February 24, 2025 • 33 mins
National Burn Awareness Week is in February, and it's recognized by the American Burn Association. It is a chance to promote burn prevention and awareness in communities. With more than 3,000 members, the ABA dedicates their efforts and resources to promoting and supporting burn-related care, prevention, education, and research.
The Connecticut Burn Center in Bridgeport Hospital is the only burn center in the state. Dr Roselle Crombie is a member of the ABA. She is a surgeon specializing in burn surgery and surgical critical care at several of the Yale New Haven Health Systems flagship hospitals in Southern Connecticut including the Bridgeport Burn Center. Her particular passion is a mix of burns, burn and trauma reconstruction, wounds, and general surgery. Dr. Crombie talked about the long road to recovery for some burn patients. She says the number of burn patients has decreased and many burns are preventable. The most common type of burn is a scald burn usually in the kitchen. Dr. Crombie says patients and their families can benefit from CT Paid leave, because it can help financially and emotionally, and it allows for caregiver leave.
To get in touch with the ABA please go to their website: ameriburn.org American Burn Association – Improving the lives of those affected by burn injury
To get in touch with the Bridgeport Burn Center go to their website at: The Connecticut Burn Center - Bridgeport Hospital
For information or to apply for benefits please go to: ctpaidleave.org https://www.ctpaidleave.org/
https://ctpaidleave.org/s/?language=en_US
https://www.facebook.com/CTPaidLeave
https://www.instagram.com/ctpaidleave/
https://twitter.com/CTPaidLeave
https://www.youtube.com/results?search_query=ct+paid+leave
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nancy Barrow (00:01):
Hello Connecticut, and welcome to The Paid Leave
Podcast The title basically saysit all. I'm Nancy Barrow, and I
will be delving into this newstate program and how it can
help you and your family. Thispodcast will give you
information you should knowabout Connecticut Paid Leave and
maybe just a little bit more.
Connecticut, paid leave bringspeace of mind to your home,
(00:22):
family and workplace. Welcome toThe Paid Leave Podcast.
The National Burn Awareness Weekis in February, and it's
recognized by the American BurnAssociation, also known as the
ABA. It's a chance to promoteburn prevention and awareness in
communities, and this year'stheme focuses on reducing burn
(00:45):
risks in homes, apartments andall living spaces. My guest
today is Dr Roselle Crombie, whois a surgeon specializing in
general surgery, burn surgery,and surgical critical care at
several of the Yale New Havenhealth system, flagships,
hospitals in southernConnecticut that includes the
Bridgeport Burn Center. Herparticular passion is a mix of
(01:07):
burns, burn traumareconstruction and wounds and
general surgery. She is highlyinvolved as faculty in the
department of surgery the YaleSchool of Medicine over the
course of her career, andmentors the younger, pre health
generation. Her post graduatefellowships were in burn surgery
and surgical critical care atYale University School of
(01:28):
Medicine, where she currentlyremains on faculty. Outside of
her job nationally, she hasserved as the 32nd president of
the North American burn societyand served on the ethics
committee and epidemiology forthe American Burn Association.
She is a fellow of the AmericanCollege of Surgeons, a fellow of
the American Burn Association.
She was recently appointed to bethe director at large for the
(01:50):
board of the American Board ofwound medicine and surgery, and
is currently the VP programchair for the Connecticut
American College of Surgeonschapter, the executive board and
chair of the women's surgerygroup, and is involved in the
women's surgeon groups withinseveral national societies. She
serves as a reviewer for TheJournal of Burn Care and
(02:12):
Research the Journal of WoundCare, and has served on the
Military review for Burn Grants.
She's a member of the consensuscommittee on tissue regeneration
for the Journal of wound care.
With a team of other burncolleagues, she sits as VP of
the non for profit Reach BurnFoundation to support the needs
(02:32):
of adult burn survivors.
Additionally, she serves on theboard of the Burn Research
Foundation. She has numerouspublications. And finally, Dr
Crombie is married with threechildren. Welcome to The Paid
Leave Podcast. Dr Crombie, youare a busy woman!
Dr. Roselle Crombie (02:49):
Thank you.
Yeah. You know, I think we alltry to do our part. It takes a
team, right?
Nancy Barrow (02:54):
It sure does.
We'll start at the beginning.
Can you tell me about yourinvolvement with the American
Burn Association, also known asthe ABA.
Dr. Roselle Crombie (03:02):
Yeah so, you know, the ABA is kind of
like our over arching body thatoversees a lot of the burn
surgeons and burn carethroughout the United States. It
first started in 1967 reallyjust kind of grassroots these, I
think it was like 17 surgeonshave been meeting for a period
of six years, and then they kindof decided, hey, this is we have
(03:23):
a unique specialty. We'velearned a lot after the war. Why
don't we actually form anassociation? So four of those
individuals, including a bunchof different positions, there's
a Basil Pruitt was at the he'slike a pillar in burn care, and
Dr. McMillan, Dr.Arts, Dr.
Feller and Dr. Boswick, born theactual ABA in 1967 all those
(03:45):
guys have all been presidents ofour association, and since then,
it's grown to 1000s of membersnow that include the burn really
the burn team. I'm really justone small part of the burn team
I can't take away from my allimportant, my nurses, my
therapists, the social workers,the firefighters that get the
(04:07):
patients to us, and EMTs andcertainly all of the other staff
that support us to create thisburn environment and the
continuum of burn care evenbeyond the hospital. And that's
really what the ABA formed, wasit formed this incredible team
of just individuals that arepart of the care. And I wish
every disease had something likethat. It's essential to the burn
(04:29):
patient, because there's so manyother issues that they need to
deal with. Yeah, that's how itall started.
Nancy Barrow (04:37):
And how does it affect Connecticut? How does the
American Burn Association? Areyou a member of it, and what are
their responsibilities for that?
Dr. Roselle Crombie (04:43):
I first became a member when I was a
fellow, and that was really myfirst exposure to this
community. It's a very uniquespecialty in that it crosses for
physicians. It crosses bothgeneral surgery, plastic
surgery. I know some colleaguesof mine that are in rehab
medicine. Yeah, and it's reallya home for all of those
individuals. So you could reallyjust be a member and come to the
(05:05):
conferences, which there aremany. Now, there's our one
conference that happensthroughout the usually in the
spring of the early spring ofthe year. But there's regional
conferences, like we're in thenortheast, there's a south,
Southern burn Colloquium. Andthen there's, they're just
reenacting Western burn. There'sa Midwest, there's Ohio. So in
addition to overseeing and kindof helping all of those
(05:26):
different areas, it really is aresource for us to kind of talk
about protocols, what's beingdone. Because there's only, at
the actual moment, about 250burn surgeons in the nation that
are caring for all of thesepatients. I mean, we have teams.
We've got, you know, mid levelproviders, nurse practitioners
(05:46):
and PAs and stuff like that. Soit's essential that we have a an
overarching body that can kindof guide us. And so the way that
it kind of helps us is to reallyhelp with things such as
training and something calledabls or advanced burn care. And
that can be many people can takethat even EMTs, it doesn't. You
don't need to be a physician.
And certainly they do thingssuch as lobby for us. I remember
(06:08):
as a fellow going to DC, beingdragged down there, and that was
my first experience of likemeeting our senator at the time
and really advocating for thedifferent things that we were
having in Connecticut related toour burn patients. And so they
so they are involved both inadvocacy, prevention. I was
involved in publishing ontreadmill injuries, because
(06:30):
people, January, people would begetting back in shape, and then
a lot of these kids would justgrab the treadmill and then get
a full thickness friction burn.
So we were able to, you know,lobby and change the through a
lot of publications and stufflike that, to change the safety.
I don't know if you notice, ifyou go and look at, you know, a
(06:52):
treadmill, like Dick's SportingGoods now, it has a has a, like
a safety latch to it that willimmediately shut off if you were
to fall off of it, or anythere's different safety things,
and that's all part of the, youknow, the lobbying and different
research that we kind of broughtthe to, you know, our nation. So
the ABA is very involved in, youknow, a lot of things,
education, prevention, but alsocare.
