Pre-hospital care in burn injury

ABSTRACTThe care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans

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Perception and Practice among Community People and Health Service Providers on Care and Management of Burn Injuries in Nepal: A Qualitative Study

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v17i3.1640 ◽

2019 ◽

Vol 17 (3) ◽

pp. 315-319

Author(s):

Santosh Bikram Bhandari ◽

Sujit Kumar Sah ◽

Khakindra Bahadur Bhandari ◽

Jaswan Sakya ◽

Laxmi Raj Pathak ◽

...

Keyword(s):

Health Service ◽

Qualitative Study ◽

Service Providers ◽

Burn Injury ◽

Good Practice ◽

First Aid ◽

Burn Injuries ◽

Burn Care ◽

Health Service Providers ◽

Community People

Background: According to WHO, burns are a serious public health problem and the second most common cause for injury in rural Nepal, accounting for 5% of disabilities. The overall objective of the study is to assess the prevailing perception and practice among community people and health service providers on care and management of burn injuries in Nepal. Methods: This was a qualitative study conducted in 2016 representing all eco-development regions. A total of 40 key informants interviews with health personnel and 18 focus group discussions with the community people were conducted.Results: There are very limited dedicated burn care facilities in Nepal. During discussion, the service providers and community people mentioned that a burn injury can affect any one irrespective of their age and socioeconomic status. The study showed that females are at higher risk for burn injury which is associated mostly with wood fire cooking.The burn cases in the hospitals were more during winter than insummer season. Among all the ethnic groups, Dalit and indigenous population were found more vulnerable towards burn injuries. Intentional burn injuries such as self-inflicted burns/suicidal attemptwere found to occur more in females.The community people had a good practice of taking the majority ofpatients having burn injury immediately to the hospital,if not, they at least provided them with a first aid treatment. Conclusions: Majority of burn injured cases are getting first aid treatment at the incident places and taking hospital immediately. Main reasons, who reached late, are unaware about seeking services and financial constraint. Overall, the community people are partially aware about the burn injury.Keywords: Burn injuries; community practice; hospitals; incident and types.

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102 Wildfire Burns: Implications for Burn Care

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.105 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S67-S67

Author(s):

Tina L Palmieri ◽

Kathleen S Romanowski ◽

Soman Sen ◽

David G Greenhalgh

Keyword(s):

Length Of Stay ◽

Burn Injury ◽

Total Body Surface Area ◽

Ventilatory Support ◽

Mass Casualty ◽

Inhalation Injury ◽

Burn Injuries ◽

Injury Incidence ◽

Burn Centers ◽

Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

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Epidemiology of burn injury in older adults: An Australian and New Zealand perspective

Scars Burns & Healing ◽

10.1177/2059513120952336 ◽

2020 ◽

Vol 6 ◽

pp. 205951312095233

Author(s):

Lincoln M Tracy ◽

Yvonne Singer ◽

Rebecca Schrale ◽

Jennifer Gong ◽

Anne Darton ◽

...

Keyword(s):

Older Adults ◽

New Zealand ◽

Older Adult ◽

Surgical Management ◽

Surgical Procedure ◽

Burn Injury ◽

Burn Injuries ◽

Younger Patients ◽

Care Community ◽

Burn Care

Introduction: The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand. Methods: The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated. Results: There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013–1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft. Discussion: Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people. Lay Summary The number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients. We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit. Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part). This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.

