BURN PREVENTION DAY- 18TH JANUARY | Challenges beyond survival

Developing countries have a high frequency of burn injuries, making it a formidable public health problem
"Burns are one of the most catastrophic injuries a person can sustain. These injuries account for the second commonest cause of all trauma-related mortality in the developing as well as the developed countries." [Representational Image]
"Burns are one of the most catastrophic injuries a person can sustain. These injuries account for the second commonest cause of all trauma-related mortality in the developing as well as the developed countries." [Representational Image] Flickr [Creative Commons]

Burns are a global public health issue, adjudged to give rise to approximately 180,000 deaths annually. The substantial numbers of these occur in low- and middle-income countries and almost two-thirds occur in the WHO African and South-East Asia regions.

So, the burn injury load falls primarily on the world’s poor (95% of deaths happen in low and middle-income countries). Fire-related injuries are estimated to be accountable for a loss of 10 million disability-adjusted life years (DALY) annually.

The precise aggregate of burns is difficult to ascertain: the strategic extrapolation indicates that in India, over 1million people are moderately or severely burnt each year with 1.4 lakh deaths (comes to one death every 4 minutes due to burns) and 2.4 lakh people inflicted with disability.

Such a high incidence qualifies burns as an endemic health hazard. Practically all the determinants like social, economic, and cultural interaction to complicate the management, reporting, and prevention of burns.                   

Burns are one of the most catastrophic injuries a person can sustain. These injuries account for the second commonest cause of all trauma-related mortality in the developing as well as the developed countries.

The burn injury strikes unfavorably almost all facets of the patient ranging from the physical to the psychological. The overt physical and the unseen psychological scars are resilient and long-lasting and more often lead to chronic disability. It affects all ages from babes in arms to the geriatric population.

Developing countries have a high frequency of burn injuries, making it a formidable public health problem. High population density, overcrowding, poor housing and sanitation, illiteracy, and other attributes of poverty are the prime demographic determinants linked with increased risk of burn injury. And several of these elements are not so quite resistant to change.

Management of burns is a team approach. The complexity of the injury and the chronic nature of the sequelae of burns require an integrated multidisciplinary approach with long follow up. Only such management can lead to the best outcome for burn patients.

This team approach has brought a dramatic change in the survival of burn patients. As such over the last several years, mortality rates and the morbidity from burns have diminished greatly so much so that a mere survival of an extensively burnt patient is no longer considered a great outcome.

The fact that 90% of burn injuries are preventable has led to many attempts to lower down their incidence. Depending on the population of the country, burns prevention can be a national program.

High-income countries have made considerable progress in lowering rates of burn deaths, through a combination of prevention strategies and improvements in the care of people affected by burns.

Most of these advances in prevention and care have been incompletely applied in low- and middle-income countries. Increased efforts to do so would likely lead to significant reductions in rates of burn-related death and disability.

The basis for all prevention is well documented epidemiological data to unfold the specific etiological factors of burns and at-risk population, both of which can be targeted. That is the reason for mandatory reporting of all burn admissions to a central registry, and these data could be corroborated to devise strategies and prevention programs.

The most successful prevention strategies/ campaigns have targeted specific burn causes, vulnerable populations, and training of communities in first aid. An effective burn prevention plan should include broad efforts like improving awareness, developing and enforcing effective policy, describing burden and identifying risk factors, strengthening burn care, etc.

This should ensure that sufficient funds are available and lead to proper coordination of district, regional, and tertiary care centers. The World Health Organization is promoting interventions that are successful in reducing the incidence of burns.

The Organization is also supporting the development and use of a global burn registry for the globally harmonized data collection on burns and increased collaboration between global and national networks to increase the number of effective programs for burn prevention.

The main aims of burn care are to restore form, function, and “feeling”. It is the degree of restoration to preburn level and “return to society” which is more important. 

Burn survivors are often left with disability and disfigurement that interferes with their future life. Rehabilitation measures such as physical therapy and addressing psychological issues can assure a better life to burn survivors. In a true sense, the rehabilitation of burns patients is a continuum of active therapy.

There should be no delineation between an “acute phase” and a “rehabilitation phase”; instead, therapy needs to be started from the day of admission and continues for years after he or she has left the facility. The aim is to return patients, as far as possible, to their pre-injury levels of physical, emotional, and psychological well-being.

For every member of the burn team, rehabilitation must start from the time of injury. Patients need to be encouraged to work to the best of their abilities and accept responsibility for their management.

Education is of paramount importance to encourage patients to accept responsibility for their rehabilitation and remerge into society. A consistent approach from all members of the multidisciplinary team facilitates ongoing education and rehabilitation.

With the increased survival of patients with large burns comes a new focus on the psychological challenges and recovery that such patients must face. Most burn centers employ social workers, vocational counselors, and psychologists as part of the multidisciplinary burn team.

The psychological needs of patients with burn injuries are unique at each stage of physical recovery. The long-term stage of recovery typically begins after discharge from the hospital, when patients begin to reintegrate into society.

This is a period when patients slowly regain a sense of competence while simultaneously adjusting to the practical limitations of their injury. Patients face a variety of daily hassles during this phase, such as compensating for an inability to use hands, limited endurance, and severe itching. To add more, severe burn injuries that result in amputations and scarring can have an emotional and physical effect on patients.

Also, patients must deal with social stressors including family strains, return to work, sexual dysfunction, change in body image, and disruption in daily life. Social support is an important buffer against the development of psychological difficulty.

Ancillary resources such as support groups and peer counseling by burn survivors can also be important services to burn survivors. Adjustment difficulties that persist longer usually involve perceptions of diminished quality of life, lowered self-esteem and social withdrawal.

Many patients face a lengthy period of outpatient recovery before being able to return to work. As expected, patients who sustain larger burns take longer to return to work.  About half of the patients require some change in job status too.

It is a bitter truth that a ‘burn survivor’ is a ‘burnt patient’ for life. So, to conclude a burn injury and its subsequent treatment are among the most painful experiences a person can encounter.

The emotional needs of patients with burns have long been overshadowed by the emphasis on survival. Patients undergo various stages of adjustment and face emotional challenges that parallel the stage of physical recovery.

Adjustment to a burn injury seems to involve a complex interplay between the patient’s characteristics before the injury, moderating environmental factors, and the nature of the injury and ensuing medical care.

Dr. P. UMAR FAROOQ BABA, Additional Professor, Department of Plastic Surgery and Burns, SKIMS, Srinagar

DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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