Nancy Barrow (07:13):
It's amazing. I know that you work at the
Bridgeport Burn Center, and it'sthe only burn center in
Connecticut, but you saidthere's only, like, 250 burn
surgeons. So do a lot of peoplefrom out of state come to
Connecticut to the BridgeportBurn Center?
Dr. Roselle Crombie (07:29):
Yeah, so we draw from the other burn centers
in our area are, there'sCornell, which is down in the
city Rhode Island, which is inProvidence. And then we do send,
there's the Shriners, which is awonderful institution, kind of,
obviously very well funded, andmost of our larger burn kids we
(07:50):
send up there. Because the waythat I think about it is, if my
kid had a, you know, a terrible,devastating burn, there's a
school in the hospital. We justdon't have that at our burn
center here, but it's kind ofcool, because you have a network
of burn centers, but we drawfrom southern Rhode Island.
We'll get patients from there.
Western Massachusetts are we geta lot of patients from because
they both their burn centers arein Boston. So as you can
(08:12):
imagine, if you think of justlike the northern part of
Connecticut, as you go up, I 91like all of that, it's much
quicker for them to come down. Iremember getting a burn from
Vermont, Southern Vermont one,one of the years that I was
here. And we do get some, youknow, New Yorkers as well,
depending on where they are,because the Connecticut State
line is, is, you know, on theborder there.
Nancy Barrow (08:35):
How did you get interested in helping burn
patients? Because I think ittakes a very special kind of
person to do this work. It's alot there's a lot of
disfigurement. It must be reallyhard or rewarding when you can
help patients.
Dr. Roselle Crombie (08:51):
You know, I never think of the hard part. So
my personal story is that wayback when it was a required
rotation for my training, so youhad to have burn surgery as a
rotation, and that was really myfirst exposure. I was shocked
and pleasantly surprised that itcombined a lot of different
things that I like. So in thatsix week period, I had a lot of
(09:12):
inspirational patients. So Ithink that that's what really
drew me to it. And then Iwanted, I sought, to pursue an
extra year of that training.
And, you know, to just tie itback to the ABA, I didn't
realize that it was going to besuch a collaborative community,
which is wonderful. And I think,I think in medicine, there's so
much competition, and it's verydifferent than some of the other
(09:34):
specialties that I hadexperienced. Like there was, it
was really neat to meet peoplethat were ahead of me in their
career. It was so collaborative.
And I think that that we have tobe that way within burns,
because there's so few of us,yeah, and so all of those things
are really kind of brought meinto the field. And kind of like
(09:54):
you, it's like, when we chooseour career, we figure out what,
what are the things that welike. It just, it kind of comes
just naturally.
Nancy Barrow (10:00):
What are the most common types of burns that you
see? Do you see home, kitchensplatter burns? Or is it work?
Or are they all over the place?
Electrical, chemical?
Dr. Roselle Crombie (10:10):
Yeah so we see all of them. Just percentage
wise, the vast majority of burnsare scalds. Unfortunately,
there's a more of a malepredilection in sort of the
younger age group as well.
Unfortunately, it's a lot likethis. There's seasonalities to
burn. So right now it's whenwe're in the winter time, and we
see a lot of kids with scaldinjuries. So they're pulling
down, like toddlers that pulldown the tea because it's up on
(10:30):
top there, you know, waterbottles, or some of that size.
So those are, or they, they putthe baby in the sink, and the
baby, like, kick the, you know,the faucet and hot water came
down on them, you know. And alot of our prevention is focused
around that. For, you know, anoverwhelmed parent or whatever.
There's house fires, obviously,at this time of year as well.
(10:51):
You know, with the advent of thefire pits, that happens to, you
know, a lot more in in sort of,like the fall and the spring
season, you know, celebrating,maybe not paying attention to
different things. We've hadpeople literally fall into fire
pits. That's a whole, that's awhole big thing. And then
(11:13):
certainly the other, the othersort of recreational thing that
we see a lot of fireworks. Youknow, there's always, like, a
little bit of something going onwith that. Or people will
barbecue on the beach. We've gotbeaches down in southern
Connecticut, and they'll forgetto bury the poles and you're
walking, you know, barefoot onthe beach, as people do when you
get burned. So, yeah, we see allof them, you know, in terms of
(11:35):
those are the most common, butwe definitely have, you know,
like, I've had chemical burnsfrom the various universities
around us. I've had somebody puttoo much chlorine in the pool,
and the poor kid got shocked.
Wow, yeah, we've got, you know,electrical workers that are up
there trimming bushes, and, youknow, they forget the concept of
(11:57):
physics and the electricalfield, and they get zapped. So
there's all sorts of differentmechanisms that we see, but
statistically, the most commonare really the open flame and
that scald is the most common,followed by open flames.
Nancy Barrow (12:09):
And how do you treat them differently? And
maybe you should tell me whatthe difference is between like
first degree and fourth degreeburns.
Dr. Roselle Crombie (12:17):
Yeah, first degree burn is everybody, sadly,
is very familiar. It's sunburn.
So it is injury to your toplayer of your skin, called your
epidermis, and it's usually verypainful, as you can imagine,
because all the nerves areintact. Second degree burn is
really the best way to describethat is if you see blistering.
So it's gone through the firstfirst layer the epidermis, and
(12:38):
then into the second layer ofthe dermis. And it's your body
is reacting by, you know,putting fluid into that area
and, and that's really nervesare still intact. And there's
also a superficial second degreeand deeper second degree, which
is closer to third degree. Thirddegree means that you, you
really, you know, you've goneall through the layers of the
(12:59):
skin and kind of sitting intothe pretty deep layer. And
those, those by appearance, tendto be really thick and kind of
not sensate, and they don't moveas much as you can imagine,
right? The way that I can ittoo, is like when you fry an
egg, you can't get it back tothat liquid stage. It's, it's
just, it's just solid, and thenfourth degree burn is beyond
(13:21):
that, down into sort of thedeeper tissues like the bones
and the muscles and stuff likethat. And we really see those
more and sort of more thedevastating industrial injuries,
or if there's a house fire andthe patient's been found down
for longtime, car fires, and youknow, stuff like that.
Nancy Barrow (13:37):
And tell me what you do as a surgeon and how you
treat people.
Dr. Roselle Crombie (13:42):
Just like any other surgical disease, we
always have to ask ourselves, dothey need surgery to begin with,
right? Are we going to make thepatient better that way?
Specifically for burns, they canbe incredibly painful, as you
can imagine, if you know everysingle part of our skin has
nerves, right? So to treat thethe skin, you have to take out
(14:02):
the devitalized tissue. That'snot something most people will
tolerate, if you can imagine,like a very painful sunburn, and
even some, you know, very fairindividuals, like I have my
husband's red headed if heblisters, it's very painful. So
that's something that you haveto take them to the operating
room for, primarily foranesthesia. But the goal is
really a concept calleddebridment where you take away
(14:25):
the dead tissue to allow theliving tissue to heal, and then
eventually, if you need somesome of it heals on its own,
some of it we need to replacewith its own skin. And that's
what a skin graft is. It's likeplanting a sod. We take a little
piece from somewhere else in thebody where there's normal skin,
and we put it in put it into thearea after it's been debrided.
(14:45):
That's, you know, thicklyburned. But there's also other
things, such as down the linepeople have scars. So one of my
big interests is to do a lot ofdifferent reconstructions to,
you know, loosen up that scar,make it more functional. And
then some of that includeslasers. There's quite a bit that
we do as a surgeon for thosethose treatments.
Nancy Barrow (15:05):
Yeah and I know that you mentioned a team, so
tell me how that works, too. Soif a burn patient comes to you.