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Quantifying the efficacy of first aid treatments for burn injuries using mathematical modelling and in vivo porcine experiments

10.1101/131391 ◽

2017 ◽

Author(s):

Matthew J Simpson ◽

Sean McInerney ◽

Elliot J Carr ◽

Leila Cuttle

Keyword(s):

Experimental Data ◽

Mathematical Model ◽

Thermal Energy ◽

Tissue Damage ◽

Burn Injury ◽

Blood Perfusion ◽

First Aid ◽

Burn Injuries ◽

Threshold Temperature

AbstractFirst aid treatment of burn injuries reduces scarring and improves healing. Here, we quantify the efficacy of various first aid treatments by using a mathematical model to describe a suite of experimental data from a series of in vivo porcine experiments. We study a series of consistent burn injuries that are subject to first aid treatments that vary in both the temperature and duration of the first aid treatment. Calibrating the mathematical model to the experimental data provides estimates of the in vivo thermal diffusivity, the rate at which thermal energy is lost to the blood (perfusion), and the heat transfer coefficient controlling the loss of thermal energy at the interface of the fat and muscle layers. A limitation of working with in vivo animal experiments is the difficulty of resolving spatial variations in temperature across the tissues. Here, we use the solution of the calibrated mathematical model to predict and visualise the temperature distribution across the thickness of the tissue during the creation of the burn injury and the application of various first aid treatments. Using this information we propose, and report values for, a novel measure of the potential for tissue damage. This measure quantifies two important aspects that are thought to be related to thermal injury: (i) the volume of tissue that rises above the threshold temperature associated with the accumulation of tissue damage; and, (ii) the duration of time that the tissue remains above this threshold temperature. We conclude by discussing the clinical relevance of our findings.

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A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

European Journal of Burn Care ◽

10.3390/ebj2040021 ◽

2021 ◽

Vol 2 (4) ◽

pp. 293-300

Author(s):

Stephen Frost ◽

Liz Davies ◽

Claire Porter ◽

Avinash Deodhar ◽

Reena Agarwal

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Burn Injury ◽

Burn Injuries ◽

Burn Patients ◽

Review Of The Literature ◽

Respiratory Compromise ◽

Burn Care ◽

Membrane Oxygenation ◽

Regular Time ◽

Major Burn

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

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58 The Homelessness Crisis and Burn Injuries: A Cohort Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.062 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S38-S39

Author(s):

Sebastian Q Vrouwe ◽

Maxwell B Johnson ◽

Christopher H Pham ◽

Christianne J Lane ◽

Warren L Garner ◽

...

Keyword(s):

Cohort Study ◽

Burn Injury ◽

Care Facility ◽

Burn Injuries ◽

High Risk Population ◽

Burn Prevention ◽

Stable Housing ◽

Lower Socioeconomic ◽

Adult Inpatient ◽

Using Data

Abstract Introduction Many metropolitan areas face a growing homelessness crisis. Lower socioeconomic status has been shown to be a consistent risk factor for burn injury; however, only a limited number of studies have specifically examined homeless burn patients. The purpose of this study is to characterize the demographics and outcomes of homeless patients who sustain burn injuries and compare them to a cohort of domiciled patients in a large, metropolitan city. Methods A retrospective cohort study was performed at an ABA-verified center located in a major metropolitan area. Consecutive acute burn admissions in adults from June 1, 2015 to December 31, 2018 were included. Prevalence was estimated using data from the regional homeless count. Comparisons of demographics, burn characteristics, clinical outcomes, and disposition were made between patients categorized homeless or domiciled at the time of their injury. Results Of 881 admissions, 751 (85%) had stable housing, and 130 (15%) were homeless. The mean prevalence rate of burn injury requiring hospitalization for homeless adults was estimated at 88 per 100,000 persons. Homeless patients had a significantly larger median burn size (7% vs 5%, p< 0.05), characterized by a greater rate of flame burns (68% vs 42%, p< 0.001). For the homeless, rates of assault and self-inflicted injury were four- (18% vs 4%, p< 0.001) and two-fold higher (9% vs 4%, p< 0.001), respectively. Homeless patients had higher rates of mental illness (32% vs 12%, p< 0.001) and substance abuse (88% vs 22%, p< 0.001), and were less likely to follow-up as outpatients (54% vs 87%, p< 0.001). There were no significant differences in mortality. Homeless patients had a longer median length of stay (LOS, 11 days vs 7 days, p< 0.001), but there were no significant differences in LOS per %TBSA. Homeless patients had more complex discharge dispositions and were more frequently discharged to a recuperative care facility than domiciled patients (27% vs. 1%, p< 0.001). Conclusions Homeless patients comprised a significant subset of our adult inpatient population, with an estimated five-fold greater rate of burn injury requiring hospitalization compared to the national average. These patients sustained larger burn injuries with greater rates of assault or self-inflicted injury. Applicability of Research to Practice Homeless individuals should be considered a high-risk population for burn injury. This distinction serves as a call to action for the development of burn prevention strategies.

