Burn injuries are a major health issue in India, with thousands of people affected each year. According to the World Health Organization (WHO), over 1 million people are severely or moderately burned annually, making it one of the leading causes of injury-related deaths. The impact of burns on individuals and their families can be severe, leading to long-term physical and emotional challenges. As a doctor, opening a specialized burn care facility can play a crucial role in improving patient care, providing timely treatment, and supporting the community.
Having a dedicated burn care facility is essential for providing comprehensive treatment, from immediate care to recovery and rehabilitation. In India, where burns are often caused by household accidents, workplace hazards, and environmental factors, having access to specialized care can help lower death rates and improve recovery outcomes.
Setting up a burn care facility in India requires thoughtful planning and adherence to medical standards. It involves not only providing the right medical expertise but also ensuring you have the right infrastructure, equipment, and support systems for optimal patient care. The following guidelines will help you, as a doctor, understand the minimum standards needed to establish a burn care facility. By following these standards, your facility will be well-equipped to offer safe, high-quality care to patients.
In this article, we will walk you through the key aspects of establishing a burn care center, including the services you need to offer, the human resources required, necessary equipment, and support services. These guidelines will help you set up a burn care facility that can manage burn cases effectively and compassionately.
Minimum Standards for Establishing a Burn Care Facility in India
Definition
Basic Burn Care Facility: As a doctor planning to open a burn care facility, your basic burn care facility should be equipped to handle patients with burns affecting up to 25% TBSA (Total Body Surface Area) in adults and up to 15% TBSA in children, provided there are no comorbid conditions. The care is primarily general and supportive, designed to treat burn injuries and prevent complications.
Advanced Burn Unit: For more severe burns requiring ICU-level care and intensive management, your advanced burn unit should cater to all burn patients, regardless of severity, and should have a minimum of two ICU beds.
Scope of Services Provided
For both basic and advanced burn care facilities, the following services should be available:
- General Purpose Care: Provide basic burn treatment, wound care, and follow-up consultations.
- Single Specialty Care: Focus exclusively on burn care, treating patients with burn injuries.
- Multispecialty Care: Ensure access to additional specialties like plastic surgery, physiotherapy, and psychological support as needed.
- Superspecialty Care: Available in advanced burn units for complex cases requiring specialized interventions, such as reconstructive surgery or advanced physiotherapy.
Human Resources
Your burn care facility will require qualified professionals across various domains to ensure comprehensive care:
- Doctors:
- Anaesthetist: You will need a dedicated anaesthetist for managing pain and sedation during burn treatments and surgeries.
- Surgeon: You should have a MS General Surgeon (1) for general surgical care and a Plastic Surgeon (MCh/DNB) for advanced burn treatments and reconstructive surgeries.
- Consultants: Depending on the complexity, part-time or visiting consultants may be needed.
- Anaesthetist: You will need a dedicated anaesthetist for managing pain and sedation during burn treatments and surgeries.
- Nurses:
- Nursing Head: A Nursing Head will oversee the nursing staff and their roles.
- General Nurses: At least 2 staff nurses are required to provide round-the-clock care on a shared basis.
- Trained ICU/OT Nurses: For patients in critical condition or those undergoing surgeries, specialized nurses are essential.
- Nursing Head: A Nursing Head will oversee the nursing staff and their roles.
- Pharmacists: One pharmacist is required to manage medication and drugs, both on-site and as part of your hospital network.
- Para-Medical Staff:
- Lab Technicians: For on-site diagnostics (if your facility operates its own lab).
- X-Ray Technicians: Required for diagnosing and managing burn-related injuries.
- OT Technicians: To assist during surgeries, especially in the major OT.
- ECG Technicians: Desirable for cardiac monitoring, although not mandatory.
- Dieticians and Physiotherapists: Especially important in advanced burn units for nutritional management and rehabilitation.
- Psychologists and Medicosocial Workers: Required in advanced care settings to address the psychological impact of burns and facilitate patient rehabilitation.