Dr. Roselle Crombie (15:10):
So the team includes, first, the outside
hospitals where they're beingseen, or clinics, and that's
incredibly important. We do alot of outreach. This great guy,
former burner, Jay Bresky, whogoes out and does a lot of
education to the to the variousdifferent not only ERs, but just
urgent cares. Because a lot ofpeople are seeking care, they're
just what should be referred andwhat should be referred, but
(15:31):
also how you can, you know,dress a burn, all that other
stuff, but we really teach themhow to evaluate it. So just like
you asked me, What's the first,second and third degree burn
like, it's very important, if Ican't see the pictures, for them
to be able to describe that. Sothere's education of that. So
that's the beginning of theteam. And then there's the
transport team, which includes,obviously, the EMTs, the the
(15:54):
pilots or the ambulance drivers,paramedics that get the patient
safely from wherever they'regoing to our hospital. And then
there is the the on site team,which always includes the
nurses, the burn surgeon.
There's typically a burn Techwho is medically trained to help
us with, you know, dressings andstuff like that. And then,
(16:16):
literally, every week, we kindof map out for the family and
for the patient, what happens.
Once a week, we meet with thewhole team, so the doctors, the
nurses, the physical therapists,the occupational therapists
really deal with kind of justface and hands, nutritionists,
(16:37):
there's social workers to kindof help with the overall
planning on how we're going toget them through the hospital
stay and how we get them home,what support that they need. And
then there is clergy, and wehave a different types of
counseling services that happenas well. So we that team sits
down pretty faithfully everyweek, on Tuesday at 10am to go
(16:58):
through every patient that hasbeen admitted to the burn center
to kind of come up with acomprehensive plan. And I find
it great because two things, Ialways learn something from
listening, and I think it comeit allows us to come up with a
more comprehensive plan for thepatient. But then additionally,
I think it's incrediblyimportant for each one of those
individuals that are sitting atthe table to know that they have
(17:20):
an important role in thispatient's care that we can't do,
you know, without them. So it'sa chance for them to speak, and
it really kind of helps toreally just make it a wholesome
team effort to get this patientthrough their care. We also have
an outpatient, you know, afterthey go home, they come and see
our PA and then us. I have aburn fellow. They're their
(17:40):
residents, obviously, becausethe faculty at Yale, they're
rotating as well, and we seethat they're part of their care,
both in the inpatient and theoutpatient and and it's nice
because it's a continuum forthem to be seen, you know, as
outpatient care as well. Becausea lot of I guess I should say
that we've been really greatnationwide about doing things,
about prevention and gettingthem numbers, I think, down to a
(18:03):
much better level than you know,when I first started this, over
20 years ago. But what thatmeans is that we're managing a
lot more of those patients asoutpatients. So we are. We've
created effectively the samesome you know, team in the
outpatient setting to help themthrough the next phases of their
recovery, probably the mostimportant phase, quite frankly.
Nancy Barrow (18:21):
Yeah it's interesting that you said the
educational part of it, thatyou've educated enough people so
that with prevention, so thatthe numbers have really
decreased in the last 20 years.
Dr. Roselle Crombie (18:30):
Yeah, it's still a big problem. You know,
we and like I was alluding to atthe beginning of the podcast,
there's been a lot of safetythings that you know that
happen, you know over time interms of building in, like, I
bring up the fireplaces, like alot of places in the nation,
they don't have centralizedheating. They have, like, a
(18:51):
stove with the glass stove. Sowe were getting, like, a bunch
of people and toddlers justgoing up to the glass so there's
been a lot of changes in thedesign of both fireplaces and
glass stoves to be a little bitmore, you know, to be safer.
Nancy Barrow (19:05):
Yeah, and that's your advocacy, right there. You
know, with the ABA going, goingand advocating for those burn
patients, I know that youmentioned counseling, and tell
me about the mental health andbehavioral health, how important
is, is that for recovery inpatients who have severe burns.
Dr. Roselle Crombie (19:23):
it's, it's incredibly important. It's
probably one of the mostimportant things after you kind
of get them through the burn. Alot of our patients, there is a
there is a percentage ofpatients that come with mental
illness, so we have to addressthat and keep their therapies
going throughout the hospitalstay, and kind of keep that in
mind. In addition to that, youknow, no matter how, whether
(19:48):
it's an accidental thing orintentional or something
happened, it's a traumaticevent. And we, really, all of
us, have been kind of. Trainedin having to help the patient
through the trauma, andsometimes we have to get our
psychiatric colleagues involved.
We certainly have education andcounseling, you know, throughout
(20:11):
their hospital stay as well.
Because in a lot of ways, theirtheir lives are forever changed,
right? Because they've hadsomething happen, and even if
they're able to heal from theinitial injury, they they have,
they have scars, whether they bephysical or emotional. Yeah. So
(20:32):
100% what I do with my patientsis, after the they get through
the, you know, hospital stay,and they're kind of seeing our
pas and us, and the outpatientis really recommend, you know,
for for actually counseling tohappen, and everybody needs a
little bit different everybody'sgot a little bit different
support system. Some peopledon't have any. So it's really a
matter of, you know, matchingthe patient with what they need.
(20:55):
And then the other thing Ishould point out is there's a
wonderful society that kind ofcame out of the ABA called the
Phoenix society, and it's aspecific society for burn
survivors. And they have createdsomething called the SOAR
program, where you can actuallyeven have some of my old
patients that have gone throughit the SOAR program become
advocates, and we call them into talk to our current patients,
(21:19):
you know, to actually be sort ofbuddies, and we have a support
group, and that's a lot of what.
You know, I realized probablyearly on in my career that we
were, we were needing to do moreof that for survivors.
Nancy Barrow (21:35):
Let's talk about the caregivers, because I
imagine there's a bit of traumadealing with a loved one who has
been burned. Do you have supportgroups for them as well?
Dr. Roselle Crombie (21:44):
We do. We do. I mean, a lot of the the
nurses and the physicians arereally great at pointing that
out. I think when I first sitdown with with a family of a big
burn in our in our patientsroom, I I literally tell them
that you're gonna we're gonnatie we're gonna die 1000 deaths
before we come out the otherside. We hope to come out the
other side, but there's going tobe good days and there's going
to be bad days, and that's justjust the norm, but we're here to
(22:07):
help you through it. And thenurses, we've had wonderful kind
of like you were saying that ittakes a special person to do
burns from the physicians, Ithink it's even more of a
special person as the to be aburn nurse. And we've been very
lucky over the years to have hadpeople that have been here for a
long time, or people that comefor a period of time in their
lives, and then they go on toother places, but they're
(22:29):
incredibly dedicated, and theyare amazing with the families,
and I think just bringing themback down, and, you know, we do
this, it's a continuousconversation that we have with
the families and the supportcaregivers, because those,
ultimately, those are the peoplethat are going to be helping
them through the most importantphase, right? A lot of my bigger
(22:51):
burn patients, they don'tremember at all their their
acute hospital stay, and thenall of a sudden they're like,
whoa. What happened? Next thingthey know they're going to
rehab. So it's really a lot ofeducation and helping the, you
know, the family members orloved ones, acclimate to that
this trauma has occurred. Theseare the things that we are
concerned about. This is what toexpect, you know, and you know,
(23:13):
we're very lucky that over overtime, you know, the survival
rate has gotten a lot better,that we can talk about those
wonderful you know, this is thisstage of healing.
Nancy Barrow (23:22):
Connecticut Paid Leave offers up to 12 weeks of
income replacement for mentalhealth issues, and you can take
your 12 weeks off all at once orin a block that we say you can
do intermittent leave or reduceschedule leave from work. So
there is flexibility for thecaregiver and for yourself if
you're getting treated. So Ilove the fact that, you know, we
(23:44):
can help in this instance, withthe caregivers and and with
someone who's going through areally traumatic burn, with
getting some some financialassistance, right, like FMLA
gives you your job back, but weare the income replacement
portion of it, and it's a it's apretty new program. We've only
(24:04):
been around giving benefitssince January of 2022, so I
think that it would be a reallygood resource for them to know
that Connecticut paid leave canhelp them. And how important are
our resources like this for youguys to have to talk to your
patients and their caregivers.
