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CHAPTER2 Burn prevention
Categories ofburn prevention
countermeasures
These strategies represent the ways in which the transfer of energy can be
controlled, modied, or interrupted:
• Prevent the creation of the hazard
• Ban manufacture and sale of unsafe products
• Prohibit unsafe practices
• Reduce the amount of energy in the hazard
• Prevent the release of a hazard that already exists
• Modify the rate or spatial distribution of the hazard
• Separate the hazard from those to be protected, in space or time
• Separate the hazard by a material barrier
• Modify relevant basic qualities of the hazard
• Make what is to be protected more resistant to damage from the hazard
• Counter the damage done by the hazard
• Stabilize, repair, and rehabilitate the one damaged by the hazard
Third dimension ofHaddon matrix
Decision- making for selection of burn prevention intervention strategies
can be facilitated by the use of value criteria:
• Eectiveness
• Cost
• Freedom
• Equity
• Stigmatization
• Preferences
• Feasibility
In general, implementation of burn prevention programmes takes place
through the three Es:
• Enforcement of legislation or regulations
• Education
• Engineering and design modication
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MONITORING AND EVALUATION
Monitoring and evaluation
Ongoing appraisal of the process and outcomes is critical to the success of
any burn prevention programme.
• Understanding of scope and magnitude of burn problem
• Epidemiological pattern
• Major causes
• Risk factors
• Documentation of eectiveness of programmes
• Cost– benet ratio
• Modication vs. discontinuation of unsuccessful programmes
• Future directions
• Continuation and expansion of successful programmes
• Resource allocation
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CHAPTER2 Burn prevention
Examples ofsuccessful strategies
Several burn prevention programs have documented eectiveness,
including epidemiological studies, controlled trials, and evidence of sustained decreases in population- based burn rates.
Child- resistant lighters
2
• Nature of the problem— many residential res (and associated burns
and deaths) are caused by children playing with cigarette lighters and
matches
• Solution— ignition mechanism can be designed to prevent operation by
children under 5years of age
• For example, depression of the metal shield is required before the
ywheel can be turned to make a spark
• Implementation of the solution— U.S. Consumer Product Safety
Commission developed standards in 1994
• Nearly 60% reduction in childhood injuries and deaths caused by
playing with lighters in the USA following implementation
• Similar standards in UK, EU, Canada, Australia, and New Zealand
Electrical safety
• Nature of the problem— increasing electrication of low- and middle-
income countries is associated with concurrent upsurge in electrical
injuries and structure res
• Solution— both engineering design and regulations play a role in
prevention of electrical injury, including
• Insulation of wires
• Fuse and circuit- breaker systems
• Safe routing of electrical wires within and between structures
• Implementation of the solution
• Underwrites laboratory tests and standardizes safety features of
electrical products, and National Fire Protection Agency publishes and
updates National Electrical Code
—Ground fault circuit interrupter shuts o electrical device when
escape of current is detected, preventing electrocution
— Arc fault circuit interrupter disconnects device when arc is
detected, preventing res
— Occupational Safety and Health Administration mandates
workplace safety standards
—Employee training in electrical theory
—Safe work procedures
—Hazard identication
—Proper use of protective equipment
—First aid and rescue techniques
Child nightware safety
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• Nature of the problem— clothing can be ignited by contact with stoves,
heaters, cigarettes, or other sources of ames; very serious burns occur
when children’s sleepwear ignites
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EXAMPLES OFSUCCESSFUL STRATEGIES
• Solution— fabrics can be made less ammable by increasing the content
of synthetic material, by making clothes tight- tting, and by adding
ame- retardant chemicals
• Implementation of the solution— The nightware (safety) regulations
1985 was amended to minimize the risk of ignition of children’s
sleepwear and reduce the speed at which re would spread after ignition
occurred
• The National Fire Protection Agency estimates that there was a 10-
Fire- safe cigarettes
fold reduction in children’s sleepwear deaths after implementation of
the standards
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• Nature of the problem— cigarettes are frequent ignition sources for
structure res
• Each year in the USA there are over 700 deaths from res caused by
cigarettes
• In the European Union in 2006, cigarettes caused 650 deaths and
€48million in property damage
• Solution— cigarettes can be manufactured so that they self- extinguish