- Lab Technicians: For on-site diagnostics (if your facility operates its own lab).
- Support Staff:
- Reception & Billing Staff: These staff members are required to manage patient registrations and payments.
- MRD Office: To manage medical records.
- Security: Mandatory to ensure patient and staff safety.
- Transport Facility: An ambulance and driver should be available either in-house or outsourced for emergency transport.
- Reception & Billing Staff: These staff members are required to manage patient registrations and payments.
- Rapid Response Team: An emergency team, which is desirable for all burn care facilities but mandatory for advanced burn units to handle sudden complications.
Equipment needed for Burn Care Facility
Your burn care facility must be equipped with the necessary therapeutic and diagnostic tools for effective burn management.
- Therapeutic Equipment:
- Vital Parameter Monitors: At least 2 monitors to track patient vitals.
- Skin Graft Mesher: For performing skin graft surgeries.
- Humby’s Knife: Used for eschar removal and wound debridement.
- Portable Light: For proper illumination during procedures.
- Ultrasonic Therapy Machines: For pain relief and wound healing.
- Rehabilitation Equipment: Items like overhead pulleys, shoulder wheels, quadriceps tables, and hand grippers to assist in rehabilitation post-burn recovery.
- Paraffin Box: For applying paraffin wax treatments to aid skin recovery.
- Vital Parameter Monitors: At least 2 monitors to track patient vitals.
- Diagnostic Equipment:
- Sterilization Equipment: Required for infection control and maintaining hygiene.
- Drugs, Medical Devices, and Consumables: A regular stock of essential drugs such as IV fluids, antibiotics, sedatives, analgesics, antiseptic creams, and plasma expanders must be maintained. These should be stored in compliance with hospital protocols.
- List of Disposables: Ensure that all necessary disposables such as sterile gloves, syringes, and dressings are available.
- Sterilization Equipment: Required for infection control and maintaining hygiene.
- Annual Maintenance Records: Keep detailed records of maintenance for all major equipment, ensuring functionality and compliance with safety standards.
Support Services
Your facility should have a range of support services in place to ensure seamless operations:
- Reception & Billing: These services are mandatory and must be part of your hospital network.
- Laboratory Services: Either an in-house laboratory or an outsourced service should be available for diagnostic testing.
- Imaging Services: X-ray or MRI services (in-house or outsourced) for diagnosing burn-related complications.
- Pharmacy: A fully equipped pharmacy to provide prescribed medications.
- Sterilization/CSSD: A dedicated sterilization unit for surgical and medical tools.
- Laundry/Kitchen: Either in-house or outsourced laundry and kitchen facilities for patient care and staff.
- Medical Gas and Manifold System: Ensure that oxygen and other medical gases are available for patient care.
- Blood Storage Unit/Blood Bank: You must have an arrangement for blood storage, either in-house or in collaboration with an external blood bank.
- Ambulance Service: A fully equipped ambulance service for transportation of critical patients to the hospital.
Additional Requirements
- Personal Record Keeping and Training: Maintain detailed records for all staff, including their qualifications, training, and certifications.
- Payment and Roster of Staff: A proper roster system should be in place to manage shifts, salaries, and attendance.
- Periodic Health Checkups and Vaccinations: Ensure that all staff undergo regular health checkups and vaccinations, particularly for staff in high-risk areas like laboratories and blood banks.
- Staff Rotation: Implement a policy for staff posting and rotation, ensuring there is sufficient coverage and expertise across all departments.
Conclusion
Opening a burn care facility in India requires substantial planning and investment, both in terms of infrastructure and human resources. Whether you’re setting up a basic burn care facility for general surgical care or an advanced burn unit with ICU support, it’s essential to meet these minimum standards to ensure high-quality care for burn patients.
By adhering to these guidelines, you can create a facility that provides comprehensive treatment and rehabilitation for burn victims while maintaining legal compliance and patient safety.
