Here’s Why I Attended the Wisconsin Burn Ball 2023
If you’ve been following me (through this blog or Instagram), you know I have a particular affinity for the BICU — Burn Intensive Care Unit. But if you’re new here, the long story short is that in my second year of OT school, we had a class called Medical Conditions. Each week, an occupational therapist in a particular specialty came and gave a presentation on that medical condition, along with the OT’s role in that specialty. Eileen Riordan came and gave a talk about the OT’s role in the BICU, and I was sold. I found her talk to be so engaging, and the possibility of a career in burns had a hold on me. I shadowed with Eileen which then led to a clinical fieldwork, resulting in me meeting Melissa Kersten and learning about Burn Camp.
I’ve now been at camp for ten years, eight of which as the Youth Girls’ Coordinator. This past weekend was the 4th annual Burn Ball in Madison, Wisconsin, held by the Professional Firefighters of Wisconsin Charitable Foundation. This was my first time at the Burn Ball; I generally attend the Fired Up Ball held in Milwaukee. Attending the Burn Ball provided me with a nice excuse to have a date night (an overnight, at that!) with Nate, and a good amount of money was raised for some of my favorite kiddos ($55k and counting!). We got dressed up for the first time in a long time, spent quality time with some of my best-camp-friends, and won a kombucha package in the silent auction (literally two growlers plus 24 individual bottles — good thing we’re a kombucha friendly household!). All in all, it was an amazing night.
Something else wonderful came out of meeting Eileen on that fateful day in Fall 2011: after I graduated, I was offered a PRN position in the Burn Intensive Care Unit at the same hospital at which I did my clinical. So few occupational therapists have experience in burns care that, according to my then-boss, it was a no-brainer to hire me — the ultimate compliment! What specialized training and knowledge did I have that a general acute care clinician might not be exposed to? Here are a few of these skills:
Isolated, fully protected range of motion (ROM). As occupational therapists, we are trained in measuring ROM using goniometers and instructing patients on performing functional, composite movements. Burns care requires much more attention to detail when performing ROM than in general acute care: there are exposed muscles, tendons, and bones to pay attention to, skin grafts that are still healing, and simply wounds upon wounds. All range of motion must be performed in the most gentle, isolate way humanly possible. Each joint requires special care. The documentation supporting this must be worded specifically so as to support continuation of care, as well as assuring the surgeons you are observing all their precautions both pre- and post-operatively. When it’s time to start improving their ROM, you must be able to measure the smallest of joints with the utmost precision. There’s a good deal of pain involved for the patient (even while medicated), and you have to be willing to put your fingers in people’s mouths. Just things to be aware of.
Splinting. In my experience, these splints were each made custom to the patient, and if you know anything about splinting (especially when it involves highly compromised skin), you know this can be an arduous process. It’s a lot of measuring, cutting, positioning, trimming, remeasuring… It can take at least an hour for one custom splint if you really get into it. The most common splints I have made in my time in the Burn Unit are finger extension splints, inter digit splints, resting hand splints, and I have distributed mouth orthoses. I have never made an axillary splint or a clavicle strap; as a therapist on the unit, we used positioning to address any potential shrinkage as the skin healed.
Self cares. As occupational therapists, educating and teaching patients on performing ADLs is one of the hallmarks of our occupation. It’s one of my favorite things to do with my patients! Performing self cares in the burn unit, however, sometimes takes on a life of its own. It comes down to stages of healing: what is the integrity of their grafts? What are their precautions? Do we need to supply them with pressure garments? Do we need to contact an outside vendor to come in and provide the patient with custom pressure garments? What is their wearing schedule? It is 100% in our scope of practice to provide pressure garments as well as instruct the patient on how to doff/don them, clean them, and how to dress themselves while wearing the garments. It’s also important to know how to measure a burns patient for their garments. Self cares for the patients in the burn unit are slightly more complex than they are for the general population.
Positioning. We’re talking pillows, wedges, elevated legs, elevated torso — and we’re doing all of this with a patient who is very likely deeply sedated. Have you ever moved a person who is in twilight? It’s one of the most challenging things you can do! I am a pretty functionally strong person, yet I always need at least one additional set of hands for this type of positioning. Even if your patient is not sedated and is able to participate in therapy, positioning can be a challenge due to their precautions: no scooting, no shearing, no doing anything that might compromise the integrity of their grafting or other operations. Again, this is likely a two-person job!
There are certainly more skilled that go into being a successful burn occupational therapist — these are just the ones I feel come up the most in the unit. While these specialized skills for this unit are ones that take time to learn, once you know them, you can apply some of this knowledge to other areas of the hospital. No one will ever be mad you took extra time to ensure a patient safety!