when not being smoked, and thus are less likely to ignited clothing,
bedding or furniture if dropped
• Implementation of the solution— legislation has been passed in the USA,
Canada, Australia, European Union, South Africa, and many countries of
the former USSR
• Attempts at Federal legislation in the USA failed in the 1970s because
of opposition from the tobacco industry
• Eventual success in the USA was due to passage of State laws,
beginning in 2004 in NewYork
— Smoking material re deaths in NewYork State decreased by
40% after implementation of the law
Fireworks safety
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• Nature of the problem— pre- adolescent and adolescent boys are at
greatest risk, sustaining not only burns, but blast injuries to the hands
and eyes
• Solution— local or state legislation bans or restricts the sales of reworks
• Implementation of the solution
• Regulation of reworks sales in the UK and Denmark— particularly
when combined with education programmes— has reduced the
number of reworks injuries
• Repeal of legislation in Minnesota led to resurgence of injuries
Regulation ofhot water heaters
• Nature of the problem— scald burns caused by hot water are among
the most common types of burns, particularly in very young children
• Solution— reducing the temperature of water, the duration of exposure,
or both will diminish the depth of burn and severity of injury
• Implementation of the solution— setting the temperature regulators of
hot water heaters to keep hot tap water below 120°F (50°C) has been
shown to reduce the number and severity of paediatric scald burns
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CHAPTER2 Burn prevention
Smoke alarms
• Nature of the problem— houseres account for majority of burn deaths
in high- income countries (HICs)
• Solution— early detection of heat, smoke or carbon monoxide gives
occupants time to escape
• Implementation of the solution— education campaigns and enforcement
of legislation has led to implementation of installation and maintenance
of smoke alarms
Sprinklers
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• Nature of the problem— structure res in the USA caused over 2,700
deaths and resulted in $9.7 billion in direct property damage in 2010
• Solution— sprinkler systems detect re and douses it with water, limiting
its spread
• Risk of death from residential re is 80% lower in homes with
sprinklers
• Property damage in structures protected by sprinklers is 1/ 5 the
damage in unprotected structures
• Implementation of the solution— legislation and enforcement of
regulations are necessary to bring about widespread installation of
residential sprinkler systems
• Homeowners and the construction industry are resistant to
additional costs
— Sprinkler installation increases the cost of a new home by $1– 2
per square foot
— Retrotting a home costs about the same amount as laying
new carpet
• Only 2% of family homes in the USA are protected by sprinklers
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References
1. Haddon W. The changing approach to the epidemiology, prevention, and amelioration of
trauma: the transition to approaches etiologically rather than descripti vely based. American
Journal of Public Health 1968;58:1431– 8.
2. World Health Organization. Burn prevention: success stories and lessons learned.
Geneva:WHO; 2011.
REFERENCES
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Chapter3
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Pathophysiological
response toburns
Understanding the pathophysiological response to burns 20
Local responses to burns 21
Systemic changes 22
Further reading 27
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CHAPTER3 Pathophysiological response toburns
Understanding thepathophysiological
response toburns
An understanding of the pathophysiological responses to burns has underpinned advances in care and outcomes. Burns result in local and systemic
changes which aect organs distal to the focus of injury.
Zone of
a
Zone of stasis lostZone of stasis preserved
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LOCAL RESPONSES TOBURNS
Local responses toburns
The model proposed by Jackson considers the local response to burns in
three concentric zones (see Fig. 3.1). The ‘zone of coagulation’ is where
irreversible necrosis of skin has occurred. Surrounding this there is the
‘zone of stasis’ where the tissue has sustained a sub- critical insult. Antiinammatory agents and vasodilators may prevent progression to necrosis
in this area. Wound healing begins from the outermost ‘hyperaemic zone’.
Vessels in this area are dilated to facilitate the delivery of immune components including cells and mediators such as cytokines.
coagulation
Epidermis
Dermis
Adequate
resuscitation
Zone of
coagulation
21
Zone of
stasis
Zone of
hyperaemi
Inadequate
resuscitation
Fig 3.1 Jackson’s burn zone model.
Reproduced with permission from Hettiaratchy S, Dziewulski P. ABC of burns:pathophysiology and
types of bur ns. The British Medical Journal 328(7453):1427– 9, Copyright © 2004, British Medical
Journal Publishing Group.
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