The Burn Centre at Maasstad Hospital

The Burn Centre at Maasstad Hospital treats patients with burns and other skin conditions. Maasstad Hospital is home to one of the Netherlands’ three burn centres. The other two burn centres are based in the Rode Kruis Hospital (Beverwijk) and the Martini Hospital (Groningen). Maasstad Hospital’s Burn Centre treats an average of forty percent of the burns patients admitted to centres throughout the Netherlands. We provide high quality burns care 24 hours a day 7 days a week.

The Burn Centre treats patients with serious burns from all over the country, particularly from the southern half of the country and the South East Netherlands.

Maasstad Hospital has specialised in the treatment of burns since the end of the 1960s, when the hospital was known as Zuiderziekenhuis. In 1986 this resulted in the establishment of a new burns centre.

The specialist burns care at Maasstad Hospital is based on three pillars:

Specific knowledge and skills;
Special structural provisions;
Multidisciplinary treatment.

Specific knowledge and skills The Burn Centre is an acute in-patient department within the hospital where specialists and specially trained nurses work in the field of burns care. This is their area of expertise. Specific knowledge and skills The Burn Centre is an acute in-patient department within the hospital where specialists and specially trained nurses work in the field of burns care. This is their area of expertise.

Hence all nurses who work in the Burn Centre have completed the specialist Burns Nurse Training (Opleiding tot BrandwondenVerpleegkundige - OBV). Their constant presence means that the nurses are closely involved with the burns patient. The daily physical, mental and social care is correctly harmonised together using a nursing system.

Because the Burn Centre is not part of a teaching hospital it also focuses on research and training for professionals.

A specialist research team has been set up to conduct research. This makes it possible to apply innovative techniques and new treatments which have been scientifically researched within the Burn Centre.

Special architectural facilities The Burn Centre has special architectural facilities It is effectively ‘a hospital within a hospital’. Special architectural facilities The Burn Centre has special architectural facilities It is effectively ‘a hospital within a hospital’.

The Burn Centre contains an admission room for acute admissions. Operations are carried out in an advanced operating theatre within the Burn Centre so that patients do not need to leave the department.

There are also a total of twenty beds, divided into fourteen single rooms (of which ten are equipped for intensive care and high-care patients) and three double rooms. Two double rooms are furnished for children.

All rooms use an airlock system. The building is also equipped with an advanced air conditioning system. These systems provide climate control and the isolation of patients in order to prevent infections.

Multidisciplinary treatment Burns care requires personnel with specialist training and a multidisciplinary approach during admission and aftercare. Multidisciplinary treatment Burns care requires personnel with specialist training and a multidisciplinary approach during admission and aftercare.

Within the Burn Centre there is close collaboration within both in-patient and out-patient treatment between burns doctors, trauma surgeons, intensivists, anaesthetists, (plastic) surgeons, paediatricians, medical microbiologists, physiotherapists, occupational therapists and paramedics. The specialist nature of burns care means that clinicians from various specialisms are called upon where necessary.

The treatment team is supplemented with burns nurses, intensive care nurses, paediatric nurses and an aftercare nurse. Teaching assistants, psychologists, hospital chaplains and social workers assist with psychological and social care.

If admission is not required, wounds are also treated as day cases. There is also an out-patient clinic where the emphasis is on aftercare: the treatment of patients’ scars and the provision of psychosocial care. All this together means that patients with burns are provided with high quality care whereby the focus is entirely on the patient.

Common causes Burns can have many causes. Burns can be caused by fire, hot liquids, contact with a hot object, radiation, chemicals or electricity. Some 10,000 patients a year attend Accident and Emergency with burns in the Netherlands. Around 650 patients are admitted to a burns centre. The majority of burns suffered by young children are caused by hot water, tea or coffee. Most burns therefore occur in and around the home. Common causes Burns can have many causes. Burns can be caused by fire, hot liquids, contact with a hot object, radiation, chemicals or electricity. Some 10,000 patients a year attend Accident and Emergency with burns in the Netherlands. Around 650 patients are admitted to a burns centre. The majority of burns suffered by young children are caused by hot water, tea or coffee. Most burns therefore occur in and around the home.

Young patients Patients of all ages are treated in the Burn Centre. A quarter of the burns patients are young children aged between birth and 4. If one adds the older children up to the age of 16 to this, children make up at least one third of the total number of burns patients. A special playroom, bathroom and teaching assistants are provided for children. Parents have the opportunity to sleep in the same room as their children. Young patients Patients of all ages are treated in the Burn Centre. A quarter of the burns patients are young children aged between birth and 4. If one adds the older children up to the age of 16 to this, children make up at least one third of the total number of burns patients. A special playroom, bathroom and teaching assistants are provided for children. Parents have the opportunity to sleep in the same room as their children.

