title: Examining national burn care policies--is the Israeli burn care alignment based on national data?
abstract: The treatment of burn victims constitutes a considerable challenge both to the clinician in regard to mundane treatment and to health systems in regard to structural organization. The state of Israel is in dire need of competent burn care capabilities for political, geographical, and demographic reasons. Israel currently has five designated burn units but no burn center. A review of the recent literature suggests that larger burn centers can convey lower mortality rates and better functional outcomes for severe burn patients in comparison to smaller burn units. The objective of this study is to assess Israel's burn care alignment needs and capabilities based on Israel's burn patient and burn unit data. In addition, the authors aim to compare the burn care alignment capabilities with those of the country's European and American counterparts. Data of all the burn patients hospitalized in Israel's level 1 trauma centers' burn units between the years 1998 and 2005 according to the Israeli Trauma Registry were analyzed. Simultaneously, data regarding the setup and arrangement of each burn unit were obtained from each burn unit director via phone. Between the years 1998 and 2005, 974 adult patients with burns of the second degree or higher spanning 20% TBSA and more were hospitalized in the five hospitals that operate a functional specialized burn unit. The average hospitalization period was 32.4 days while the mortality rate was 21.1%. Currently, Israel's five burn units report possessing 27 burn beds and 14 burn intensive care unit beds. Due to the continuous risk for terror attacks and military campaigns and due to Israel's inability to refer excess burn patients to neighboring countries, Israel desperately needs efficient burn care capabilities. Israel currently trails both the United States and Europe in regard to burn beds and burn centers per population. The annual quantity and severity of burn patients in Israel largely exceeds the amount needed to justify an establishment of a burn center by the current American Burn Association guidelines, while the literature provides vast amount of evidence proving burn centers' efficacy in improving outcome, shortening hospitalization periods, and reducing costs. Taking all these elements into consideration, it might be prudent to establish a national burn center in Israel to promote burn care standards and disaster planning up to international standards.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Josef
authors.initials: J
authors.lastname: Haik
authors.forename: Oren
authors.initials: O
authors.lastname: Weissman
authors.forename: Adi
authors.initials: A
authors.lastname: Givon
authors.forename: Alon
authors.initials: A
authors.lastname: Liran
authors.forename: Ariel
authors.initials: A
authors.lastname: Tessone
authors.forename: Demetris
authors.initials: D
authors.lastname: Stavrou
authors.forename: Arie
authors.initials: A
authors.lastname: Orenstein
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002053:Burn Units / Q000458:organization & administration; D002056:Burns / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006291:Health Policy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult