Helping Children Heal

There is a significant need for burn care in the South, and according to the American Burn Association (ABA), it is estimated that children under five are 2.4 times more likely to suffer burn injuries than the general population.

So what should you do if your child gets severely burned?

Oftentimes, burn patients go to their primary care doctors’ offices or sometimes to an out-of-state burn center. Once there, the initial injury can be cared for, but because burns often require many follow-up visits, these patients would have to commute back and forth to get all of the other care that they need.

To  address those types of challenges, the MUSC Shawn Jenkins Children’s Hospital created the state’s only comprehensive pediatric burn center, which is led by Rohit Mittal, M.D., medical director of the Pediatric Burn Unit and the Shriners Children’s Endowed Professor in Pediatric Burn Care.

Raised in Atlanta, Georgia, Mittal received his medical degree from Emory University and pursued a fellowship in pediatric burn care, as well as burn reconstructive surgery, at the University of Texas Medical Branch in Galveston, Texas. He went back to Emory where he worked at Grady Hospital, a Level I trauma center in the Atlanta metropolitan area and came to MUSC in December of 2022.

In the following Q&A, Mittal discussed his vision for the Pediatric Burn Unit here at MUSC.

What attracted you to MUSC and this program specifically?

Throughout my training, I gained expertise and refined my surgical technique so that I can handle just about any situation that comes my way. Then, at Grady Hospital, I gained an understanding about some of the intricacies of leadership at a burn center, including what steps a trauma center undergoes for accreditation.

I think those skills, combined with my background, are what led me to the exciting opportunity at the pediatric burn program here. I had also gotten pretty familiar with the vision and team that Steven Kahn, M.D., chief of burn surgery, and Aaron Lesher, M.D., pediatric burn medical director, put together. I wanted to move that vision forward by growing the program, performing innovative or life-impacting research and seeing the program verified as a center of excellence through the ABA. I thought this was a good way to have a regional impact and grow a program that is esperatelyneeded in this state.

Can you describe what you’ll be doing in your new role as part of the Pediatric Burn Unit?

My new role will consist of both clinical and administrative tasks. From the clinical standpoint, my role will be to help to develop a comprehensive plan to take care of pediatric burn patients over the course of their lives. To give you a point of perspective, if a child has a 50% burn – a burn that spread to over half of his or her body – over the course of a lifetime, that patient will end up needing 50 to 100 reconstructive interventions. Not all of those would be major surgeries, but they are designed to improve a patient’s functional outcome – that’s what a Burn Center of Excellence is designed to do.

We want to provide all the resources patients might need: access to good, high-quality burn care; access to reconstructive resources, including a laser program and surgical reconstruction; and access to multidisciplinary care, consisting of psychiatrists, psychologists and vocational counselors.

For children, we want to help to reintroduce them back into school and help them through some of the challenges they may face as they start living their lives again. We also facilitate support groups to guide them through the recovery process and provide them an environment where they can meet others who’ve gone through similar experiences.

On the administrative side of my job, a major focus for me and for MUSC Children’s Health is to ensure that the Pediatric Burn Center is successfully accredited by the ABA. They have strict criteria that centers need to meet in order to verify that they can deliver high-quality care based against rigorous standards. Our newly formed collaboration with Shriner’s Hospitals, along with the endowed professorship grant, will provide the additional support and research to help to achieve ABA accreditation.

I will be working closely with key stakeholders across the institution to ensure that we have the multidisciplinary support, funding and resources necessary to be ready for accreditation. If I can accomplish what I hope to within the next year, we aim to go up for verification in 2024.

I am also particularly passionate about community outreach and burn prevention, especially pediatric burns. That’s something I hope to grow over the next several years. I want to work with firefighters, law enforcement officers and EMS providers to educate them and help them to get patients to us in an expeditious and safe fashion.

We are also visiting different emergency rooms to talk to emergency room doctors about the resources our center has, how they can provide immediate burn care and how they can triage who needs to come to us immediately or who can be seen there as an outpatient.

Additionally, MUSC has a robust telemedicine network, so there are many ways we can help first responders remotely. We want to stress that we are available 24/7, and providers throughout the state can call us and have a burn care doctor on the phone anytime.

