U.S. hospitals are increasingly shutting down their burn centers in a trend experts say could leave the nation unable to handle widespread burn casualties from a fiery terrorist attack or other major disaster.
Associated Press interviews and an examination of official figures found that the shrinking number of beds is a growing cause for concern in this post-Sept. 11 world.
Experts say burn centers are expensive to maintain and often lose money because they are staffed with highly specialized surgeons and nurses and stocked with sophisticated equipment designed to ease patients' excruciating pain, fend off deadly complications and promote healing.
The number of burn centers in the U.S. has dropped from 132 in 2004 to 127, and burn beds have fallen from 1,897 to 1,820, according to American Burn Association records compiled from voluntary reporting by hospitals.
The U.S. Department of Health and Human Services puts the number of burn beds even lower, at just 1,500. And most of those are already filled, with the number available on any given day variously estimated at just 300 to 500.
"If something happens and we need the beds for burn patients, it is going to be a real catastrophe," said Dr. Alan R. Dimick, past president of the American Burn Association and founder of the burn center at the University of Alabama at Birmingham.
Some states - Mississippi, North Dakota, Montana, Wyoming, Idaho and New Hampshire among them - have no burn centers at all. South Carolina has only a children's burn center, and there are just a few dedicated burn beds in Maine, Alaska and Hawaii.
"People ought to be pretty frightened by this," said Dr. Barbara Latenser, burn center director at the University of Iowa Hospitals. "Some people who live out West, they are 800 miles from a burn center."
Many hospitals contend their general trauma units can handle burn victims adequately. But many authorities say burn units are far superior because of the equipment and expertise they offer.
"You need a burn team to take care of folks, not just docs and nurses," Dimick said.
HHS oversees the Homeland Security Department's efforts to prepare the nation's medical system for a disaster. HHS preparedness spokesman Marc Wolfson acknowledged that a disaster such as nuclear blast in a large urban area could produce thousands of burn victims, and that there would not be enough burn facilities to treat everyone.
"The number of total beds available in hospitals, we don't have direct control over that," he said.
But he said he hopes some of the money the government has been dispensing to hospitals since 9-11 for disaster readiness goes toward preparing for a surge of burn victims, even if does not lead to an increase in burn beds.
Wolfson said that if burn beds are full, patients can be taken to trauma units. Also, he said some veterans hospitals have beds that could be used in a fiery catastrophe. And he said burn centers can be expanded in an emergency.
Some burn experts are not reassured.
Severely burned patients suffer extreme pain, their bodies lose the ability to regulate temperature and fluid levels, and they are highly vulnerable to infections because their skin has been stripped away.
Burn centers are staffed by medical professionals specially trained in treating people with severe burns.
They also have special features such as individually temperature-controlled rooms, mattresses with circulating air to support a burn victim, and beds that automatically turn immobile patients to prevent further skin damage.
In addition, there are warming devices for beds since burn patients get cold easily, and tubs in which patients can be immersed to clean their wounds and promote drainage.
Other burn center features include synthetic material that serves as a temporary skin substitute, and a device that uses ultrasound to determine the severity of burns without having to touch a seriously burned patient.