The exact number of burn beds in the U.S. is a matter of dispute, and may well be overstated, because hospitals do not always distinguish between specialized burn beds and beds that are used for various traumatic injuries, including burns.
Wolfson said one recent report to the federal government showed that only 520 beds were actually available for use. Dr. William B. Hughes, director of the Temple University Hospital Burn Center in Philadelphia, said that more commonly, only about 300 beds are available at any one time.
Hughes said the United States had easily more than 3,000 dedicated burn beds in the early 1970s. But there has been a steady decline since then.
"We keep hearing we are ready for a terrorist attack," said Dr. Jeffrey Guy, director of the 29-bed Vanderbilt University Burn Center in Nashville. But even now, "our space is full almost all the time."
Guy said it is not uncommon for regional burn centers to be full and for patients to be transported long distances. "There are days we are taking burn calls for Chicago," he said.
Burn center directors say more beds are likely to disappear. Most burn centers are losing money because Medicare and Medicaid reimbursements have not kept up with the cost of providing care, experts say. Private insurers often follow Medicare's lead.
Since it costs about $10,000 a day to treat a patient with severe burns, and such patients typically require 50 days of intensive care, a single uninsured patient can wreck the finances of a small burn program.
Some burn centers around the country have lost a lot of money treating uninsured adults and children who were severely burned in explosions of clandestine methamphetamine labs.
"Burn units are money-losers," Hughes said.
Some health industry officials say that it is unreasonable to expect the nation's hospitals to be prepared for a worst-case burn scenario at all times.
"You don't want to have so much capacity you lose your shirt on it," said Jim Bentley, the American Hospital Association's senior vice president for strategic policy planning.
Dr. David Mozingo, director of the Shands Burn Center at the University of Florida in Gainesville, said state officials there have, in fact, begun committing some terrorism and disaster-preparedness money to burn care.
"They have been buying equipment and training. A lot of supplies and equipment have been distributed that are burn-care specific," he said.
Some burn-care experts warn that in an all-out disaster, health professionals would have to conduct a pitiless form of triage and decide which patients get sent to burn centers and which ones do not.
"The person on scene is going to look at people who have the best chance of surviving," Iowa's Latenser said. "We will not have the resources."
Burn care professionals "spend a lot of time talking about, `How do we get the government to listen to this?'" Latenser said. "You can't have the disasters and then say, `Oh golly, we should have had the centers.'"
On the Net:
Health and Human Services: http://www.hhs.gov/disasters
Vanderbilt Burn Center: http://www.vuburncenter.com
University of Iowa Burn Center: http://www.uihealthcare.com/depts/burntreatmentcenter