Dr. Roselle Crombie (24:22):
They're incredibly important. I think
you know, if you if you thinkabout it, for this part of my
practice, they these patientsnever expect to meet me, right?
And then all of a sudden, theirlife has changed. And that is
the biggest question I have, is,when am I going home? When can I
go back to my job? When can I goback to school? Is another one.
(24:44):
There's a lot of, you know,obviously, and, and that's, it's
so amazing that you guys wereable to get that program
through, so that they can havethat little breath of, okay.
They've got me, it's, it's, it'sgoing to be okay. So, you know.
Kudos to all of you that wereable to push that through,
because it's incrediblyimportant. If you can imagine,
(25:05):
it's just that safety net of oneless thing to worry about
amongst the many stressfulthings that you have to worry
about in a blind patient.
Nancy Barrow (25:13):
Yeah and I think the other thing is, you talked
about occupational therapy andphysical therapy that happens
afterwards, and it's a longprocess, and if it's a child
like the parents have to takethem, and so they can take that
time away from work to drivetheir child to, you know,
occupational therapy or physicaltherapy, and they can get income
replacement. So it's it just, isthat, that flexibility, that
(25:36):
they can take, you know, smallamounts of time to go drive them
to their therapies, you know.
And I think that that is also areally good and beneficial
program for burn patients andtheir caregivers.
Dr. Roselle Crombie (25:49):
You know, it's, it's super important. So
thank you.
Nancy Barrow (25:52):
Yeah, what can you tell me about burn prevention,
since this month kind ofhighlights the awareness of it,
like, what would you tellparents to do in the home,
because you say it's tea, it'sthe scaldings, it's the things
that are preventable.
Dr. Roselle Crombie (26:06):
Yeah, I mean, it's a lot of the same
things that our pediatriccolleagues and our trauma
colleagues do in terms ofprevention of trauma, you know,
like, I think of, you know, ifyou've got toddlers, I would
just crawl on down on the floorand see what they see. So so the
outlets are every now and thenI'll get it. I'll get somebody
(26:28):
that got zapped in an outletbecause somebody stuck something
in there. Right? The bath is avery big location for a lot of
accidents. And as much as we alllove our hot showers, I'm a huge
proponent of the, you know, theactual water being at that
proper temperature. Because, ifyou can imagine, both for old
(26:49):
people and for babies, they havethinner skin than, say, you and
I do so in less than a secondwith very hot water, they will
have a full thickness burnversus, you know, something you
know, that hit you and I sowater temperature is huge. The
kitchen is another big place,both not only for skull, but
just if you're going to cook.
And lots of people have gasflame, don't, don't wear a
(27:11):
fluffy sweater or fluffy shirt,tie, tie your hair back. Have
pot holders, you know, all ofthese things we get a lot during
COVID. Oh my gosh, we got somany grease burns. I think
people were just making Frenchfries, left and right comfort
food. Yes, exactly. So there wasa, there was a ton of grease
(27:33):
burns. And that's, that's awhole nother thing. Grease is
worse than water. It actuallycarries the heat a lot more. So
those, those tend to be reallythick burns if you, if you spill
the oil. And then the other bigthing was to, basically, if
you've got a grease fire, don'tput water on it, because that's
just going to spread it. Justget a just get a cover of a pot.
(27:54):
And how do you kill a fire? Yousuffocate it, cut off its
oxygen. It'll go out. So theseare the types of things that I
mean, it seems like sort ofcommon sense, right? The other
thing, when to the fall season,we've got a lot of woods in
Connecticut. People have a lotof leaves. One of the things,
you know, I've had unfortunatepatients over the years that
wanted to kind of get thoseleaves to burn, and they do that
(28:15):
with an accelerant, and theaccelerant, the vapors are also
flammable. So, you know, that'sa no go on that. So just, you
know, the same bear that taughtus all of those things, if
you're a little about forestfires, it's Smokey Bear. It's
the same Smokey the Bear. Yep,exactly.
Nancy Barrow (28:39):
Yeah well, how do you refill your coffers? Since,
you know, I say it takes a veryspecial person to do this, to be
a surgeon and to work on thesepatients, I do feel that, what
do you do to refill your coffersand take care of yourself?
Dr. Roselle Crombie (28:55):
Good question. So I personally like
to exercise. So I need toexercise every day. My family
knows if I they can't talk to meuntil I've gone and done my
thing. But I saw that question.
I was thinking myself, there's abunch of different things that
we do when we've had, you know,and when we've had, like, a
particularly traumatic eitherday or a patient, you know, who
happened to pass away, we alwaystry to take the time to have a
(29:18):
debrief, to sit down with thenurses and the team that was
involved with them, so that wecould, you know, really talk
about, what are the things like,what are you feeling? What are
the things that we think wecould have done better? What are
the things that and I take thattime also. I think we're really
good at telling people thethings they've done wrong, but I
I'd like people to know thethings they've done right,
(29:42):
because I think that's just asimportant to hear, if not more,
to be positive about that. Theother thing is we, we have
because there's so few of us. Ithink a lot of us are very well
connected. I like I am connectedto so many burn surges
throughout the country throughtext. I. Even in this less than
half hour podcast, I can seetexts coming from, you know,
(30:04):
probably about 25 different burnsurgeons various different
issues. So we always it's like abig group that we can kind of,
hey, what do you think aboutthis? Hey, this is going on.
What do you think about that? SoI think having that collegiality
is really helpful. And thencertainly the the team is huge,
like, I don't, I don't reallyget that in a lot of different
(30:24):
parts of medicine, and certainlyin in surgery, but I think that
it's we really depend on eachother. So we all, we all just
work together, which is, whichis really nice.
Nancy Barrow (30:37):
Yeah and when you have good outcomes, right? When,
when the people come back to youand and you see that they've
regained their life back afterit must be really rewarding for
you.
Dr. Roselle Crombie (30:48):
It is. And I always like I see them that I
worry most about my inpatientnurses, because they're not
seeing them in the outpatientlike when, when you see them
across the street in the clinic,and you see them like returning
to life and enjoying i I alwaysask them when they get to a
certain point, like, do me afavor. Go go back to me and
visit them. If it's not going tobe too much of a trauma for you,
because it would really mean alot, you know, to those
(31:08):
caretakers, and you know a lotof them do, and it's, it's
wonderful, yeah, to see themregain their lives.
Nancy Barrow (31:15):
What would you like people to take away from
this podcast I studied here?
Dr. Roselle Crombie (31:19):
I have an MPH myself. So I just really
like, love the fact that youwould be able to create the
support of the paid leave,because I think it's incredibly
important. I think that's theone thing to know about that,
because it's a newer programthat started in 2022 and then
also, obviously, a lot of theprevention things that I had
spoken about. And just that theburn center is a special place
(31:41):
that we're resourced for thestate and obviously many other
states as well. So don'thesitate to call us if you if
you need us, or have a questionor need education. We've got,
like a whole team of peopledoing a lot of different things
that can can help so that, that,you know, we can help the burn
patient, but also prevent thenext patient from happening burn
like I have had a patient that Iknew as a seven year old that's
(32:05):
now in his in his mid 20s, and Ithink as a as a surgeon, that's
an unusual sort of longevityrelationship that we have and
and that individual is nowgiving back to my current
patients, which is, which iskind of cool. So it's a really
cool field that has a lot tooffer.
Nancy Barrow (32:22):
Well, I want to thank my guest, doctor, Roselle
Crombie, for taking time out ofyour very busy day to be a guest
on the paid leave podcast. Allgood.
Dr. Roselle Crombie (32:30):
And thank you for putting together the
program that's amazing.
Nancy Barrow (32:33):
So it took a long time for this program to get up
and and have Governor Ned Lamontmake it a law that was passed in
2019 and it really is arewarding program, as well as
how you talk about your program.
It, it, it's very rewardingknowing that we're helping
people.
Dr. Roselle Crombie (32:49):
You are and it's, I love, the fact that you
thought about not only just theperson that was injured, but
really the whole big picture.
