From the oldest tertiary care hospital in the city in 1942, Safdarjung Hospital is now spread across a 47-acre campus in south Delhi and receives between 1,200 and 1,500 emergency patients across different specialties every day. Within this bustling centre is a smaller 106-bed centre with its own emergency, ICU and OTs, for burns patients across north India.
Started in 1962 in the middle of a dhobi ghaat, the burns department in Safdarjung is the oldest specialised emergency unit that still receives emergency cases from as far as Badaun, Bulandshahar, Jammu and Panipat.
An alley in the front of the three-storey unit is the burns casualty or emergency. Equipped with a continuous oxygen central line, patients rushed in are first laid on two beds in this alley for initial evaluation. In contrast to “regular” emergencies, doctors here are armed with water baths, litmus paper, suction tubes to clean wounds, and charts to note the percentage of burns.
When a patient is first wheeled in to the emergency, doctors start with the A, B and C. The A is for airway, B for breathing and C for circulation. These are basics all the staff, including nurses and paramedics, learn. “Burns emergencies are unique from other emergencies. Here, we have to first evaluate the patient’s A, B and C before starting treatment for burns. This is the first step to see whether treatment for burns is required, or if it is too late.
Our first priority is to save the life of the patient,” says Dr R P Narayan, head of the burns department at the hospital. In electrical burns, often it may “look like” the patient is sleeping. The external electrical signals interfere with the electrical system of the heart, halting its circulation. In case of household burns, the patient’s airway may be blocked due to foreign materials in the respiratory passage.
The critical water wash comes next. With patients writhing in pain and relatives hovering around, as doctors shoot questions of what chemicals or agents led to the burns, the answer is usually always the same. “Tezaab” (Acid).
Doctors who have manned the emergency for some time know tezaab in layman terms is just a generic term for chemical and not specifically an acid. So for a 13-year-old boy brought in on June 17, nurses start the wash as a doctor holds out the litmus paper on his burnt arms. It is turning red, so this is an acid burn. If the paper turns blue, the chemical would be alkaline.
Doctors fill in a chart of the human body, front and back, to identify the part of the body which is burnt and enumerate the percentage of burns. This forms the most critical part of the burns emergency conversations. When relatives of patients ask the all-encompassing question, ‘Will our loved one live?’, doctors have a formula.
“If the age of the patient and the percentage of burns adds to 100 or more, the patient is extremely critical. For numbers over 60, chances of survival are inversely proportional, and we start explaining that to patients from the start,” says Dr Narayan.
With infection control being a concern for patients, the emergency is air conditioned and room fresheners are sprinkled frequently. The oxygen central line supply runs up to the waiting area and outside the minor OT and OPD of the burns department.
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