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        JACKSON, Mississippi. Shortly after the patient’s arrival, Dr. William Liniveaver arrived at the burn center. “They flew in by helicopter and we put them in intensive care units,” he said. “First we go through the airways, check the cardiovascular system, make sure the tube is in the right place.”
        Lineaweaver tells the story of a patient who was burned to death in a house fire several years after the Joseph M. Still Burn Center moved to Jackson Merit Central Health in 2013. They received severe burns to their forearms, chest and face. “Their swelling of the face was getting worse. Firefighters arrived, an ambulance arrived. They applied initial dressings and intubated them to protect the airways,” he recalled in an interview.
        Rescuers then took the injured directly to the JMS Burn Center, the only specialized burn unit within nearly 200 miles in any direction of Jackson. What follows is a battery of ratings. “(The patient) had a chest X-ray to look for progressive lung damage and a bronchoscopy to check for airway damage,” he said in a Dec. 12 interview.
        Resuscitation is the next step in restoring circulation to vital organs to preserve kidney and lung function. Lineweaver’s team found carbon monoxide in the patient’s blood, and an intravenous injection helps rehydrate the body. Sharp cuts at the site of the burn help relieve pressure on tight skin and restore blood flow to the limbs with the threat of breathing. Then a urinary catheter: healthy urination is a measure of safe fluid retention.
        The job of Lineweaver and his team at the JMS Burn Center is to deal with the delicate chaos of a body in a state of disorder. They maintain pressure and pulse and cleanse the wounds of patients in preparation for the subsequent long recovery and recovery phase.
        Less than two hours passed between the moment of injury and the first moment of calm, when the survivor was bandaged with an antibiotic bandage. “At this point,” Lineiweaver said, “the first part of the treatment has been determined.”
       Today, access to that level of care would require the same patient to fly out of Mississippi.
        For more than a decade, Dr. Liniveaver treated cases like the one he described at the Joseph M. Still Burn Center at Merit Health Central, a private facility originally located in Brandon, Mississippi and later relocated to Jackson. After Delta Regional Medical Center closed the Mississippi Firemen’s Memorial Burn Center in 2005, JMS Burn Center became the beating heart of Mississippi’s burn care system in 2008. The center receives referrals from across the state for everything from superficial injuries to fatal injuries to the entire body.
        “During its first year of operation,” Lineweaver wrote last month in an editorial in the Journal of the Mississippi Medical Association, “the center treated 391 patients with severe burns. to (former JMS Burn Center in Augusta, Georgia) 0.62%. There were 1629 pediatric cases.”
        But in the shadow of the COVID-19 pandemic and its accelerated fragmentation of the healthcare environment, Merit announced in September 2022 that JMS would suffer the same fate as Mississippi’s last dedicated burn center in 2005. It closed in October 2022 and its predecessor is now based in Georgia, where they host many of the most severe cases that would otherwise be treated well in their home state. Mississippi has no other entity like JMS.
       Following the closure of the JMS Burn Center, Liniweaver met with representatives from the Mississippi Free Press at his Madison, Mississippi home on December 12, 2022 to reflect on his efforts to create long-term burn care in Mississippi and what he hopes will happen next. .
       Most importantly, Lineweaver warned that the state is being forced to rethink how to care for its most severely burned residents.
        “Since I moved here in 1999, we have twice given a private practice the opportunity to provide full-time burn care in Mississippi,” he said. “Having seen it fail completely twice, I think the responsibility should go back to the state.”
        Neshoba County Hospital CEO Lee McCall has had enough trouble running a rural hospital during the pandemic. The end of reliable burn care in Mississippi is just another burden: supply chains stretched to breaking point, national staffing shortfalls, and the depletion of all the excess disease and death this decade has brought.
        “It’s a huge inconvenience,” McCall admitted in an interview with the Mississippi Free Press on Dec. 7 about the closure of JMS. “It is disappointing that our state currently has no other options.”
        It’s not every day that Neshoba County General Hospital sees patients with severe burns. But after the JMS burn center closed, severe burns meant the difficult process of finding specialized care somewhere outside of Mississippi.