Because it is we all know thatyou know, we get family members
that need, need or or caregiversor friends that you know,
whoever is the significantothers for these individuals
need help too. So keep doingwhat you're doing, because I've
listened to all your podcasts.
I'm like,these are great peoplelisten.
Nancy Barrow (33:11):
Thank you. Well for more information about burn
prevention and information aboutthe American Burn Association,
you can go to theirwebsite@ameriburn.org And for
information or to apply forbenefits, please go to
ctpaidleave.org This has beenanother edition of The Paid
Leave Podcast. Please like andsubscribe so you'll be notified
(33:32):
about new podcasts that becomeavailable. Connecticut Paid
Leave is a public act with apersonal purpose. I'm Nancy
Barrow, and thanks forlistening.
Hello Connecticut, and welcome to The Paid Leave
Podcast The title basically saysit all. I'm Nancy Barrow, and I
will be delving into this newstate program and how it can
help you and your family. Thispodcast will give you
information you should knowabout Connecticut Paid Leave and
maybe just a little bit more.
Connecticut, paid leave bringspeace of mind to your home,
(00:22):
family and workplace. Welcome toThe Paid Leave Podcast.
The National Burn Awareness Weekis in February, and it's
recognized by the American BurnAssociation, also known as the
ABA. It's a chance to promoteburn prevention and awareness in
communities, and this year'stheme focuses on reducing burn
(00:45):
risks in homes, apartments andall living spaces. My guest
today is Dr Roselle Crombie, whois a surgeon specializing in
general surgery, burn surgery,and surgical critical care at
several of the Yale New Havenhealth system, flagships,
hospitals in southernConnecticut that includes the
Bridgeport Burn Center. Herparticular passion is a mix of
(01:07):
burns, burn traumareconstruction and wounds and
general surgery. She is highlyinvolved as faculty in the
department of surgery the YaleSchool of Medicine over the
course of her career, andmentors the younger, pre health
generation. Her post graduatefellowships were in burn surgery
and surgical critical care atYale University School of
(01:28):
Medicine, where she currentlyremains on faculty. Outside of
her job nationally, she hasserved as the 32nd president of
the North American burn societyand served on the ethics
committee and epidemiology forthe American Burn Association.
She is a fellow of the AmericanCollege of Surgeons, a fellow of
the American Burn Association.
She was recently appointed to bethe director at large for the
(01:50):
board of the American Board ofwound medicine and surgery, and
is currently the VP programchair for the Connecticut
American College of Surgeonschapter, the executive board and
chair of the women's surgerygroup, and is involved in the
women's surgeon groups withinseveral national societies. She
serves as a reviewer for TheJournal of Burn Care and
(02:12):
Research the Journal of WoundCare, and has served on the
Military review for Burn Grants.
She's a member of the consensuscommittee on tissue regeneration
for the Journal of wound care.
With a team of other burncolleagues, she sits as VP of
the non for profit Reach BurnFoundation to support the needs
(02:32):
of adult burn survivors.
Additionally, she serves on theboard of the Burn Research
Foundation. She has numerouspublications. And finally, Dr
Crombie is married with threechildren. Welcome to The Paid
Leave Podcast. Dr Crombie, youare a busy woman!
Dr. Roselle Crombie (02:49):
Thank you.
Yeah. You know, I think we alltry to do our part. It takes a
team, right?
Nancy Barrow (02:54):
It sure does.
We'll start at the beginning.
Can you tell me about yourinvolvement with the American
Burn Association, also known asthe ABA.
Dr. Roselle Crombie (03:02):
Yeah so, you know, the ABA is kind of
like our over arching body thatoversees a lot of the burn
surgeons and burn carethroughout the United States. It
first started in 1967 reallyjust kind of grassroots these, I
think it was like 17 surgeonshave been meeting for a period
of six years, and then they kindof decided, hey, this is we have
(03:23):
a unique specialty. We'velearned a lot after the war. Why
don't we actually form anassociation? So four of those
individuals, including a bunchof different positions, there's
a Basil Pruitt was at the he'slike a pillar in burn care, and
Dr. McMillan, Dr.Arts, Dr.
Feller and Dr. Boswick, born theactual ABA in 1967 all those
(03:45):
guys have all been presidents ofour association, and since then,
it's grown to 1000s of membersnow that include the burn really
the burn team. I'm really justone small part of the burn team
I can't take away from my allimportant, my nurses, my
therapists, the social workers,the firefighters that get the
(04:07):
patients to us, and EMTs andcertainly all of the other staff
that support us to create thisburn environment and the
continuum of burn care evenbeyond the hospital. And that's
really what the ABA formed, wasit formed this incredible team
of just individuals that arepart of the care. And I wish
every disease had something likethat. It's essential to the burn
(04:29):
patient, because there's so manyother issues that they need to
deal with. Yeah, that's how itall started.
Nancy Barrow (04:37):
And how does it affect Connecticut? How does the
American Burn Association? Areyou a member of it, and what are
their responsibilities for that?
Dr. Roselle Crombie (04:43):
I first became a member when I was a
fellow, and that was really myfirst exposure to this
community. It's a very uniquespecialty in that it crosses for
physicians. It crosses bothgeneral surgery, plastic
surgery. I know some colleaguesof mine that are in rehab
medicine. Yeah, and it's reallya home for all of those
individuals. So you could reallyjust be a member and come to the
(05:05):
conferences, which there aremany. Now, there's our one
conference that happensthroughout the usually in the
spring of the early spring ofthe year. But there's regional
conferences, like we're in thenortheast, there's a south,
Southern burn Colloquium. Andthen there's, they're just
reenacting Western burn. There'sa Midwest, there's Ohio. So in
addition to overseeing and kindof helping all of those
(05:26):
different areas, it really is aresource for us to kind of talk
about protocols, what's beingdone. Because there's only, at
the actual moment, about 250burn surgeons in the nation that
are caring for all of thesepatients. I mean, we have teams.
We've got, you know, mid levelproviders, nurse practitioners
(05:46):
and PAs and stuff like that. Soit's essential that we have a an
overarching body that can kindof guide us. And so the way that
it kind of helps us is to reallyhelp with things such as
training and something calledabls or advanced burn care. And
that can be many people can takethat even EMTs, it doesn't. You
don't need to be a physician.
And certainly they do thingssuch as lobby for us. I remember
(06:08):
as a fellow going to DC, beingdragged down there, and that was
my first experience of likemeeting our senator at the time
and really advocating for thedifferent things that we were
having in Connecticut related toour burn patients. And so they
so they are involved both inadvocacy, prevention. I was
involved in publishing ontreadmill injuries, because
(06:30):
people, January, people would begetting back in shape, and then
a lot of these kids would justgrab the treadmill and then get
a full thickness friction burn.
So we were able to, you know,lobby and change the through a
lot of publications and stufflike that, to change the safety.
I don't know if you notice, ifyou go and look at, you know, a
(06:52):
treadmill, like Dick's SportingGoods now, it has a has a, like
a safety latch to it that willimmediately shut off if you were
to fall off of it, or anythere's different safety things,
and that's all part of the, youknow, the lobbying and different
research that we kind of broughtthe to, you know, our nation. So
the ABA is very involved in, youknow, a lot of things,
education, prevention, but alsocare.
Nancy Barrow (07:13):
It's amazing. I know that you work at the
Bridgeport Burn Center, and it'sthe only burn center in
Connecticut, but you saidthere's only, like, 250 burn
surgeons. So do a lot of peoplefrom out of state come to
Connecticut to the BridgeportBurn Center?
Dr. Roselle Crombie (07:29):
Yeah, so we draw from the other burn centers
in our area are, there'sCornell, which is down in the
city Rhode Island, which is inProvidence. And then we do send,
there's the Shriners, which is awonderful institution, kind of,
obviously very well funded, andmost of our larger burn kids we
(07:50):
send up there. Because the waythat I think about it is, if my
kid had a, you know, a terrible,devastating burn, there's a
school in the hospital. We justdon't have that at our burn
center here, but it's kind ofcool, because you have a network
of burn centers, but we drawfrom southern Rhode Island.
