A patient comes into a small town's emergency room with burns. Can the local hospital help, or does this patient need to be rushed to a burn centre?
"Most ERs are very uncomfortable in assessing a burn," explains Dr. Marc Jeschke, director of the Ross Tilley Burn Centre, "and it's very difficult because it's not their expertise."
Yet, he points out, with serious, deep burns, treatment is not just a question of dealing with pain and scarring. "With big burns you're actually fighting for your life."
To help ERs decide what to do, Sunnybrook's prestigious burn centre is offering a new consultation process through a recent initiative called Teleburn.
The initiative is part of the Ontario Telemedicine Network. At least 30 hospitals, some in remote areas, now have cameras in their emergency rooms, able to transmit images of their patients to a monitor at Sunnybrook.
"So we get a phone call," Dr. Jeschke says. "Someone from CritiCall Ontario calls me, and says, 'We have a patient.' Our burn centre has an in-house resident, a fellow and an attending, so the resident will take the call and look at the patient, just like going down to the ER here. Instead of going there physically, he goes to the TV, turns it on and looks at the patient. Then we can say, this patient has to come, or this patient can stay, given the circumstances and the facility they have."
"It enables us to actually plan acute treatment," he adds. "If it's a severe burn, we say, 'Come right away. You need to be at a specialized centre as soon as possible.' Because the earlier they come to us, the better it is."
On the other hand, if the burn is not serious and the patient can be treated near his or her home, the Teleburn consult can potentially dispense with the need for burn patients and their families to travel, avoiding both stress and expense. The Ross Tilley staff also does followup work with patients in rehabilitation and their doctors outside of Toronto, mostly through phone consultations.
Sunnybrook's burn centre already provides advice to emergency room staff faced with burn patients all over the province.
"A burn," says Dr. Jeschke, "is a very complex injury, and a very long injury, and most people are not aware of that."
Yet survival rates for burn patients have increased greatly over the past 20 years. Previously, medical experts added the size of the burn to the patient's age and if they reached a score of 100, they expected only a 50-per-cent rate of survival. Today, thanks to scientific research and breakthroughs in treatment, that survival rate is considered likely with a score of 140, depending on variations. "A 30-year-old with 90-per-cent burns and no inhalation – I would fight for his life," says Dr. Jeschke.
In fact, while still a medical student in Tuebingen, Germany, it was the enormous challenge of treating burn patients that attracted him to specialize in their care. "I was interested in the complexity of the injury," he said, "in the combination of surgery, critical care and reconstruction, but mostly the aspect of the science. Because it's a very underappreciated scientific approach and a very challenging critical entity."
Before coming to Sunnybrook in 2010, Dr. Jeschke worked at the Shriners Hospitals for Children in Galveston, Texas, a centre that sees about 2,000 young burn patients every year.
At Sunnybrook, he says, he has found "a very fertile, enriching environment for academic science. The critical care department here is world-class, and the burn centre is just one aspect of that."
The Ross Tilley Burn Centre's 80 medical professionals treat almost 2,000 patients a year, a number that is on the rise.
This year their work was recognized as among the best in the world when the American Burn Association and the American College of Surgeons awarded the unit its burn centre verification. The process of going through verification is a lengthy and arduous one, says Dr. Jeschke, and has been awarded to only one other hospital outside the United States.
"It means you do everything according to evidence-based medicine," he says, "according to the newest standards of care, and according to publications. You fulfil all criteria in all aspects: in medicine, [intensive care] research, teaching, nursing, pharmacy and so on.
"It's a tremendous honour for Sunnybrook," he adds, "but it's also a tremendous potential for Ontario, in that they have a burn centre that is one of the world-recognized burn centres."