What do you think some of the greatest strengths of the burn unit are? How might you strengthen the program?

I think the biggest strength here is the people that are involved in the center. Dr. Kahn set up an excellent foundation of really motivated individuals that share the vision for the future of the South Carolina Burn Center at MUSC Health. For me, it is great that there are people I can rely on to take initiative and work hard to serve the patients. And, as I mentioned, our Shriner’s affiliation will impact the level of care we can provide pediatric burn patients in the Southeast region.

One area I’m passionate about and would like to strengthen is burn reconstructive care, which is a little bit different than what one might think reconstructive surgery means. It is a mindset where you approach a patient, look at all of the things that this patient is struggling with and what his or her life goals are and come up with a plan to help to correct those problems to achieve the end goal. It is a patient-centered approach to reconstructive care.

What challenges do you think you might encounter in your new position?

One challenge is a product of what almost every health care field has faced over the past couple of years due to the pandemic – struggling with personnel and staffing issues. This is a challenge that we have to address because burn care requires specialized nursing care that often comes from experience. It’s laborious work that requires a lot of passion from our nurses.

There’s not a national program that teaches nurses how to take care of burn patients, but our team has developed an educational framework where nurses are taught the basics of burn care every quarter and then are consistently mentored with on-the-job-learning from not only physicians but all the ancillary staff and other experienced nurses.

Are there common features of burn care between children and adult patients, or are there special considerations when treating a child?

I think the basic principles of wound care apply across the board. But treating children is more challenging because they still have a lot of psychological and emotional growth to do and a burn injury can sometimes stunt that. Also, the child is not your only patient. You have to counsel the family on how to manage wound care at home, which can be challenging.

The healing process can take several months, so there is a state of chronic inflammation that affects every metabolic and hormonal pathway in your body. In pediatrics, it’s been shown that a burn injury has repercussions on a patient’s metabolism for years afterward – it can affect the way his or her heart functions, the way the lungs work, the way the body handles blood sugar (children with severe burns have a higher incidence of diabetes) and the way the bones mature.

The other thing is, as children grow, their scars don’t grow with them. They may have small scars that don’t bother them when they’re younger, but as they grow, those small scars may result in a lot of functional problems. So pediatric burn patients require a lot of support, not just in the acute phase but also in their long-term care.

That continuity of care drives us and keeps us motivated and engaged in the field. We get to operate on our patients and then see them grow over time and witness big moments in their lives, including graduations, marriages and births. At my last center, we had patients that had been coming in to see us for over 20 years.

What are some of your immediate and long-term goals for the burn center?

I think there are two big ones. First and foremost, we need to focus on accreditation as we talked about earlier. The second is developing the clinical practice here to make sure that we have appropriate guidelines and protocols in place to take care of these patients holistically. In addition to the nursing support, the surgical support, the child-life support, it is also important to have appropriate support for the families.

Because burn care is so specialized, it’s often seen as this mysterious, nebulous thing that a lot of people don’t understand, but in reality, working with burn care truly is multidisciplinary. I don’t think there’s a single department in the hospital that we don’t interact with in some way and doesn’t provide valuable input in taking care of these patients. This multidisciplinary approach is important for the long-term success of the unit.

Are there examples where MUSC is creating new paradigms for treating pediatric burns?

I think in order to be a center of excellence, we have to be involved in state-of-the-art research. We have several clinical trials underway, working with different industry partners to have the best and latest technology available for children as well as adults. For example, we are taking photos of burn wounds to train AI, over time, to classify burns and determine if they are shallow or deep.

We are also working with “Spray on Skin.” We take a small biopsy of a patient’s skin and turn it into a spray to help wounds to heal faster and hopefully reduce long-term scarring. Another colleague is working on describing the biochemical changes that may alter the bacterial environment in our skin after a burn happens to understand more fully why some burns get infected and others don’t.

Is there something you would like to share about yourself – something people might not know?

I came here looking to put down roots. I have a fiance, and we’re getting married next year, so this was an opportunity for us to be in a place with like-minded people to do work that I’m really passionate about, in a place where we can be members of the community. That’s what we’re really excited about.