accepterait les patients civils
et pourrait être utilisé en cas de brûlures en masse. Les critères de base suivis
pendant la construction du Centre sont définis, et il y a une description du
fonctionnement actuel du Centre.
- Reda Mabrouk AW.: The causes and incidence of bums
and factors in their prevention and management in the UAR. In: Wallace A.B. (Ed.):
"Research in bums", E. & S. Livingstone, Edinburgh, 1966.
- Feller 1, Crane K.H.: Planning and designing a burn
care facility. Ann Arbor, Michigan, Institute for Burn Medicine, 1971.
- Reda Mabrouk AW.: Bum injuries in Egypt. Incidence
and management. Annals of the Mediterranean Bums Club, 1: 2 1-261988.