"Optimizing Combat Casualty Care"

Col. (Dr.) Booker T. King, U.S. Army Institute of Surgical Research Burn Center director place the latest re-certification certificate on the wall at the USAISR Burn Center.

Burn Outpatient Clinic Provides Vital Care

Story and photo by Steven Galvan, DBA
USAISR Public Affairs Officer

U.S. Army Institute of Surgical Research
15 JUNE 2017

The U.S. Army Institute of Surgical Research Burn Center at Fort Sam Houston, Texas, recently received reverification status by the American Burn Association and the American College of Surgeons for its commitment to providing quality burn care to military and civilian patients. A critical component of the verification process for a burn center is operating and maintaining an outpatient burn clinic. Even though the USAISR Burn Center has been operational since the 1940s, it wasn’t until the late 1990s that the Outpatient Burn Clinic was established.

The first Outpatient Burn Clinic was created in 1996 when Brooke Army Medical Center was opened in its current location. The 40-bed Burn Center has 16 Burn Intensive Care Unit and 24 Progressive Care Unit beds. As the only burn center in the region, the USAISR Burn Center cares for patients with all sizes of burns. Prior to 1996, patients requiring extensive burn care were admitted to the PCU, and those who did not require hospitalization were discharged with follow up elsewhere. Beginning in 1996, a small number of patients were treated in a triage room outside of the BICU. With an increase in patients requiring clinical evaluation and care, then, Maj. (Dr.) Leopoldo Cancio, Chief of the Clinical Division, established a permanent burn clinic. He was assisted by Dr. Christopher Lentz, Shari French, Carolina Lopez (registered nurses), Michael Shiels, Reuben Salinas and Sgt. Karliss Kimbrough (licensed vocational nurses).

“Before we opened the outpatient clinic, burn patients were either admitted to the Burn Intensive Care Unit or the Progressive Care Unit, it all depended on the severity of the burn,” said Kimbrough, Burn Outreach and Burn Residency /GME Program Coordinator. “There wasn’t a clinic for minor burns or outpatient care before the Burn Outpatient Clinic was established.” The clinic was moved from the BICU into a larger location at the PCU, but that move was short-lived due to infection control issues of treating in- and outpatients in the same area. The burn clinic was then moved from the PCU to the second floor of BAMC where patients were seen on Tuesdays during a four hour timeslot.

“By 2006, the clinic had moved to the fifth floor of BAMC alongside the pain management clinic,” said Wanda Segroves, burn clinic head nurse. The staff consisted of two physician assistants, Peter Yen and Michael Chambers; Wanda Segroves (RN), Karliss Kimbrough, Juan Soltero, Gracie Turner (LVNs), Anna Rodriquez (medical clerk), and Sgt. 1st Class Harrison Jules, noncommissioned officer in charge.

“In conjunction with burn care, patients also received physical and occupational therapy as well as burn plastic reconstruction,” added Segroves.

The following year, the clinic was relocated to the seventh floor where services were expanded to include acupuncture therapy and burn research support. The burn clinic also incorporated video teleconferencing that allowed physicians to coordinate care with doctors at the Good Samaritan Hospital in Baltimore, Maryland as well as with University of California Los Angeles for Operation Mend. With the utilization of video teleconferencing, the burn clinic staff treated more than 4,000 patients that year. In 2008, the clinic staff integrated telephone consultations and treated more than 6,000 patients which required the clinic to expand. The burn clinic was moved again in 2010 to a temporary facility in the BAMC parking lot due to the construction of the Consolidated Towers.

“This location outside the main hospital building came with many challenges,” said Segroves, who became the head nurse in 2009. “The distance from BAMC limited physician support and made it difficult for patients to be re-admitted.”

In 2012, the Outpatient Burn Clinic moved to its permanent location at BAMC’s fourth floor of the Consolidated Tower which had four large treatment rooms and an expansion of services that included Pulse Dye laser therapy for the management of hypertrophic burn scars. The staff consisted of the director, two physician assistants, the head nurse, one triage RN, four LVNs, a uniform billing officer, a medical clerk and the NCOIC.

“This enabled us to include procedures like tissue expansion, staple and suture removal, acupuncture and laser therapy, soft tissue debridement, Recell application (spray-on skin), and negative pressure wound therapy,” said Bethany Martinez, burn outpatient clinic RN. With the staff and capabilities, the number of procedures performed at the clinic more than quadrupled from 2013-2016. In 2016, the clinic increased the treatment rooms to six and added CO2 laser for complex hypertrophic scarring. The staff also increased with the addition of a social worker as well as working closely with the Burn Post Anesthesia Care Unit to facilitate patients pre-operatively.

Today, the Burn Outpatient Clinic sees patients Monday through Friday and is an integral part of the Burn Center and treats more than 3,000 patients every year, providing the world-renowned care for which the Burn Center is recognized. Thank you to everyone who contributed to this story: Dr. Leopoldo Cancio, Karliss Kimbrough, Reuben Salinas, Michael Shiels, Wanda Segroves, Bethany Martinez, and Frank Moran.