Burn Prevention

Original Editor - Manisha Shrestha Top Contributors - Manisha Shrestha and Kim Jackson

Introduction

Burn is a global public health problem, and are more common in developing as well as low- and middle-income countries (LMICs), where more than 95% of severe burns occur[1]. Fire-related burns are the most common type of burn, with over 90% occurring at home.[2]

Industrial worker working with burning coal

Risk factors of burn

  • The use of potentially unsafe kerosene cooking appliances and open fires at floor level, and wearing traditionally loose clothing and wraps are seen as significant risk factors for flame related burns in younger women aged 16-35 years.[3]
  • Adult males are typically most at risk for burns in the workplace, second to exposure to flames, scalds, and faulty electrical wiring.
  • Children under the age of 15 are at increased risk of burns, with 84% of all pediatric burns occurring at home, particularly in the kitchen, where 80% of the time the child is unsupervised. The unsupervised use of homemade fireworks by children during festivals also increases the incidence of burns in LMICs.
  • Babies and young infants one year or under are at most risk from burns from bed netting and sleepwear, second to faulty electrical wiring and simple devices such as mosquito coils. In addition, local traditional practices of hot water baths for mothers immediately after childbirth, and treating convulsions in children with fire are added risk factors for burns, unique to some African countries.
  • Unfortunately, burns from intentional exposure to chemicals, including chemical assaults, are also seen in LMICs, mostly inflicted upon males as violent crimes or as a crime-of-passion. Intentional burns from flames are also suffered by females in the 20-30 age group due to suicide attempts, or assaults by men.
  • Living in LMICs, being unemployed, low socioeconomic status, alcohol, tobacco, and illicit drug consumption are all independent risk factors for burns.
  • Civilians living in situations of armed conflict are at high risk of burns, with approximately 9% of all civilian injuries during conflict due to burns.[2]

Since these risk factors are preventable, burns are preventable too, according to the World Health Organization (WHO).[4]

Complication of burn

There are various complications associated with the burn. Not only the physical but also the psychological and socio-economical state of individuals suffering from burns are affected.

Poverty and Burn- a vicious cycle

  • Not only are burn deaths and injuries more common in people with low socioeconomic status, but also the survivors find their pre-injury poverty levels worsen after recovery. Most burn injuries lead to prolonged and expensive hospital stays for pain management and wound care. In addition to that, burn patients require attention to nutritional deficiencies, to the consequences of suppression of the immune system, and to rehabilitation therapy. This makes the financial status of the family weaker.
  • Survivors develop burn wound contractures and other physical impairments that limit function, lead to disability, and reduce their chance of leading economically productive lives.
  • Disfigurements caused by burning often result in social stigma, restriction in their participation in society, and disadvantage in their future employment. As they do not have the financial means to pay for surgery and other treatments needed to achieve functional and aesthetic improvements after the initial healing and grafting.

Psychological scar

  • Coping skills, family and community support, and general psychological health have more impact on recovery from burns than the burn itself.
  • Following the healing of the wound, the child often has post-traumatic stress, with nightmares, anxiety, depression, and loss of motivation due to the stigma, and exclusion from school and society.

Thus, it is very important to prevent burn.

Prevention is key

As risk factors of burn are preventable and the complication caused by burns in burn survivors is life-threatening, truly the best way to treat a burn is to prevent it from happening in the first place. Reports indicate the success of burn prevention programs in developed countries whereas the lack of a coherent and robust program for the prevention of burns being the reason hindering the success of these programs in developing countries.[1] Thus increased efforts to do so would likely lead to significant reductions in rates of burn-related death and disability in developing countries.
The main aim of burn prevention is to increase awareness about burn hazards and thus reduce the incidence and severity of burn injuries.[5]  Prevention is cost-effective than acute burns management and will clearly reach greater numbers of people. So, a burn prevention program would be of great help.[4][6]

Prevention strategies

An effective burn prevention plan

It should be multisectoral and include broad efforts to:

  • Improve awareness.
  • Develop and enforce the effective policy.
  • Describe the burden and identify risk factors.
  • Set research priorities with the promotion of promising interventions.
  • Provide burn prevention programs.
  • Strengthen burn care.
  • Strengthen capacities to carry out all of the above.[7]

Burn injuries can be successfully prevented using

  • Education,
  • Engineering changes,
  • Enforcement of legislative protection, and
  • Environmental modifications.[4]

Among the list of burn prevention strategies that have been developed and implemented in developed countries, these are the most common and effective ones: community implementation of smoke detectors, regulation of hot water heater temperatures, flame-resistant children’s sleepwear, and housing codes that assure the safety of electrical wiring.[4][2]

For example,

The State of Washington (USA) mandated in 1983 that the water temperature of new home hot water heaters be preset at 49° Celsius (120° Fahrenheit). Five years later the admission rate at the regional burn center in Seattle had dropped from 5.5 cases to 2.4 per year.[7]

