Burns Unit

By Muriel Jeffcott, Clinical Nurse specialist

  • The Birmingham Burns Unit opened within the Accident Hospital in June 1944 with MRC support.
  • The Normandy Campaign provided the first patients, the first civilian burn injured patients being admitted August 31 st 1944
  • Details of all new admissions to the unit were recorded by the MRC from the day the unit opened until its closure on August 31 st 1944
  • The burns unit took all comers unselected from a 60 mile radius and readmitted patients for corrective and reconstructive surgery
  • The policy of the unit was to exclusively dress burn wounds using antibacterial cream with the exception of burns to face, buttocks and genitalia which were treated by exposure and application of an antibacterial solution.
  • Bathing was not undertaken for the routine treatment of burn wounds.
  • The Burns Unit was U shaped comprising 2 wards (E and F)
  • A main corridor connected the 2 wards. Off the corridor was a plenum +ve pressure ventilated dressing station and adjacent autoclave room.
  • Ward E had 18 beds for low dependency adults.
  • There were 2 single and 8 double rooms off a central corridor with a sluice, toilet, and bathroom at the far end.
  • At the entrance, a kitchen plus offices for nurses, consultants, and secretaries.
  • Ward F had 18 beds for high dependency patients and children plus 2 shock rooms
  • The entrance comprised of a kitchen, sisters office and junior doctor’s office. Off a central corridor, leading to a part cubiclized 12 bed children’s bay were 2 single and 2 double high dependency rooms and 2 shock rooms.
  • Sluice toilet and bathroom at the far end.
  • Across the landing from the unit
    • Plenum +ve pressure ventilated Hydrotherapy treatment bathroom, packing room/ dressings store and a lounge /waiting room.
  • Total bed number 38 (1970)
  • Major reconfiguration and refurbishment of the whole unit undertaken from November 1998 – March 1990
  • Officially reopened by Princess Diana, March 8th 1990.
  • Ward E reduced to 13 low dependency beds.
  • 5 single rooms, 4 double bays.
  • Secretaries office became a day room.
  • Kitchen and consultant’s office remained.
  • Ward F reduced to 14 beds.
  • 2 shock rooms.
  • 6 high dependency rooms
  • 6 bedded open bays for children.
  • Nurses station created.
  • Kitchen remained.
  • Junior doctor’s office relocated on main corridor.
  • Main corridor
  • Weighbridge installed (what a boon)
  • Hydrotherapy treatment bathroom now adjacent to the dressing station. Both plenum +ve pressure ventilated.
  • Across the landing from the unit
  • Play room
  • Multipurpose lounge /meeting room
  • Total bed number 27 (1990)
  • Burns unit bed space
  • Sister reading to burns patient
  • Patient care at bed space


Information from Keith Porter

The Burns Unit

  • 1943 – Established under direction of Leonard Colebrook
  • Colebrook previously in Glasgow
  • Microbiologist
  • 36 beds
  • Unit designed to reduce cross infection
  • Showed value of ventilation
  • Colebrook assisted by Mrs Florey (later Lady Florey)
  • Colebrook/Florey researched use of penicillin after burning
  • Additional staff – Mr J MK Duncan (surgeon)
  • One house surgeon

Landmarks

  • 1945 £5,000 donation from Bernhard Baron Charitable Fund
  • Colebrook elected Fellow of the Royal Society
  • Colebrook retired in 1948 but worked on and was largely responsible for the “Fireguards Act” 1954
  • Then established Performance Requirement for Fabrics of Low Flammability – BS3121 1967
  • Subsequent Director Dr Williams then handed over to Professor JR Squire and subsequently Dr John P Bull
  • 1946 Dr E Topley
  • Gissane had the foresight to persuade Colebrook to take over the directorship of the Medical

Research Council Unit

  • Revolutionary care to reduce infection
  • Patient on admission
  • Taken to first plenary dressing room
  • When further dressings or surgery required patient taken through airlock room into theatre with frequent air exchange
  • Penicillin cream applied by smearing on dressings reduced incidence of infection caused by haemolytic streptococcus and related organisms
  • Colebrook pioneered guards on electric fires
  • Mr Rainsford Moleman undertook monthly sessions to provide plastic surgical input
  • Mervyn Evans, Ruscoe Clark provided their support and expertise to the Burns Service
  • Stuart Harrison undertook three month sabbatical arranged by Gissane to improve knowledge and skills in plastic surgery
  • By 1963, the burns unit had already become a large regional centre comprising 36 beds, a ‘clean air’ dressing station and expanding research facilities
  • Treating over 18,000 burned patients between 1941 and 1993, the burns unit developed a planned, systematic approach to the treatment of these injuries, which greatly reduced the frequency of associated infections.
  • The aseptic room in which the patients had their burnt areas dressed at the Acci were unique – throughout the time of dressing a constant stream of filtered fresh air was directed into the room by an electric fan, while open culture-plates were exposed at different parts of the room so that, if any pathological germ grew on any of the plates it would be possible to trace it to its source by bacteriological examination of every person who was known to be in the room at the time of dressing the wound.