        “First of all, we want to open in Augusta, Georgia,” McCall said. “Then we have to figure out a way to get patients there. If ground transportation is safe enough, it’s a long way for an ambulance. If we can’t get them over the ground, they’ll have to fly. how much does this flight cost? Is it so? The financial burden on patients is heavy.”
        Lineaweaver explains a wide range of burn hazards. “A burn can be anything from a painful but inherently minor blister to an injury in which a person permanently loses most of their skin,” he said. “It damages the eyes and other organs, yes, but it also causes an extremely complex physiological shock response. Not only does the entire stress hormone axis get thrown into disarray, but the person loses fluid as a result of the injury.”
        The Lineaweaver illustrates the complex balance of repair and restoration required to keep severely burned patients alive. “This fluid needs to be replaced. It does not so much complicate the work of the lungs as it harms the kidneys, ”he said. “Burns can involve inhalation of smoke or flames, which can cause direct lung damage.”
        The cascading complications of burns can kill a person in countless ways. “Certain types of burns can have chemical consequences,” Lineweaver continued. “For example, hydrofluoric acid is very harmful to the nerves. Carbon monoxide from burns can be very deadly if not recognized at the burn site.”
       The role of McCall’s team at Neshoba is not to provide definitive care for patients with severe burns, but to connect them in time with a team of specialist doctors and surgeons like Lineaweaver to save them.
        For a centrally located modern burn center, this is a relatively simple task. Now, this process comes with all the delays and complications that the rest of Mississippi’s chaotic medical environment faces. The consequences can be serious.
        “The longer the delay between being injured, showing up at the main emergency site, and moving to the final burn site…” Lineweaver said, his voice getting quieter. “This delay could be problematic.”
        “If a special operation is required, such as cutting a burn scar to maintain circulation, can it be done on the spot? If this is a child with severe burns, does the local emergency department know how to catheterize the bladder? are fluids properly controlled? In the transfer planning process, many things can fall behind schedule.”
       Currently, about 500 patients who would go to JMS for specialized burn care are currently being transported through the state’s overburdened transportation system, with many of the most serious patients being sent out of state for terminal care, Liniveaver said.
        Lineaweaver attributed the sudden cessation of JMS Burn Center services to the untimely death of Dr. Fred Mullins, medical director of the original JMS Augusta, Georgia site. Since Mullins passed away in 2020 at the age of 54, Lineweaver wrote, “The practice has gone on and on through numerous leadership changes and most hubs have closed or are no longer connected to the network.” state bodies.
       But Lineaweaver attributes Mississippi’s lack of full-service burn centers to a previous setback—a missed opportunity to establish a dedicated burn unit at the University of Mississippi Medical Center.
        In 2006, after the closing of the firemen’s memorial, Lineweaver participated in a reconstructive microsurgical practice at the University of Mississippi Medical Center in Jackson. In Mississippi, as now, there are not enough specialized facilities for the treatment of complex, life-threatening burns. Lineaweaver said he thought at the time that an advanced government research hospital and only a level-one trauma center was an obvious alternative. “I envision the burn center as an extension of this complex wound center, using many of the same principles of operation and efficiency,” he said.
        Lineaweaver began making plans for a government burn center, which he considered inevitable at the time. A truly comprehensive burn treatment plan includes not only emergency care, but also advanced plastic surgery to address the complex damage that a burn can cause.
        “Let’s start with the fact that I was completely wrong,” he admits. — I assumed that UMMC should do it. So my only concern was to show you how to do it.”
       The Lineaweaver plan would have been an expensive addition to the suite of services offered by Jackson’s sprawling UMMC, but the Mississippi legislature has been willing to help, he said.
        In 2006, Rep. Steve Holland, now a retired Democrat from Tupelo, introduced Bill 908 in the House of Representatives specifically to establish a burn center at UMMC and ensure the continued operation of the medical center’s burn unit. Substantial funding offer.