We'll get patients from there.
Western Massachusetts are we geta lot of patients from because
they both their burn centers arein Boston. So as you can
(08:12):
imagine, if you think of justlike the northern part of
Connecticut, as you go up, I 91like all of that, it's much
quicker for them to come down. Iremember getting a burn from
Vermont, Southern Vermont one,one of the years that I was
here. And we do get some, youknow, New Yorkers as well,
depending on where they are,because the Connecticut State
line is, is, you know, on theborder there.
Nancy Barrow (08:35):
How did you get interested in helping burn
patients? Because I think ittakes a very special kind of
person to do this work. It's alot there's a lot of
disfigurement. It must be reallyhard or rewarding when you can
help patients.
Dr. Roselle Crombie (08:51):
You know, I never think of the hard part. So
my personal story is that wayback when it was a required
rotation for my training, so youhad to have burn surgery as a
rotation, and that was really myfirst exposure. I was shocked
and pleasantly surprised that itcombined a lot of different
things that I like. So in thatsix week period, I had a lot of
(09:12):
inspirational patients. So Ithink that that's what really
drew me to it. And then Iwanted, I sought, to pursue an
extra year of that training.
And, you know, to just tie itback to the ABA, I didn't
realize that it was going to besuch a collaborative community,
which is wonderful. And I think,I think in medicine, there's so
much competition, and it's verydifferent than some of the other
(09:34):
specialties that I hadexperienced. Like there was, it
was really neat to meet peoplethat were ahead of me in their
career. It was so collaborative.
And I think that that we have tobe that way within burns,
because there's so few of us,yeah, and so all of those things
are really kind of brought meinto the field. And kind of like
(09:54):
you, it's like, when we chooseour career, we figure out what,
what are the things that welike. It just, it kind of comes
just naturally.
Nancy Barrow (10:00):
What are the most common types of burns that you
see? Do you see home, kitchensplatter burns? Or is it work?
Or are they all over the place?
Electrical, chemical?
Dr. Roselle Crombie (10:10):
Yeah so we see all of them. Just percentage
wise, the vast majority of burnsare scalds. Unfortunately,
there's a more of a malepredilection in sort of the
younger age group as well.
Unfortunately, it's a lot likethis. There's seasonalities to
burn. So right now it's whenwe're in the winter time, and we
see a lot of kids with scaldinjuries. So they're pulling
down, like toddlers that pulldown the tea because it's up on
(10:30):
top there, you know, waterbottles, or some of that size.
So those are, or they, they putthe baby in the sink, and the
baby, like, kick the, you know,the faucet and hot water came
down on them, you know. And alot of our prevention is focused
around that. For, you know, anoverwhelmed parent or whatever.
There's house fires, obviously,at this time of year as well.
(10:51):
You know, with the advent of thefire pits, that happens to, you
know, a lot more in in sort of,like the fall and the spring
season, you know, celebrating,maybe not paying attention to
different things. We've hadpeople literally fall into fire
pits. That's a whole, that's awhole big thing. And then
(11:13):
certainly the other, the othersort of recreational thing that
we see a lot of fireworks. Youknow, there's always, like, a
little bit of something going onwith that. Or people will
barbecue on the beach. We've gotbeaches down in southern
Connecticut, and they'll forgetto bury the poles and you're
walking, you know, barefoot onthe beach, as people do when you
get burned. So, yeah, we see allof them, you know, in terms of
(11:35):
those are the most common, butwe definitely have, you know,
like, I've had chemical burnsfrom the various universities
around us. I've had somebody puttoo much chlorine in the pool,
and the poor kid got shocked.
Wow, yeah, we've got, you know,electrical workers that are up
there trimming bushes, and, youknow, they forget the concept of
(11:57):
physics and the electricalfield, and they get zapped. So
there's all sorts of differentmechanisms that we see, but
statistically, the most commonare really the open flame and
that scald is the most common,followed by open flames.
Nancy Barrow (12:09):
And how do you treat them differently? And
maybe you should tell me whatthe difference is between like
first degree and fourth degreeburns.
Dr. Roselle Crombie (12:17):
Yeah, first degree burn is everybody, sadly,
is very familiar. It's sunburn.
So it is injury to your toplayer of your skin, called your
epidermis, and it's usually verypainful, as you can imagine,
because all the nerves areintact. Second degree burn is
really the best way to describethat is if you see blistering.
So it's gone through the firstfirst layer the epidermis, and
(12:38):
then into the second layer ofthe dermis. And it's your body
is reacting by, you know,putting fluid into that area
and, and that's really nervesare still intact. And there's
also a superficial second degreeand deeper second degree, which
is closer to third degree. Thirddegree means that you, you
really, you know, you've goneall through the layers of the
(12:59):
skin and kind of sitting intothe pretty deep layer. And
those, those by appearance, tendto be really thick and kind of
not sensate, and they don't moveas much as you can imagine,
right? The way that I can ittoo, is like when you fry an
egg, you can't get it back tothat liquid stage. It's, it's
just, it's just solid, and thenfourth degree burn is beyond
(13:21):
that, down into sort of thedeeper tissues like the bones
and the muscles and stuff likethat. And we really see those
more and sort of more thedevastating industrial injuries,
or if there's a house fire andthe patient's been found down
for longtime, car fires, and youknow, stuff like that.
Nancy Barrow (13:37):
And tell me what you do as a surgeon and how you
treat people.
Dr. Roselle Crombie (13:42):
Just like any other surgical disease, we
always have to ask ourselves, dothey need surgery to begin with,
right? Are we going to make thepatient better that way?
Specifically for burns, they canbe incredibly painful, as you
can imagine, if you know everysingle part of our skin has
nerves, right? So to treat thethe skin, you have to take out
(14:02):
the devitalized tissue. That'snot something most people will
tolerate, if you can imagine,like a very painful sunburn, and
even some, you know, very fairindividuals, like I have my
husband's red headed if heblisters, it's very painful. So
that's something that you haveto take them to the operating
room for, primarily foranesthesia. But the goal is
really a concept calleddebridment where you take away
(14:25):
the dead tissue to allow theliving tissue to heal, and then
eventually, if you need somesome of it heals on its own,
some of it we need to replacewith its own skin. And that's
what a skin graft is. It's likeplanting a sod. We take a little
piece from somewhere else in thebody where there's normal skin,
and we put it in put it into thearea after it's been debrided.
(14:45):
That's, you know, thicklyburned. But there's also other
things, such as down the linepeople have scars. So one of my
big interests is to do a lot ofdifferent reconstructions to,
you know, loosen up that scar,make it more functional. And
then some of that includeslasers. There's quite a bit that
we do as a surgeon for thosethose treatments.
Nancy Barrow (15:05):
Yeah and I know that you mentioned a team, so
tell me how that works, too. Soif a burn patient comes to you.
Dr. Roselle Crombie (15:10):
So the team includes, first, the outside
hospitals where they're beingseen, or clinics, and that's
incredibly important. We do alot of outreach. This great guy,
former burner, Jay Bresky, whogoes out and does a lot of
education to the to the variousdifferent not only ERs, but just
urgent cares. Because a lot ofpeople are seeking care, they're
just what should be referred andwhat should be referred, but
(15:31):
also how you can, you know,dress a burn, all that other
stuff, but we really teach themhow to evaluate it. So just like
you asked me, What's the first,second and third degree burn
like, it's very important, if Ican't see the pictures, for them
to be able to describe that. Sothere's education of that. So
that's the beginning of theteam. And then there's the
transport team, which includes,obviously, the EMTs, the the
(15:54):
pilots or the ambulance drivers,paramedics that get the patient
safely from wherever they'regoing to our hospital. And then
there is the the on site team,which always includes the
nurses, the burn surgeon.
