In April 2008, Mr. Jason Maxwell was performing his usual job duties as an electrician when a power box exploded and he was engulfed in a fireball that caused third degree burns to 85% of his body.  When describing his injuries, it is easier to say what was spared than what was burned.  The only areas where the skin was not destroyed were his mid-back, left buttock cheek, perineum, genitalia, and his ankles and feet as they were protected by work boots.  During the explosion he also breathed in the super-heated air, essentially burning the insides of his lungs.

Mr. Maxwell was rushed to a Boston area hospital where he remained in the burn ICU for more than four months.  Not that long ago an injured worker like Mr. Maxwell with 85% TBSA burns combined with an inhalation injury would not have survived.  According to the American Burn Association’s National Burn Repository (NBR), an 85% burn with inhalation injury has a less than 5% chance of surviving. The NBR is a review of the most recent 10 years of burn patients.  Fortunately, burn care has evolved so that with modern day expert care and vigilant oversight, patients now have a shot at beating the odds.

Paradigm’s Role

The insurer promptly contacted Paradigm to begin care management of Mr. Maxwell’s catastrophic condition on day two of his burn injury.  Paradigm immediately assigned Alan Dimick, MD, to be the Paradigm Medical Director on the case.  Dr. Dimick is a nationally recognized burn surgeon, scholar and researcher, and his experience also includes being the chief physician in charge of an academic burn unit at the University of Alabama Birmingham for more than 30 years.  Paradigm also assigned a seasoned Network Manager, Adele Pollard, and a Director of Clinical Services, Vance Landis-Carey, to manage and coordinate this challenging burn injury.

While the hospital’s treating burn team was fighting to save Mr. Maxwell’s life, the Paradigm Management Team consulted with the treating hospital and physicians to ensure that he received the best care possible.  Dr. Dimick received daily updates on the care plan that involved difficult hemodynamic issues along with systemic infections, pneumonia, sepsis and multiple wound infections that jockeyed for attention on any given day and threatened the patient’s recovery.  Because of the vast burn area, insufficient healthy skin remained available to serve as donor sites for needed skin grafts; this made the process of wound coverage much more difficult.

The Recovery Process

Very slowly, under scrutiny by Paradigm’s expert team, Mr. Maxwell’s clinical condition began to stabilize and eventually his burn wounds were successfully covered with grafts.  After 104 days in the burn unit, the hospital discharged Mr. Maxwell.  It was then that the real work began.

Paradigm selected Spaulding Rehabilitation Hospital for Mr. Maxwell’s inpatient acute rehabilitation out of all rehabilitation facilities in Massachusetts because of Paradigm’s knowledge of the center’s rehab resources and its ability to manage the complexity of his injuries.  It took more than six weeks for Mr. Maxwell to regain the endurance necessary to move home as he was so profoundly deconditioned from months of immobility.

Mr. Maxwell finally returned home in August, nearly five months following the workplace accident.  Still, the Paradigm team of experts knew that his recovery was incomplete.  His facial burns frightened his children and his disfigurement even impacted his marriage.  Over the next four years, Paradigm assisted Mr. Maxwell to work hard in therapy to regain functional use of his badly burned hands.  During that time he relearned how to feed himself, to walk, to perform personal hygiene and eventually to drive an automobile again.

As burn scars mature, they contract and require surgical release to improve physical function.  Mr. Maxwell’s treating burn surgeon, Dr. Colleen Ryan, in consultation with Paradigm’s Dr. Dimick, utilized new laser technology to avoid many surgeries.  It may seem counter-intuitive to treat burned skin by burning it, but laser technology is being utilized in growing frequency to soften burn scars and arrest the contracture process.

Biopsychosocial Care

Mr. Maxwell was plagued by pain throughout the entire burn recovery process.  Regular debriding procedures required to excise necrotic tissue are painful and some burn patients are kept in medication-induced comas to spare them the trauma.  Still, it is impossible to shield burn patients completely, and pain is always present.  Following the grafting, therapists require daily stretching to maximize skin mobility.  This, too, is painful and Paradigm’s expert team ensured that Mr. Maxwell received the very best pain management available.  Paradigm’s Management Team closely monitored his growing dependence on narcotic pain medication and intervened to ensure that the level of narcotic usage was properly balanced with his pain symptoms to prevent any excess narcotic dependency and, ultimately, to successfully curtail any need.

Perhaps the greatest challenge facing the Paradigm team was to assist Mr. Maxwell regain his psychological wellness.  During the course of his recovery, he experienced severe, debilitating depression.  Again, the Paradigm Management Team ensured that he received expert psychiatric and psychological treatment. Paradigm also connected him with the Phoenix Society for Burn Survivors and sent him to their annual conference to gain the support of peers and be a resource to others.

Restoring Life

By April 2012, Mr. Maxwell’s long ordeal was finally over and medical experts concluded that his acute recovery was complete.  The Paradigm team and the highly skilled treating physicians and therapists not only saved his life, but they restored his quality of life, as well.

The complexities of severe burns are best handled by dedicated care management professionals with experience in catastrophic injuries.  Paradigm’s Systematic Care Management^SM practices have been shown to improve a patient’s chances of returning to full work duty after significant burn injury by 40 percent, according to an independent comparison conducted by Milliman.  Contact us www.paradigm.com or call (888) 621-6602 to refer a case today. You can also join us on LinkedIn, Twitter, and Facebook.

Please note: Paradigm changed the name of the injured worker for privacy.