By Cindy Krischer Goodman
South Florida Sun-Sentinel
MIAMI — Just hours after Cassandra Rivera had been celebrating Memorial Day on a boat with her husband and young sons, she was on a stretcher in an ambulance on her way to Jackson Memorial’s Miami Burn Center.
Cassandra, 29, shut her eyes tightly as her pain intensified, praying that she and her family would survive after their boat burst into flames. Ahead, Rivera’s husband and sons were in ambulances, too, sirens on as they raced down the highway.
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At the same time, Dr. Carl Schulman had been in Fort Lauderdale, enjoying the day off with his brother, when he and his team at Jackson’s Miami Burn Center received the call for a “mass casualty” event. Eleven people on a boat that exploded near a sandbar in Fort Lauderdale were on their way in.
Everyone from surgeons to trauma anesthesiologists would be needed.
Most hospitals in South Florida can handle emergency care and some burn wounds. Only Jackson has a dedicated building and medical experts with the know-how and equipment to save the lives of people who are severely burned.
Schulman, a burn/trauma surgeon with a calm disposition, joined the 50-year-old Miami Burn Center in 1995 and has trained hundreds of trauma surgeons, treated thousands of burn injuries and has rallied for the resources to make it one of the most comprehensive burn treatment centers in the country.
Housed in the Ryder Trauma Center, patients arrive by helicopter and ambulance or are raced over from nearby emergency departments. The response team steps in immediately with trauma resuscitation and hypothermia prevention. But the healing process also includes psychological counseling, physical therapy, reconstructive surgery, and long-term wound care.
“If you’re on this stretcher and you’re looking up at us, something bad has happened to you,” Schulman said. “I tell people, you never want to see me professionally.”
When the boat the Riveras were on exploded on Memorial Day, Cassandra’s burns covered about 20% of her body — including her shoulders, hands, thighs and toes.
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Seconds after arriving at the Miami Burn Center, a medical team ensured she had a clear airway and administered fluids to prevent dehydration and maintain her blood pressure. They surgically removed dead and damaged tissue from her burn wounds and applied a special dressing to cover them. With medical advances, doctors now have a wider variety of skin substitutes to apply to burn wounds.
“They’re just temporary things that we put in and around wounds to make them heal quicker,” Schulman explained. If skin is damaged to the point where it cannot heal itself, Schulman will use skin grafting or thin layers of skin cells grown in a laboratory.
By the time Cassandra’s ambulance arrived, doctors were already at work on her two sons — 5-year-old Kash, who had burns on 40% of his body and 7-year-old Anthony, who had fared worse with 80% of his body singed. Initially, Rivera’s husband, Antonio, who was hanging off the side of the boat when it exploded, didn’t appear to have burns. Later that evening, he discovered his arm had blistered, and his minor burn was treated.
Schulman said only a burn center like Jackson’s could respond to 11 severely burned people arriving at the same time. “We’re a big teaching hospital, we’re able to handle it.”
The team at the Miami Burn Center treats the worst of burns that humans endure — from gas grill and boat explosions to kitchen fires and electrocutions. For children, the most common burns are scalds or burns from playing with fire. The Fourth of July is a common time for burns and medical emergencies.
A look inside
The Miami Burn Center houses five resuscitation bays and seven observation bays. It has an intensive care unit for adults and a separate one for children. It’s one of the world’s only freestanding trauma centers. “This is an entire trauma hospital that you could break off of the main hospital and it would be self-sufficient, except for maybe CT scanners, which are 20 feet out the door,” Schulman said.
When patients arrive, time is crucial. A dedicated operating room lies open, reserved for burn emergencies.
The immediate concern with patients is the inflammation a burn causes in the body, Schulman said. “It causes the cellular functions not to work properly and we have to give them a massive amount of fluid and medications to keep their bodies going….then of course the initial management of the skin also is designed to minimize any future damage or what we call progression of the burn wound.”
As patients arrive, many must be intubated and put on a breathing machine.
Standing in the middle of the resuscitation bay, Schulman said the room could be used for any reason, short of a major operation. “We can intubate people here, put them on a ventilator, there’s an ultrasound machine, and there’s a rapid infuser for blood and fluids,” the doctor said. “All of this was redesigned over the years to make it amenable to mass casualties.”
Four attending physicians, nurses, and technicians are fully dedicated to the Burn Center, which has met the rigorous standards of the American Burn Association .
In the intensive care unit, patients are categorized based on the percentage of their body burned and the severity of the burns. The length of stay and the recovery process can take weeks, months, and even as long as a year. The scars can last forever.
Rivera has been discharged from her week-and-a-half stay. But her children remain in the pediatric intensive care unit and continue to undergo surgeries. “They saved our lives,” she said of her doctors at the center.
On the day a reporter visited, another survivor of the Memorial Day boat explosion raised herself from a wheelchair, grasping a parallel bar in the Burn Center’s therapy gym. “It’s nice to see you upright,” Schulman said to her, explaining that the young woman has had difficulty bending her knee.
On the third floor of the burn center, a rehabilitation therapist works with patients in the renovated space that now includes parallel bars, a trampoline and exercise balls used by as many as 300 patients a year. “As you transition from inpatient to outpatient, one of the most important things is therapy,” Schulman said.
Long after discharge, patients remain connected to the Miami Burn Center. They come for physical and occupational therapy, follow-up surgeries, and participate in a support group as the healing process continues.
Rivera said she remains in horrible pain, “I know it will never go away until I am fully healed,” she said. “In the wind or sun, it tingles because I still have open wounds on my left leg and right arm.”
As a teaching hospital, the Miami Burn Center has 20 active clinical trials, 14 surgical fellows, and trains military healthcare personnel to provide care to those injured on the battlefield.
In recent years, the center has added two lasers that doctors use on patients to help alleviate disfiguring scars.
It’s a mind game
Surviving a horrific burn is only the first step. The trauma stays with survivors for decades. Every other Wednesday at the Miami Burn Center, about a dozen people gather, either in person or by remote video, to share their physical and emotional journeys.
Dr. Marie Ishii, a burn clinical psychologist, leads the discussion, encouraging each person to share.
Mariana Maysonet, who has joined in person, arrived in a wheelchair wearing a hospital gown and hairnet, her arms and legs bandaged. Maysonet was burned in a backyard bonfire three weeks ago.
Dwayne Torres, who was electrocuted 15 years ago and lost an eye, offers encouragement to Maysonet, a newcomer. “Take one day at a time, and keep coming back. They will help you get better.”
Michael Craig of Hollywood shares that he was burned in a workplace grease fire as the manager of a KFC . He is approaching his “burnversary” and wonders if he should still be angry. “You could celebrate life, but you can still be angry it happened,” Dr. Ishii said.
One survivor, electrocuted less than a year ago, feels his wife looks at him differently, concerned that maybe it’s pity in her eyes. “Maybe it’s admiration for the courage and strength you are showing,” Dr. Ishii suggests.
Rivera said she is not yet ready for a support group. She spends her days managing her sons’ care. “Dr. Ishii has been by our side since the ICU. Her presence is very calming to me and my children,” the young mother said.
“I want to be strong for my boys,” she said, “because they need me now more than ever.”
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