The role of the Burn Centre in disasters The Burn Centre also plays an important role in receiving burns patients after a (major) disaster. The role of the Burn Centre in disasters The Burn Centre also plays an important role in receiving burns patients after a (major) disaster.

What does the Burn Centre do in disasters?

If a disaster occurs, the Burn Centre becomes part of a triage team, also called a trauma team. The following is assessed in order to ensure that patients are treated effectively:

How many patients are there?
What are the diagnoses and what treatment is required?
Can the treatment be provided by local hospitals?
Does the patient need to be taken to a burn centre?
Can the patient be transported?

Air ambulance

Where necessary and possible, seriously injured patients can be brought to the Maasstad Hospital Burn Centre in an air ambulance.

List of disasters

The Burn Centre played an important role in the following disasters:

Bijlmer disaster, Amsterdam, 1992: 36 injured, 3 patients transferred to the Burn Centre
Fireworks disaster, Enschede, 2000: 600-950 injured, 1 patient transferred to the Burn Centre
Hotel fire, Antwerp, 1995: 164 injured, 16 Dutch patients transferred to the Burn Centre
Air crash, Faro, Portugal, 1992: 236 injured, 26 patients transferred to the Burn Centre
Air crash, Hercules, Eindhoven, 1996: 7 patients transferred to the Burn Centre
Café fire, Volendam, 2001: 277 injured, many patients transferred to the Burn Centre
Nightclub Fire, Bucharest , Romania, 2015: 100-200 wounded, two patients to the Burn Center. Maasstad Hospital coordinated the arrival of patients to the three burn centers in the Netherlands.

Scientific research Scientific research is an important aspect of the Burn Centre. Since 2004 most of the scientific research into burns has been co-ordinated by the Association of Dutch Burn Centres in the Netherlands (ADBC). Scientific research Scientific research is an important aspect of the Burn Centre. Since 2004 most of the scientific research into burns has been co-ordinated by the Association of Dutch Burn Centres in the Netherlands (ADBC).

The objectives of the ADBC are:

to improve the treatment of the patient with burns in various areas, from first aid to aftercare;
expanding knowledge with regard to specific problems relating to burns treatment and patients;
raising the standard of scientific research in the field of burns care/patients, and
the optimised implementation of the results of research in a clinical context.

Research team

A research team operates in the Maasstad Hospital Burn Centre. This team consists of nurses, professionals allied to medicine, doctors, a research nurse, a nurse scientist, PhD-students and a research coordinator/epidemiologist. The research team initiates its own scientific research and collaborates other studies within the ADBC and with partners from universities including the department of Public health and the department of Trauma surgery, Erasmus University.

The emphasis of our research has traditionally been on epidemiology and registration. The epidemiology looks at the occurence of illness and its determinants The economic studies were added to our research area a few years ago.

Dutch Burn Repository R3

The Dutch Burn Repository R3 (DBR R3) is a uniform registration, including all admissions in Dutch specialized burn care. It has developed into an established entity of burn care, thanks to the dedication of members of the Dutch Burn Repository group. The DBR R3 was launched in January 2009. In combination with the unified historical databases from the three burn centers, national data became available from 1995 onwards.

The general aims of the DBR R3 are to:

monitor burn injury incidence, burn injury aetiology, and to collect data on treatment, outcomes and quality of care, to enable and support research and improve quality of burn injury prevention and patient care;
to deliver bench mark information, information for research purposes and policy making.

We conduct epidemiologic studies on specific high risk populations for burn injuries and outcome after burns. Next, we perform cost studies in specialized burn care and on burn care in non-specialized settings and economic evaluations of specific diagnostics and interventions in burn care, to improve burn care efficiency.

Clinical studies

We initiate and collaborate in clinical studies, including randomised clinial trials into the effectiveness of upcoming diagnostics and treatment. Forthcoming studies are:

randomized controlled trial on the effectiveness of hydrosurgical versus conventional tangential excision in patients with deep dermal burns on long term scar quality.
a prospective cohort study on the burden of burn injuries, in which we will quantify the societal impact of burns with a state-of-art burden of disease methodology
an example of an ongoing study is the scientific research into the social impact of life with scars. All adult patients and their partners who are able to complete questionnaires are approached five times over an 18 month period. The aim of this research is to create better support for people with burns and to achieve a better understanding of how social problems arise. The results of this research will be shared in the future with the care providers in the burns centres so that they can cater to the specific care needs even better.