        “In addition to any funds allocated to the Medical Center from the Mississippi Burns Fund, the Legislature shall allocate at least ten million dollars ($10,000,000.00) per year to the University of Mississippi Medical Center for the operation of the Mississippi Burns Center.” says in the document. Bill is reading.
        Legislative records show a notable increase in support for the center in the Mississippi House of Representatives as its necessary revenue bill was passed by a three-fifths majority in the House of Representatives. However, the bill was rejected by Senate committees and ultimately died on the calendar.
        But Lineaweaver argued that this was not just a victim of overcrowded meetings or disinterested committee chairs. “To open a burn center through (UMMC) would require eight figures (annual) funding. As far as I understand, the university said no,” Lineweaver said.
        In an unpublished 2006 editorial, he proposed to merge his current practice of reconstructive and plastic surgery with a specialized burn center. His proposal was to create a comprehensive treatment center that could take patients from the moment of severe burns and provide assistance during physical rehabilitation and cosmetic reconstruction.
       But Lineaweaver withdrew the editorial before publishing it and published a letter three years later in the April 2009 issue of the Journal of the Mississippi Medical Association detailing pressure from then Vice Chancellor Dan Jones.
        “The publication of this editorial may undermine the credibility of the views I express on behalf of the medical center and the country,” Lineweaver wrote in 2009, citing an April 27, 2006 email in which he said Jones was quoted from an email mail. “This is contrary to the advice of the committee, which includes the governor and heads the state health officer,” he continued, quoting Jones.
        In an interview Friday, Jan. 6, Dan Jones disagreed with Lineaweaver’s characterization of how he responded to a 2006 effort to fund burn centers. Jones said he recalled thinking at the time that the UMMC “was the best organization to take responsibility for burn care”, but he could not get a “permanent commitment” from the Legislature to fund it every year.
        “The problem with a burn center or burn treatment is that many of the patients who need treatment are not insured, so building or renovating a facility is not as easy as a one-time grant,” Jones said. Honorary Professor of Medicine at UMMC and Honorary Dean of the Faculty of Medicine.
        The HB 908 text passed by the House of Representatives explicitly includes a $10 million annual allocation to UMMC, a commitment to continue funding the establishment and maintenance of the burn center. But Jones said the Senate committee that ultimately defeated the bill let him know that refunding was out of the question.
        “The bill that was originally drafted and the bill that was discussed for possible passage are always different things,” Jones said. “As the committees meet on the bill, there is a clear sign that the repetitive language will not continue.”
       Jones said the legislature will eventually propose a one-time appropriation, which he and other UMMC employees believe is not enough to cover annual expenses.
        “Things are different today because of the injury fund – basically covering car accidents and so on – the money from the injury fund can now be used to care for burn patients, so I obviously can’t know what the financial situation will be today. But in 2006 and 2007, we were unable to secure funding from the Trauma Fund,” Jones said. He was referring to the Mississippi Trauma Care System, which was enacted in 1998 and later required hospitals to either participate or pay to not participate starting in 2008.
       Jones declined to comment on his past interactions with Lineaweaver, but emphasized his desire to set up a burn center at UMMC.
        “We really want our institution to have a burn center. We want to do it,” he said. “I told the members of the Legislative Assembly that we want to provide this assistance, but we cannot do this if we do not commit ourselves to regularly provide financial support.”
        In a December 30, 2022, Mississippi Free Press interview, Rep. Holland agreed with Lineaweaver that the UMMC had put their agency’s finger on the scales to prevent the appropriations bill from passing. But he sympathized with his skeptical reasoning.
        “I can tell you one reason (HB 908) didn’t pass – and I understand that since I managed their budget for 18 years – UMMC was afraid of it. They said, “As long as Steve Holland is around, we knew we were going to get funding, but what happens the day he leaves?”
        Holland said the prospect of removing the regulatory incentive and putting the full cost of operations on public universities makes the option a risky financial proposition. “It takes a lot of infrastructure to build a burn center,” the former deputy said candidly. “This is not a maternity ward. It is very dense in terms of equipment and specialized medical facilities.”