Mil. Med. Sci. Lett. (Voj. Zdrav. Listy) 2013, vol. 82(3), p. 135-137ISSN 0372-7025

LETTER TO THE EDITOR

REPORT ON AN INTERNSHIP AT THE BURNS CENTREIN PITTSBURGH, USA

In the period between the 18th February andthe 17th March, 2013, I had the opportunity of ac-cepting an internship in The West Penn HospitalBurn Center, in Pittsburgh, Pennsylvania. Duringthe internship, I shared in the usual medical activitiesincluding working in the ICU, standard wards, op-erating theatres, out-patient clinics as well as attend-ing seminars in the Burns Centre or in the PlasticSurgery Department.

The city of Pittsburgh is located in the State ofPennsylvania, in the North-East of the USA.The inner city has about 350,000 inhabitants, but theentire metropolitan area can count almost 2.4 millionresidents. The city has several pseudonyms, such as

"Steel Capital of the World" and "City of Bridges."This is because Pittsburgh and the region wasthe largest exporter of steel in the world during pastdecades. The second epithet for the city is derivedfrom the record number of 446 bridges. The vast ma-jority of them span the three rivers that flow throughthe city - Allegheny, Ohio and Monongahela. Pitts-burgh is much like Hradec Králové in that the town–centre is located right in the middle of a two-riverconfluence. Another similarity with Hradec Královéis the relatively high number of students in the city.Pittsburg established three universities and two med-ical schools. Another interesting thing for me wasthe fact that Pittsburgh is twinned with my hometownof Prešov in Slovakia.

Figure 1. The West Penn Hospital and its Burns Centre on the second floor.

I was able to enjoy this Fellowship thanksto the "We remember Elvis Aaron Presley” Founda-tion which fully covered my expenses. The Founda-tion was established in 1989 and, since that time,it has supported the travel-costs for a number oftrainees from all over the world in an amount of 90,000 USD. The internship is usually granted to 1-2 fel-lows per year. It goes most often to young doctorswith an interest in burns-medicine, nurses or othermedical staff. We are reminded that the Elvis AaronPresley Foundation was founded by people fromthe era of Elvis Presley pop-music superstar; theseloyal fans commemorate through this method his pre-cepts of medicine and the treatment of trauma-pa-tients in particular. In addition to this work,the Foundation makes financial donations and, everyyear, organizes summer-camps for burned children.

The Burns Centre itself is located at the West PennAllegheny Hospital, which is a part of the 5 hospitalsforming the West Penn Allegheny Health System.In 2012, the company employed a total of 11,423 em-ployees of whom 1,695 were doctors who had com-pleted their training, 457 residents and 3,000 trainednurses. In 2012, 55,982 in-patients and 802,015 out-

patients were treated. The Hospital budget for thatyear was 1.6 billion USD; donations from privatesources accounted for nearly 4 million USD.

The Burns Centre has 2 permanent, fully-traineddoctors and averages 2-3 residents and 1-3 medicalstudents. The capacity of the Centre is 9 standardbeds and 5 intensive-care beds. Last year, 343 pa-tients were hospitalized and 1,500 were treatedas out-patients. In 2012, a total of 230 operations wasperformed. The most common procedure is tangen-tial early necrectomy with autotransplantationof split-thickness skin-graft performed at the sametime, most often during the 1st or 2nd post-traumaticday. An interesting finding for me was the large dif-ference in the cost of the operation. Compared withthe Czech Republic, it is approximately 5 timeshigher. Access to modern technologies is probablyone of the reasons for this. It increases the costof the operation but, on the other hand, enables fasterrecovery of the patient, a shorter hospital-stay, andreduces the level of out-patient monitoring. For de-bridement, a water-jet device removes the dead tis-sue; for hemostasis, thrombin is used; and for fixationof skin-grafts, fibrin-glue is applied.

Slaninka: Report on an Internship at the Burns Centre in Pittsburgh, USA

Figure 2. Members of the Foundation and Head of the Burns Centre Dr. Ariel Aballay (second from left).

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During my periods in the operating-theatre andafterwards, I had the opportunity of discussingvarious topics with burns-medicine experts; withAriel Aballay, MD, FACS, who is the Headof the Centre, and a former military surgeon,consultant Robert Kelly, MD. Both of them areactive members of the American BurnsAssociation. With great interest we discussedprocedures and methods that we use in our countryas well. Due to their awareness of the very goodlevel of medicine in the Czech Republic, theysometimes asked for my opinion on the treatmentor procedures that we would use in ourdepartment. During my stay there, my colleaguessuccessfully tested the use of vacuum-therapyin skin-grafting, with which we had already hadvery good experience.

In the operating-theatres, personnel do not gothrough the filter, as we do. Clothes that doctorswear in the theatres are the same as they use onthe ward, or even the same as when they go forlunch at a local restaurant. A big surprise wasthe absence of special shoes for the operating-theatres; they routinely operate in shoes, the sameas those used by the staff on the wards or on the wayto work. Observer-interest is further quickenedwhen noting the emphasis put on eye-protection,with surgeons using either operating-glasses orspecial masks to shield their faces.

Rounds took place on the wards every day duringbreaks between operations. Residents, medicalstudents and surgical assistants learn all aboutthe patients. Each participant was given printeddocuments on which basic information aboutthe patients was explained. During the rounds,a laptop is normally used for accurate interpretationof the test-results. The crucial part of communicationand information-exchange during rounds took placeoutside the patient’s room. At the bedside, onlya general discussion took place with the patient;the emphasis was put on answering a number ofquestions that patients and their family-memberscommonly have for the consultant. Nurses are alwaysinvolved and they are on hand to deal with anyaffiliated issues. The whole ward-situation is laterdiscussed, and some topics would often find theirway into seminars which are held at least oncea-week. At one of the seminars, I had the opportunityof presenting a short lecture in which I spoke aboutthe burns care-system in the Czech Republic.This was well-appreciated, and I answered somesubsequent interesting questions.

The entire internship took place in a verypleasant and friendly atmosphere. Towards the endof my stay, I was accepted as an Honorary Memberof the local "Humby Association", and I was giventhe badge with one of the most important tools fora burns-surgeon – the Humby knife. During my stayin the Burns Centre in Pittsburgh, I gainedconsiderable knowledge, and was re-assured bythe fact that in the Czech Republic and HradecKrálové, we perform medicine at a level fullycomparable with the most-developed countriesof the world. This internship also allowed meto make new professional contacts with excellentpotential for further co-operation.

Igor Slaninka, MD.Division of Plastic Reconstructive Surgery

and Burns TreatmentDepartment of Surgery, University Hospital

CZ – 500 05 Hradec KrálovéCzech Republicslaniigo@fnhk.cz

Received 7th July 2013.Revised 8th July 2013.

Published 6th September 2013.

Slaninka: Report on an Internship at the Burns Centre in Pittsburgh, USA

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