West Penn Burn Center: Comprehensive, Verified Care

• By:  Emily Adamek
• Posted:  October 27, 2020
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Burn injuries can be life-altering. Fully comprehensive care and treatment should therefore promote both physical and emotional well-being, explains Ariel Aballay, MD, director of the nationally recognized West Penn Burn Center. The center, founded in 1969, is the region’s only burn center verified by the American Burn Association and the American College of Surgeons to treat both children and adults. They deal with every type and severity of burn-related injuries, and integrate targeted psychological and therapeutic services that go beyond the physical injury.

Dr. Aballay became interested in burn care at a young age. “I had a childhood friend who experienced a burn injury,” he says. “After it happened, I saw first-hand all the unique challenges that arose for him and his family.” Over the years, his interest evolved into a deep desire to help burn patients recover physically and mentally. He took time to speak with me about burn medicine and about what makes the West Penn Burn Center a uniquely valuable resource.

Burn injury care

Emily Adamek: What kinds of care are available at the West Penn Burn Center?

Dr. Ariel Aballay: The Center extends through two main areas — inpatient and outpatient care. The inpatient side of things involves injuries of a certain extent and severity. Outpatient care is for relatively small burns. Certain therapies might also be required at an outpatient level.

Additionally, we have AHN Healthcare@Home, which helps with the coordination of resources between inpatient and outpatient settings. Once a patient is moved to outpatient, they might only come in to the Center for a weekly visit, while the rest of care can take place at home with a visiting nurse.

Care extends from the moment a person arrives at the Center throughout their recovery — including follow-up appointments and reintegration into the community. In addition to typical burns and scalding injuries, we also treat electrical burns, chemical burns, traumatic injuries like road rash, and chronic non-healing wounds. Some of our patients have not been burned, but rather have been exposed to smoke or have an inhalation injury.

We also treat skin and soft tissue conditions that mimic burn injuries, such as toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), which can result from a drug reaction or an infection.

Emily Adamek: What’s the most common type of burn you see?

Dr. Ariel Aballay: Scald burns, without a doubt. We’ve seen an increase in scald-related burns in 2020 in the pediatric department. It likely relates to the fact that everyone has been at home more and cooking more. We also see frequent burn accidents with people starting fires or working with gasoline. Alcohol is sometimes a factor.

Emily Adamek: When someone experiences a burn or is involved in an accident, do they typically come straight to the Center, or would they go to the emergency room?

Dr. Ariel Aballay: Patients with more severe burns come to us in three ways. Direct admission is when a patient is picked up at the scene of an accident by emergency services who bring them right to us. Second, a patient may come to the ER at West Penn Hospital, so we’re already there. Third, a patient might go to another ER, receive immediate treatment, and then be transferred by the ER staff to us.

If the patient has a smaller burn, they may go to their primary care physician (PCP) first, who could then refer them to us. Alternatively, if someone already knows about us, they can call directly and make an appointment. With appointments, typically we can see someone within 24 hours.

Emily Adamek: What are the initial steps when someone comes in with a severe burn?

Dr. Ariel Aballay: When any patient comes in, we initiate special attention to the management of their airways and to providing the proper amount of fluids. If we’re dealing with an electrical injury specifically, blood work will be necessary. Wound care takes place while all of this is happening. Once they go to the operating room, if necessary, then care depends on the depth of the injury. Most third-degree burns will require a skin graft using the patient’s own skin. Sometimes, we see deep burns that require treatment with artificial skin.

At the same time, when someone is admitted, we also start planning the rehabilitation process, whether that involves physical therapy, occupational therapy, speech therapy, or a psychological assessment. We have a psychologist and psychiatrist available on site.

Emily Adamek: What is important for people to be aware of when they are dealing with a burn injury?

Dr. Ariel Aballay: Whatever type of burn occurs, specific treatment must take place within a specific time frame to prevent long-term complications — so you should seek medical attention right away. For example, even with a third-degree burn, patients might think it isn’t severe if it doesn’t hurt too badly. However, we’ve seen a number of cases where the person doesn’t seek immediate attention and ends up with an infection. Another important thing to remember is that if a burn doesn’t heal by the end of the second or third week, your chances of developing severe scar tissue increase.

Emily Adamek: What advances have you seen in treating burns over the last decade?

Dr. Ariel Aballay: A number of products have become available that limit the amount of skin necessary to heal a wound during surgery, along with advancements in what is considered artificial skin. Plus, through the American Burn Association, there are a number of multi-center trials in place to try new treatments or observe the effects of new drugs. Recently, West Penn Burn Center participated in a trial sponsored by the Department of Defense looking at fluid resuscitation for patients after undergoing surgery. We are also participating in a trial in Canada that looks at whether a nutritional supplement can improve survival rates for serious burns.

Treating scars — physical and psychological

Emily Adamek: What kind of treatment do you provide for scarring?

Dr. Ariel Aballay: Even in the most capable hands, if a surgery has taken place, there will be changes to the skin. But a number of technologies and methodologies have been developed to improve scarring, including scar massage and pressure garments. At West Penn Burn Center, we’re also looking to add laser treatment as a resource. Because survival rates for burn accidents have improved so much, which is a wonderful thing, we’ve shifted to focus on how our patients can return to as normal a life as possible after their accident. That includes helping them look and feel their best.

Emily Adamek: I’m interested in the intersection between psychological services and burn care. Can you talk a bit more about that?

Dr. Ariel Aballay: In the last 10 to 15 years, the psychological element of burn care has become more and more recognized by the American Burn Association as an important aspect of recovery. Not only do we have pediatric and adult psychological services, we can also connect people with a support group like our own Burn Concern, which assists patients with questions relating to their reintegration into society. It was created in 2012 by a former patient who was injured in a burn accident as a child.

The psychological realm of burn injuries impacts patients severely and cannot be addressed in the same way as surgery or surgical intervention. It requires a more comprehensive group of professionals to assist the patient in the effort to return to normality. This is particularly true in pediatric populations, including the parent of an injured child who might be feeling guilt.

Emily Adamek: Does the Center have any programs specifically for pediatric burn patients?

Dr. Ariel Aballay: The annual West Penn Burn Camp has been running for over 30 years. It was initiated by the previous director when they started to recognize the challenges children face after they’ve experienced a severe and sometimes disfiguring burn injury. The camp brings together a group of children who can share their stories, learn about burn care and positive risk-taking, and feel like they belong. Many children who were involved early on have gone on to become camp counselors. This year, due to COVID-19, we weren’t able to offer camp, but we did offer a new concept — “camp in a box.” We’ve been sending the kids specific activities to do within a period of time at home.

Verified burn care expertise

Emily Adamek: You’re the only burn center in western Pennsylvania that is verified by the American Burn Association and the American College of Surgeons for the treatment of both adults and children. Why is verification significant?

Dr. Ariel Aballay: Getting verified is a voluntary decision. You open your doors to a group of surgeons who, in the span of two days, explore and analyze all the aspects of the care you provide. They look at available resources — which differ for children and adults — as well as systems to ensure safety and results. Lastly, they make sure that your care extends beyond surgery and takes psychological issues into account, both for the patient and their family. We can proudly say we’ve been through the verification process about eight times in two decades. It provides outside, expert confirmation that we’re providing top-tier, comprehensive care.

Emily Adamek: What else do you want people to be aware of when it comes to West Penn Burn Center?

Dr. Ariel Aballay: I encounter primary care physicians and other doctors who believe that burn center care is, or should be, limited to traumatic, overwhelming injuries. That’s not the case! Obviously, we see those cases, but catastrophic injuries are less and less common. Realistically, almost any kind of burn is better served by going to a facility with comprehensive resources like ours. While a relatively small burn can often be treated with medications that most doctors are familiar with, there are so many elements that might not be taken into account, including potential psychological issues. Plus, any burn that has taken too long to heal or isn’t properly addressed could lead to severe scar tissue and other functional problems. So, we want physicians and patients alike to be aware that our specialized expertise, sophisticated treatment facility, and broader resources are available, and it makes sense to take advantage of them. You can reach a specialist at our inpatient unit at (412) 578-5273, or talk to an outpatient clinic specialist by calling (412) 578-5120.