“The skin of a burnt person seems thick and hard,
but she is fragile ”
Amélie Nicolet, burn physiotherapist at the CHUV
December 2020
Amélie Nicolet, what does your job consist of?
First of all, it is a job that is not just focused on the burn. If I am indeed focusing on skin lesions, it is also a question of taking into account the respiratory aspect, mobilization and swallowing, all the signs to which we are attentive in intensive care. Moreover, specific physiotherapy for burns is practiced in a mixed structure bringing together all patients from intensive care.
I'm correct in saying that you are specialized in this area?
Yes, indeed. In our team of physiotherapists at CHUV, we are all trained in intensive care, but only a few of us have the necessary specialization in burns.
How long do you provide your burn physiotherapy for?
As long as the patient's stay in intensive care lasts. It is estimated on average that it takes one day per percentage of body surface area burned. Therefore, a patient with 60% burns will be followed for two months, during which we will intervene on a daily basis. My job stops after this first stage of rehabilitation. The patient will then be referred to the plastic surgery department and then to rehabilitation.
You told us earlier that skin is an extraordinary organ to work with. Can you explain?
The skin of a burnt person appears very thick, very hard, but paradoxically it is very fragile. You have to treat it very gently. The idea is to stretch the patient's skin in order to restore its length. It's a bit like stretching. Over time, sensitivity is acquired in fingers and hands, but this is not sufficient. Feedback from the patient during the sessions is essential. We ask them to warn us if “it hurts” or if “it pulls”. If it is painful, it means that we are tearing organic structures, creating a lesion and we must stop. If it pulls, then all is well; we put the skin in tension and we wait while releasing it very slowly.
This is something that requires great patience ...
Yes. In each posture, the skin is kept stretched for twenty minutes. During this time, we can chat, sing, watch TV with the patient. However, great energy is required as well as endurance and both are worth it. I once read a sentence which said that if resuscitation saves life then rehabilitation gives it back. I find this to be true.
What happens to the severely burned once they return home?
They do physiotherapy and occupational therapy on an outpatient basis. They also benefit from a consultation at the CHUV. Having said this, as soon as they leave the Hospital Center, we tend to lose track of them. I think that we, the Swiss health services, could do better in our follow-ups. We know, for example, that patients suffering from major psychiatric disorders such as schizophrenics who have set themselves on fire, will first be treated for these disorders. Unfortunately in Switzerland it's impossible to treat a psychiatric pathology while at the same time ensuring the rehabilitation and integration into society, of people with burns.
What advantages do you see in the creation of ARDEAT?
I see it as an opportunity for patients to continue everything that we have started with them. I consider the follow-up of burns as a major job that requires different teams of expertise at different times. At the CHUV, we do everything to get patients back on track, to restore in them a taste for life. But we do it in a hospital and with health professionals. When patients leave us, they no longer have this protective structure. They are suddenly alone in this big world. How do they accept and identify with their new body? ARDEAT is an ally on which patients can rely. It is a time and place that is both supportive and kind and which helps them to be a part of society once more.
And this is an extension and elaboration of the work that has been started...
Exactly. What we do would make no sense if, upon returning home after receiving high quality resuscitation, surgery and rehabilitation services, our patients went on to lead mediocre lives, refusing to go out or to eat. It would be pointless to save people and then leave them to their own devices. The creation of ARDEAT makes sense because it offers burns victims a multidisciplinary follow-up of quality long term.