There's typically a burn Techwho is medically trained to help
us with, you know, dressings andstuff like that. And then,
(16:16):
literally, every week, we kindof map out for the family and
for the patient, what happens.
Once a week, we meet with thewhole team, so the doctors, the
nurses, the physical therapists,the occupational therapists
really deal with kind of justface and hands, nutritionists,
(16:37):
there's social workers to kindof help with the overall
planning on how we're going toget them through the hospital
stay and how we get them home,what support that they need. And
then there is clergy, and wehave a different types of
counseling services that happenas well. So we that team sits
down pretty faithfully everyweek, on Tuesday at 10am to go
(16:58):
through every patient that hasbeen admitted to the burn center
to kind of come up with acomprehensive plan. And I find
it great because two things, Ialways learn something from
listening, and I think it comeit allows us to come up with a
more comprehensive plan for thepatient. But then additionally,
I think it's incrediblyimportant for each one of those
individuals that are sitting atthe table to know that they have
(17:20):
an important role in thispatient's care that we can't do,
you know, without them. So it'sa chance for them to speak, and
it really kind of helps toreally just make it a wholesome
team effort to get this patientthrough their care. We also have
an outpatient, you know, afterthey go home, they come and see
our PA and then us. I have aburn fellow. They're their
(17:40):
residents, obviously, becausethe faculty at Yale, they're
rotating as well, and we seethat they're part of their care,
both in the inpatient and theoutpatient and and it's nice
because it's a continuum forthem to be seen, you know, as
outpatient care as well. Becausea lot of I guess I should say
that we've been really greatnationwide about doing things,
about prevention and gettingthem numbers, I think, down to a
(18:03):
much better level than you know,when I first started this, over
20 years ago. But what thatmeans is that we're managing a
lot more of those patients asoutpatients. So we are. We've
created effectively the samesome you know, team in the
outpatient setting to help themthrough the next phases of their
recovery, probably the mostimportant phase, quite frankly.
Nancy Barrow (18:21):
Yeah it's interesting that you said the
educational part of it, thatyou've educated enough people so
that with prevention, so thatthe numbers have really
decreased in the last 20 years.
Dr. Roselle Crombie (18:30):
Yeah, it's still a big problem. You know,
we and like I was alluding to atthe beginning of the podcast,
there's been a lot of safetythings that you know that
happen, you know over time interms of building in, like, I
bring up the fireplaces, like alot of places in the nation,
they don't have centralizedheating. They have, like, a
(18:51):
stove with the glass stove. Sowe were getting, like, a bunch
of people and toddlers justgoing up to the glass so there's
been a lot of changes in thedesign of both fireplaces and
glass stoves to be a little bitmore, you know, to be safer.
Nancy Barrow (19:05):
Yeah, and that's your advocacy, right there. You
know, with the ABA going, goingand advocating for those burn
patients, I know that youmentioned counseling, and tell
me about the mental health andbehavioral health, how important
is, is that for recovery inpatients who have severe burns.
Dr. Roselle Crombie (19:23):
it's, it's incredibly important. It's
probably one of the mostimportant things after you kind
of get them through the burn. Alot of our patients, there is a
there is a percentage ofpatients that come with mental
illness, so we have to addressthat and keep their therapies
going throughout the hospitalstay, and kind of keep that in
mind. In addition to that, youknow, no matter how, whether
(19:48):
it's an accidental thing orintentional or something
happened, it's a traumaticevent. And we, really, all of
us, have been kind of. Trainedin having to help the patient
through the trauma, andsometimes we have to get our
psychiatric colleagues involved.
We certainly have education andcounseling, you know, throughout
(20:11):
their hospital stay as well.
Because in a lot of ways, theirtheir lives are forever changed,
right? Because they've hadsomething happen, and even if
they're able to heal from theinitial injury, they they have,
they have scars, whether they bephysical or emotional. Yeah. So
(20:32):
100% what I do with my patientsis, after the they get through
the, you know, hospital stay,and they're kind of seeing our
pas and us, and the outpatientis really recommend, you know,
for for actually counseling tohappen, and everybody needs a
little bit different everybody'sgot a little bit different
support system. Some peopledon't have any. So it's really a
matter of, you know, matchingthe patient with what they need.
(20:55):
And then the other thing Ishould point out is there's a
wonderful society that kind ofcame out of the ABA called the
Phoenix society, and it's aspecific society for burn
survivors. And they have createdsomething called the SOAR
program, where you can actuallyeven have some of my old
patients that have gone throughit the SOAR program become
advocates, and we call them into talk to our current patients,
(21:19):
you know, to actually be sort ofbuddies, and we have a support
group, and that's a lot of what.
You know, I realized probablyearly on in my career that we
were, we were needing to do moreof that for survivors.
Nancy Barrow (21:35):
Let's talk about the caregivers, because I
imagine there's a bit of traumadealing with a loved one who has
been burned. Do you have supportgroups for them as well?
Dr. Roselle Crombie (21:44):
We do. We do. I mean, a lot of the the
nurses and the physicians arereally great at pointing that
out. I think when I first sitdown with with a family of a big
burn in our in our patientsroom, I I literally tell them
that you're gonna we're gonnatie we're gonna die 1000 deaths
before we come out the otherside. We hope to come out the
other side, but there's going tobe good days and there's going
to be bad days, and that's justjust the norm, but we're here to
(22:07):
help you through it. And thenurses, we've had wonderful kind
of like you were saying that ittakes a special person to do
burns from the physicians, Ithink it's even more of a
special person as the to be aburn nurse. And we've been very
lucky over the years to have hadpeople that have been here for a
long time, or people that comefor a period of time in their
lives, and then they go on toother places, but they're
(22:29):
incredibly dedicated, and theyare amazing with the families,
and I think just bringing themback down, and, you know, we do
this, it's a continuousconversation that we have with
the families and the supportcaregivers, because those,
ultimately, those are the peoplethat are going to be helping
them through the most importantphase, right? A lot of my bigger
(22:51):
burn patients, they don'tremember at all their their
acute hospital stay, and thenall of a sudden they're like,
whoa. What happened? Next thingthey know they're going to
rehab. So it's really a lot ofeducation and helping the, you
know, the family members orloved ones, acclimate to that
this trauma has occurred. Theseare the things that we are
concerned about. This is what toexpect, you know, and you know,
(23:13):
we're very lucky that over overtime, you know, the survival
rate has gotten a lot better,that we can talk about those
wonderful you know, this is thisstage of healing.
Nancy Barrow (23:22):
Connecticut Paid Leave offers up to 12 weeks of
income replacement for mentalhealth issues, and you can take
your 12 weeks off all at once orin a block that we say you can
do intermittent leave or reduceschedule leave from work. So
there is flexibility for thecaregiver and for yourself if
you're getting treated. So Ilove the fact that, you know, we
(23:44):
can help in this instance, withthe caregivers and and with
someone who's going through areally traumatic burn, with
getting some some financialassistance, right, like FMLA
gives you your job back, but weare the income replacement
portion of it, and it's a it's apretty new program. We've only
(24:04):
been around giving benefitssince January of 2022, so I
think that it would be a reallygood resource for them to know
that Connecticut paid leave canhelp them. And how important are
our resources like this for youguys to have to talk to your
patients and their caregivers.
Dr. Roselle Crombie (24:22):
They're incredibly important. I think
you know, if you if you thinkabout it, for this part of my
practice, they these patientsnever expect to meet me, right?
And then all of a sudden, theirlife has changed. And that is
the biggest question I have, is,when am I going home? When can I
go back to my job? When can I goback to school? Is another one.
(24:44):
There's a lot of, you know,obviously, and, and that's, it's
so amazing that you guys wereable to get that program
through, so that they can havethat little breath of, okay.
They've got me, it's, it's, it'sgoing to be okay. So, you know.
Kudos to all of you that wereable to push that through,
because it's incrediblyimportant. If you can imagine,
(25:05):
it's just that safety net of oneless thing to worry about
amongst the many stressfulthings that you have to worry
about in a blind patient.