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Identifying Risk Factors That Increase Analgesic Requirements at Discharge Among Patients With Burn Injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/irab179 ◽

2021 ◽

Author(s):

Celine Yeung ◽

Alex Kiss ◽

Sarah Rehou ◽

Shahriar Shahrokhi

Keyword(s):

Risk Factors ◽

Substance Misuse ◽

Burn Injuries ◽

Patient Specific ◽

Care Providers ◽

Gender History ◽

Patient Risk ◽

Burn Care ◽

Mixed Regression ◽

History Of

Abstract Patients with burn injuries require large doses of opioids and gabapentinoids to achieve pain control and are often discharged from hospital with similar amounts. This study aimed to identify patient risk factors that increase analgesic requirements among patients with burn injuries and to determine the relationship between opioid and gabapentinoid use. Patient charts from July 1, 2015 to 2018 were reviewed retrospectively to determine analgesic requirements 24 hours before discharge. Linear mixed regression models were performed to determine patient risk factors (age, gender, history of substance misuse, TBSA of burn, length of stay in hospital, history of psychiatric illness, or surgical treatment) that may increase analgesic requirements. This study found that patients with a history of substance misuse (P = .01) or who were managed surgically (P = .01) required higher doses of opioids at discharge. Similarly, patients who had undergone surgical debridement required more gabapentinoids (P < .001). For every percent increase in TBSA, patients also required 14 mg more gabapentinoids (P = .01). In contrast, older patients (P = .006) and those with a longer hospital stay (P = .009) required fewer amounts of gabapentinoids before discharge. By characterizing factors that increase analgesic requirements at discharge, burn care providers may have a stronger understanding of which patients are at greater risk of developing chronic opioid or gabapentinoid misuse. The quantity and duration of analgesics prescribed at discharge may then be tailored according to these patient specific risk factors.

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The Practice of First Aid for Burn Injuries Among the Population of East Coast of Peninsular Malaysia for 2012–2016

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa025 ◽

2020 ◽

Vol 41 (4) ◽

pp. 905-907

Author(s):

Sul Na Seow ◽

Ahmad Sukari Halim ◽

Wan Azman Wan Sulaiman ◽

Arman Zaharil Mat Saad ◽

Siti Fatimah Noor Mat Johar

Keyword(s):

East Coast ◽

Burn Injury ◽

Tap Water ◽

Public Health Problem ◽

First Aid ◽

Burn Injuries ◽

Soy Sauce ◽

Retrospective Audit ◽

Life Years ◽

The Mean

Abstract Burns are a devastating public health problem that result in 10 million disability-adjusted life-years lost in low- and middle-income countries. Adequate first aid for burn injuries reduces morbidity and mortality. The rate of proper first aid practices in other countries is 12% to 22%.1,2 A 5-year retrospective audit was performed on the database of the Burn Unit in Hospital Universiti Sains Malaysia for 2012–2016; this involved 485 patients from the east coast of Malaysia. The mean age of the patients is 17.3 years old. The audit on first aid practices for burn injury showed poor practice. Out of 485 burned patients, 261 patients (53.8%) claimed that they practiced first aid. However, only 24 out of 485 patients (5%) practiced the correct first aid technique where they run their burn wound under cool water for more than 20 minutes. Two hundred and twenty-two patients had not received any first aid. Two patients did not respond to the question on the first aid usage after burn injury. The mean age of patients who practiced first aid was 15.6 years old. Out of the 261 patients who practiced first aid, 167 (64%) run their wound under tap water for different durations. Others practiced traditional remedies such as the application of “Minyak Gamat” (6.5%), soy sauce (5.5%), other ointments (3.6%), milk (1.8%), and eggs (0.7%), as well as honey, butter, and cooking oil (0.4% each). First aid practices for burn injuries in the population of east coast Malaysia are still inadequate. The knowledge and awareness of school children and the general Malaysian population must be enhanced.