Burns Research Group & MRC
Report by J. C. Lawrence 1989

  • The Burns Research unit was established as part of the Medical Research Council at the Acci in 1944 by Leonard Colebrook.
  • The Burns unit pioneered work recognised world-wide and established many basic principles of burn care.
  • However, the unit closed in 1982, when Dr Bull retired; a few staff also retired, others left to form a group elsewhere and the remaining 10 (4 only being part-time) formed The Burns Research Group (BRG) at the Acci.
  • MRC Groups had to apply for funding every 3 years, these, together with project grant applications from non-MRC staff (e.g. University lecturers seeking support from post-grad
  • The Burns Research Group failed at their 3rd renewal; unfortunately, there were no second chances.
  • In the seven years of the BRG’s existence the work had, perhaps, been less spectacular than that in the early days but then, apart from other factors, the staff alone approached 40 in number.
  • During this time, the group published well over 100 articles, a substantial proportion of these were in recognised scientific and medical journals. The achievements included an inexpensive but effective topical antibacterial prophylactic for burns which could be of value in the 3rd world particularly; much work on wound dressings such that for some years , the group had been a recognised centre for making impartial clinical assessments on the merits of some of the ever increasing range of materials available to treat wounds; the epidemiology of burns together with demographic studies on their incidence had also attracted the group’s attention, moreover, the Acci was the only UK centre to produce such data.
  • Despite the problems that arose on the Unit from time-to-time, such as gentamicin-resistant Pseudomonas, multi-resistant Acinetobacter and MRSA, the incidence of bacteria in burns continued to decline and, burns mortality declined by 16% in the 1980s despite an unchanged incidence of burns severity.
  • General view of burns cubicles
  • Ventilated burns cubicle
  • cots in the burns unit for young children

Feed that Burn
By Muriel Jeffcott

  • Burns place an increased metabolic load on the patient necessitating adequate nutritional support.
  • Patients fed high protein, high calorie diet from admission.
  • Nutritional requirements ascertained by the dietician and feeding programme commenced.
  • Daily charting of food and fluid intake.
  • Weekly body weight. 
  • 24 hour urine collection and regular biochemical measurement to calculate nitrogen balance /catabolism.
  • Assessment for vitamin, mineral and trace element supplementation.
  • Many patients were unable to achieve full requirements from a normal diet alone. 
  • Supplementary feeds offered in the form of milk based drinks and sip feeds. 
  • If requirements not being met, nasogastric tube feeding introduced. 
  • Parenteral feeding, only when gut not functioning or where not possible to meet nutritional requirements by enteral route alone. 
  • Ward kitchen always a hive of activity. 
  • Provision of high energy /high protein drinks and normal fluids 
  • Making up of feeds. 2hrly drinks rounds. 
  • Milk a major part of the nutritional intake. 
  • Carnation Build Up, with a variety of flavours, a well tolerated feed. 2 packets, 500 ml of milk and 2 raw eggs (pre Edwina Curry!) 
  • Many proprietary high energy drinks, Hycal, Fortison, Ensure etc. available. 
  • Always a stock of bread, butter, jam, eggs and cereal. 
  • Should meals be declined or missed due to dressing change or surgery, there was always something on offer. 
  • Relatives encouraged to bring in food. 
  • Good cooperation with the hospital catering officer who tried to provide the nutritional diet required and patient’s requests. 
  • No plated meals, food served from a trolley. That way patients could be given what they liked and more if they could manage it. 
  • Many patients required help from staff with feeding due to restrictions by injury. Occupational therapy provided adapted cutlery and non slip plate mats.
  • Weighing patients a nursing challenge!! 
  • Often difficult to achieve a regular accurate weight due to patient’s dressings and/or general condition. 
  • Admission weight of “shock cases” used in the calculation of their IV fluid replacement. 
  • Weekly weighing, a guide to adequacy of nutritional intake. 
  • A variety of weighing scales around the unit. 
  • In dressing station, a full length “bed scale” on which to lay patients. 
  • A sit on wheelbarrow scales with side extensions which could be taken to the patient’s bedside.
  • Infant and baby scales.