Examples of recent publications in scientific journals

Goei H, van der Vlies CH, Hop MJ, Tuinebreijer WE, Nieuwenhuis MK, Middelkoop E, van Baar ME. Long term scar quality in burns with three distinct healing potentials: A multicenter prospective cohort study. Wound Repair Regen. 2016 Apr 22. doi: 10.1111/wrr.12438. [Epub ahead of print]
Goei H, Hop MJ, van der Vlies CH, Nieuwenhuis MK, Polinder S, Middelkoop E, van Baar ME. Return to work afterspecialised burn care: A two-year prospective follow-up study of the prevalence, predictors and related costs. Injury. 2016 Mar 31. pii: S0020-1383(16)30076-6.doi: 10.1016/j.injury.2016.03.031. [Epub ahead of print]
Baartmans MG, de Jong AE, van Baar ME, Beerthuizen GI, van Loey NE, Tibboel D, Nieuwenhuis MK. Early management in children with burns: Cooling, wound care and pain management. Burns. 2016 Mar 26. pii: S0305-4179(16)30003-1. doi: 10.1016/j.burns.2016.03.003. [Epub ahead of print]
Hop MJ, Stekelenburg CM, Hiddingh J, Kuipers HC, Middelkoop E, Nieuwenhuis MK, Polinder S, van Baar ME; LDI Study Group. Cost-Effectiveness of Laser Doppler Imaging in Burn Care in The Netherlands: A Randomized Controlled Trial. Plast Reconstr Surg. 2016 Jan;137(1):166e-176e. doi: 10.1097/PRS.0000000000001900.
Oen IM, van der Vlies CH, Roeleveld YW, Dokter J, Hop MJ, van Baar ME. Epidemiology and costs of patients with toxic epidermal necrolysis: a 27-year retrospective study. J Eur Acad Dermatol Venereol. 2015 Dec;29(12):2444-50. doi: 10.1111/jdv.13352. Epub 2015 Sep 28.
Dokter J, Vloemans AF, Beerthuizen GI, van der Vlies CH, Boxma H, Breederveld R, Tuinebreijer WE, Middelkoop E, van Baar ME; the Dutch Burn Repository Group. Epidemiology and trends in severe burns in the Netherlands. Burns. 2014 Nov;40(7):1406-14. doi: 10.1016/j.burns.2014.03.003.

Further information

Further information about scientific research can be obtained from Dr Margriet van Baar, research coordinator and head of ‘Epidemiology, registration and economic evaluation’ at the ADBC. Contact details: (010) 291 34 28 or baarm@maastadziekenhuis.nl

Back to school support A child with burns who has just left the burns centre has been through an intense experience. The treatment after leaving the burns centre is thereby not yet at an end. It is at this point that it is particularly important for the pupil to resume their ‘normal’ life as quickly as possible. Functioning at school thereby plays an important part. Back to school support A child with burns who has just left the burns centre has been through an intense experience. The treatment after leaving the burns centre is thereby not yet at an end. It is at this point that it is particularly important for the pupil to resume their ‘normal’ life as quickly as possible. Functioning at school thereby plays an important part.

That is why the ‘Back to school’ project has been developed. The paediatric and aftercare nurses and the teaching assistants in the Burn Centre are trained to support children who have suffered burns back into school.

Support matched to situation and circumstances

A child who has been treated in the burn centre for an extended period has often missed a lot of school. They now need to learn how to adapt again to the school routine and the boundaries which apply inside (but also outside) the classroom. Children are also very inquisitive by nature and can react (non-)verbally to the child. A child senses this unerringly and may find it difficult to go back into the classroom for the first time. Support can facilitate the entire assimilation process.

The child, the classmates and the teacher are all included in the return to the classroom. Every child, parent, teacher and classmate is unique. Years of experience enable the aftercare nurse and the teaching assistant to deal with this appropriately, and the support is matched to the situation and circumstances on a case by case basis.

Jennifer’s story

Jennifer was supported in her return to school by the aftercare nurse (Anneke) and says:

“I really liked the fact that Anneke came to my classroom to explain what had happened and what burns are. She also taught the class what to do if there’s a fire. Because Anneke explained everything in the classroom, all the children understood better what had happened and why my back looks different. This also helps against bullying because all the children knew what had happened to me. When I went to a new school, Anneke came again.”

Further information

If you would like to know more about the ‘Back to school’ support please contact the Burn Centre on (010) 291 37 18.