The evolution of burn care facilities in the United States.

This historical review documents the establishment and current status of specialized burn care facilities opened in the United States since 1947, describes trends in their physical configuration and burn bed availability and discusses the terms used to classify those facilities. Lists of active burn care facilities were reviewed, including primarily the Burn Care Resource directories of the American Burn Association, which date back to 1976, along with the results of special surveys carried out by the authors in 1992 and 2006. Of the burn facilities at 175 US hospitals which had reported the presence of specialized burn beds since 1947, 25 had closed before 1992, 153 have been active as recently as 1992, and 125 were active as of early 2007. Between 1979 and 2007, total burn beds listed as available in annual surveys of hospitals reporting specialized burn care facilities ranged between about 1700 and 1800 beds. Average burn beds in those facilities increased from approximately 11.2 to 14.4. Specialized burn care facilities provide burn care in various configurations of units dedicated primarily to burns and those shared with other patients. Despite the closing of 50 such facilities in recent decades, total reported burn beds in the United States have remained essentially stable during the past 30 years. Issues related to concentrating burn beds in a smaller number of facilities and external factors affecting their past and future operations merit additional review.