A smoke alarm giveaway program in an area of Oklahoma City that had a high rate of residential fire injuries decreased house fire injury rates by 80% during the four years after the intervention.[7]

Acid Survivors Foundation (ASF) of Bangladesh- has been raising public awareness, building institutional capacity and lobbying, working with other nongovernmental organizations, the media, celebrities, and student groups to elevate community consciousness. It has also fostered advocacy and lobbying efforts with the government to ensure the passage and enforcement of laws and to create systems to provide service to acid survivors.[7]

Burn survivor groups have also played an important role, not only by providing much-needed peer support but also through their campaigning and advocacy efforts, in particular, in relation to burn prevention and treatment. In addition, they have been instrumental in gaining legal protection for burn survivors from discrimination in the workplace and society.[8]

[9]


Specific recommendations

There are a number of specific recommendations for individuals, communities, and public health officials to reduce burn risk.

  • Enclose fires and limit the height of open flames in domestic environments.
  • Promote safer cookstoves and less hazardous fuels, and educate regarding loose clothing.
  • Apply safety regulations to housing designs and materials, and encourage home inspections.
  • Improve the design of cookstoves, particularly with regard to stability and prevention of access by children.
  • Lower the temperature in hot water taps.
  • Promote fire safety education and the use of smoke detectors, fire sprinklers, and fire-escape systems in homes.
  • Promote the introduction of and compliance with industrial safety regulations, and the use of fire-retardant fabrics for children’s sleepwear.
  • Avoid smoking in bed and encourage the use of child-resistant lighters.
  • Promote legislation mandating the production of fire-safe cigarettes.
  • Improve the treatment of epilepsy, particularly in developing countries.
  • Encourage further development of burn-care systems, including the training of health-care providers in the appropriate triage and management of people with burns.
  • Support the development and distribution of fire-retardant aprons to be used while cooking around an open flame or kerosene stove.[7]

First aid

Proper first aid is very much essential for the reduction of severity of the burn. Basic guidance on first aid for burns is provided below.

What to do

  • Stop the burning process by removing clothing and irrigating the burns.
  • Extinguish flames by allowing the patient to roll on the ground, or by applying a blanket, or by using water or other fire-extinguishing liquids.
  • Use cool running water to reduce the temperature of the burn.
  • In chemical burns, remove or dilute the chemical agent by irrigating with large volumes of water.
  • Wrap the patient in a clean cloth or sheet and transport to the nearest appropriate facility for medical care.[7]

What not to do

  • Do not start first aid before ensuring your own safety (switch off electrical current, wear gloves for chemicals, etc.)
  • Do not apply paste, mud, cow dung, oil, haldi (turmeric), or raw cotton to the burn.[3]
  • Do not apply ice because it deepens the injury.
  • Avoid prolonged cooling with water because it will lead to hypothermia.
  • Do not open blisters until topical antimicrobials can be applied, such as by a health-care provider.
  • Do not apply any material directly to the wound as it might become infected.
  • Avoid the application of topical medication until the patient has been placed under appropriate medical care.[7]

Resources

  1. Burn prevention- Center for Disease Control and Prevention

References

  1. 1.0 1.1 Alipour J, Mehdipour Y, Karimi A. Epidemiology and outcome analysis of 3030 burn patients with an ICD-10 approach. Annals of burns and fire disasters. 2020 Mar 31;33(1):3.
  2. 2.0 2.1 2.2 Stokes MA, Johnson WD. Burns in the third world: an unmet need. Annals of burns and fire disasters. 2017 Dec 31;30(4):243.
  3. 3.0 3.1 Phuyal K, Ogada EA, Bendell R, Price PE, Potokar T. Burns in Nepal: a participatory, community survey of burn cases and knowledge, attitudes and practices to burn care and prevention in three rural municipalities. BMJ open. 2020 Feb 1;10(2):e033071.
  4. 4.0 4.1 4.2 4.3 Peck M, Molnar J, Swart D. A global plan for burn prevention and care. Bulletin of the World Health Organization. 2009;87:802-3.
  5. McLoughlin E, Vince CJ, Lee AM, Crawford JD. Project Burn Prevention: outcome and implications. American Journal of Public Health. 1982 Mar;72(3):241-7.
  6. MedWatch Today. Students Learn About Fire Safety and Burn Prevention. Available from: https://www.youtube.com/watch?v=xLIaWP5tMs0. [Lasted assessed: 7/11/2020]
  7. 7.0 7.1 7.2 7.3 7.4 7.5 7.6 World Health Organization [Internet]. [updated 6th March 2018; cited 2020 Nov 7]. Available from: https://www.who.int/news-room/fact-sheets/detail/burns
  8. World Health Organization (WHO). A WHO plan for burn prevention and care. Geneva, Switzerland, 2008.
  9. Burn Prevention: Home Safety. Children's National Hospital. Available from: https://www.youtube.com/watch?v=gMalF0GMLEM. [lasted assessed: 7th Nov 2020]