Nancy Barrow (25:13):
Yeah and I think the other thing is, you talked
about occupational therapy andphysical therapy that happens
afterwards, and it's a longprocess, and if it's a child
like the parents have to takethem, and so they can take that
time away from work to drivetheir child to, you know,
occupational therapy or physicaltherapy, and they can get income
replacement. So it's it just, isthat, that flexibility, that
(25:36):
they can take, you know, smallamounts of time to go drive them
to their therapies, you know.
And I think that that is also areally good and beneficial
program for burn patients andtheir caregivers.
Dr. Roselle Crombie (25:49):
You know, it's, it's super important. So
thank you.
Nancy Barrow (25:52):
Yeah, what can you tell me about burn prevention,
since this month kind ofhighlights the awareness of it,
like, what would you tellparents to do in the home,
because you say it's tea, it'sthe scaldings, it's the things
that are preventable.
Dr. Roselle Crombie (26:06):
Yeah, I mean, it's a lot of the same
things that our pediatriccolleagues and our trauma
colleagues do in terms ofprevention of trauma, you know,
like, I think of, you know, ifyou've got toddlers, I would
just crawl on down on the floorand see what they see. So so the
outlets are every now and thenI'll get it. I'll get somebody
(26:28):
that got zapped in an outletbecause somebody stuck something
in there. Right? The bath is avery big location for a lot of
accidents. And as much as we alllove our hot showers, I'm a huge
proponent of the, you know, theactual water being at that
proper temperature. Because, ifyou can imagine, both for old
(26:49):
people and for babies, they havethinner skin than, say, you and
I do so in less than a secondwith very hot water, they will
have a full thickness burnversus, you know, something you
know, that hit you and I sowater temperature is huge. The
kitchen is another big place,both not only for skull, but
just if you're going to cook.
And lots of people have gasflame, don't, don't wear a
(27:11):
fluffy sweater or fluffy shirt,tie, tie your hair back. Have
pot holders, you know, all ofthese things we get a lot during
COVID. Oh my gosh, we got somany grease burns. I think
people were just making Frenchfries, left and right comfort
food. Yes, exactly. So there wasa, there was a ton of grease
(27:33):
burns. And that's, that's awhole nother thing. Grease is
worse than water. It actuallycarries the heat a lot more. So
those, those tend to be reallythick burns if you, if you spill
the oil. And then the other bigthing was to, basically, if
you've got a grease fire, don'tput water on it, because that's
just going to spread it. Justget a just get a cover of a pot.
(27:54):
And how do you kill a fire? Yousuffocate it, cut off its
oxygen. It'll go out. So theseare the types of things that I
mean, it seems like sort ofcommon sense, right? The other
thing, when to the fall season,we've got a lot of woods in
Connecticut. People have a lotof leaves. One of the things,
you know, I've had unfortunatepatients over the years that
wanted to kind of get thoseleaves to burn, and they do that
(28:15):
with an accelerant, and theaccelerant, the vapors are also
flammable. So, you know, that'sa no go on that. So just, you
know, the same bear that taughtus all of those things, if
you're a little about forestfires, it's Smokey Bear. It's
the same Smokey the Bear. Yep,exactly.
Nancy Barrow (28:39):
Yeah well, how do you refill your coffers? Since,
you know, I say it takes a veryspecial person to do this, to be
a surgeon and to work on thesepatients, I do feel that, what
do you do to refill your coffersand take care of yourself?
Dr. Roselle Crombie (28:55):
Good question. So I personally like
to exercise. So I need toexercise every day. My family
knows if I they can't talk to meuntil I've gone and done my
thing. But I saw that question.
I was thinking myself, there's abunch of different things that
we do when we've had, you know,and when we've had, like, a
particularly traumatic eitherday or a patient, you know, who
happened to pass away, we alwaystry to take the time to have a
(29:18):
debrief, to sit down with thenurses and the team that was
involved with them, so that wecould, you know, really talk
about, what are the things like,what are you feeling? What are
the things that we think wecould have done better? What are
the things that and I take thattime also. I think we're really
good at telling people thethings they've done wrong, but I
I'd like people to know thethings they've done right,
(29:42):
because I think that's just asimportant to hear, if not more,
to be positive about that. Theother thing is we, we have
because there's so few of us. Ithink a lot of us are very well
connected. I like I am connectedto so many burn surges
throughout the country throughtext. I. Even in this less than
half hour podcast, I can seetexts coming from, you know,
(30:04):
probably about 25 different burnsurgeons various different
issues. So we always it's like abig group that we can kind of,
hey, what do you think aboutthis? Hey, this is going on.
What do you think about that? SoI think having that collegiality
is really helpful. And thencertainly the the team is huge,
like, I don't, I don't reallyget that in a lot of different
(30:24):
parts of medicine, and certainlyin in surgery, but I think that
it's we really depend on eachother. So we all, we all just
work together, which is, whichis really nice.
Nancy Barrow (30:37):
Yeah and when you have good outcomes, right? When,
when the people come back to youand and you see that they've
regained their life back afterit must be really rewarding for
you.
Dr. Roselle Crombie (30:48):
It is. And I always like I see them that I
worry most about my inpatientnurses, because they're not
seeing them in the outpatientlike when, when you see them
across the street in the clinic,and you see them like returning
to life and enjoying i I alwaysask them when they get to a
certain point, like, do me afavor. Go go back to me and
visit them. If it's not going tobe too much of a trauma for you,
because it would really mean alot, you know, to those
(31:08):
caretakers, and you know a lotof them do, and it's, it's
wonderful, yeah, to see themregain their lives.
Nancy Barrow (31:15):
What would you like people to take away from
this podcast I studied here?
Dr. Roselle Crombie (31:19):
I have an MPH myself. So I just really
like, love the fact that youwould be able to create the
support of the paid leave,because I think it's incredibly
important. I think that's theone thing to know about that,
because it's a newer programthat started in 2022 and then
also, obviously, a lot of theprevention things that I had
spoken about. And just that theburn center is a special place
(31:41):
that we're resourced for thestate and obviously many other
states as well. So don'thesitate to call us if you if
you need us, or have a questionor need education. We've got,
like a whole team of peopledoing a lot of different things
that can can help so that, that,you know, we can help the burn
patient, but also prevent thenext patient from happening burn
like I have had a patient that Iknew as a seven year old that's
(32:05):
now in his in his mid 20s, and Ithink as a as a surgeon, that's
an unusual sort of longevityrelationship that we have and
and that individual is nowgiving back to my current
patients, which is, which iskind of cool. So it's a really
cool field that has a lot tooffer.
Nancy Barrow (32:22):
Well, I want to thank my guest, doctor, Roselle
Crombie, for taking time out ofyour very busy day to be a guest
on the paid leave podcast. Allgood.
Dr. Roselle Crombie (32:30):
And thank you for putting together the
program that's amazing.
Nancy Barrow (32:33):
So it took a long time for this program to get up
and and have Governor Ned Lamontmake it a law that was passed in
2019 and it really is arewarding program, as well as
how you talk about your program.
It, it, it's very rewardingknowing that we're helping
people.
Dr. Roselle Crombie (32:49):
You are and it's, I love, the fact that you
thought about not only just theperson that was injured, but
really the whole big picture.
Because it is we all know thatyou know, we get family members
that need, need or or caregiversor friends that you know,
whoever is the significantothers for these individuals
need help too. So keep doingwhat you're doing, because I've
listened to all your podcasts.
I'm like,these are great peoplelisten.
Nancy Barrow (33:11):
Thank you. Well for more information about burn
prevention and information aboutthe American Burn Association,
you can go to theirwebsite@ameriburn.org And for
information or to apply forbenefits, please go to
ctpaidleave.org This has beenanother edition of The Paid
Leave Podcast. Please like andsubscribe so you'll be notified
(33:32):
about new podcasts that becomeavailable. Connecticut Paid
Leave is a public act with apersonal purpose. I'm Nancy
Barrow, and thanks forlistening.
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