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66 Prescribing Patterns of Opioids and Adjunctive Analgesics for Patients with Burn Injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.070 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S47-S47

Author(s):

Celine Yeung ◽

Alex Kiss ◽

Sarah Rehou ◽

Shahriar Shahrohki

Keyword(s):

Burn Injuries ◽

Prescribing Patterns ◽

Care Providers ◽

Burn Care ◽

Pain Medications ◽

Daily Dose ◽

Mixed Regression ◽

History Of ◽

Control Pain ◽

Chronic Use

Abstract Introduction Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns. Methods A retrospective review of patient charts (n = 199) between July 1, 2015 - 2018 were reviewed from a registry at a single burn center. Opioid, neuropathic pain agent (NPAs), acetaminophen, and ibuprofen quantities given before and at discharge were compared. Linear mixed regression models were used to identify factors that increased the amount of analgesics prescribed among burn care providers. Results On average, patients were prescribed significantly more analgesics at discharge compared to what was consumed pre-discharge (p < 0.0001). Specifically, on average, providers did not overprescribe the daily dose of analgesics, but overprescribed the duration of pain medications required. For every increase in percent TBSA, 14 MEQ more opioids, 203 mg more NPAs, 843 mg more acetaminophen, and 126 mg more ibuprofen were prescribed (p < 0.05). Surgery was a predictor for higher opioid and NPA prescriptions (p = 0.03), while length of stay was associated with fewer NPAs prescribed (p = 0.04). Fewer ibuprofen were given to patients with a history of substance misuse (p = 0.01). Conclusions The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.

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A qualitative study of health professionals’ views on using iPads to facilitate distraction during paediatric burn dressing changes

Scars Burns & Healing ◽

10.1177/2059513118764878 ◽

2018 ◽

Vol 4 ◽

pp. 205951311876487 ◽

Cited By ~ 2

Author(s):

Elizabeth Green ◽

Julia Cadogan ◽

Diana Harcourt

Keyword(s):

Health Professionals ◽

Burn Injury ◽

Burn Injuries ◽

Management Technique ◽

Burn Care ◽

Paediatric Burns ◽

Wide Range ◽

Pharmacologic Pain Management ◽

Care Training ◽

Burns Unit

Introduction: Distraction is a non-pharmacologic pain management technique commonly used to avert a person’s attention from procedural pain and distress during stressful procedures such as treatment after a burn injury. In recent years, computer tablets (such as iPads) have been used within paediatric burns services to facilitate distraction by way of apps, games, cartoons and videos during dressing changes. However, we know very little about health professionals’ experiences of using them in this context. Methods: The current study explored health professionals’ experiences of using iPads to facilitate distraction during paediatric burn dressing changes. Fifteen health professionals from a single paediatric burns unit were interviewed. Thematic analysis revealed two key themes: (1) the iPad is a universal panacea for distraction; and (2) trials and tribulations. Discussion: Participants considered iPads to be potentially useful and effective distraction tools, suitable for use with a wide range of patients with burn injuries including young children, adolescents and young adults. However, issues including health professionals’ understandings of one another’s roles, the challenge of working in a busy burns service, and lack of experience and confidence were identified as possible barriers to their use within routine burn care. Training for staff on the use of iPads as a means of facilitating distraction, development of guidelines and a review of how they are incorporated into routine burn care are recommended.

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