Prevention of Burn Injuries

Introduction

Prevention is the cure for the epidemic disease of injury. Burns are one of the most devastating of all injuries and a major global public health issue. Treatment of burn injuries has historically received more focus than burn prevention, but this perspective is starting to shift. Burn centers and other partners in burn prevention efforts face a number of challenges including scarce resources, legislative delays, and the need to develop high-quality research methodology to further define the ideal ways to educate and promote safety. Despite these challenges, the potential impact of burn injury prevention efforts is now being recognized and examined on a larger scale.

Injury Prevention Models

The science of injury prevention emerged in the middle of the 20th century. Injuries became recognized as avoidable events resulting from a combination of adverse environmental conditions, equipment, behavior, and personal risk factors, rather than unpredictable accidents. William Haddon developed a system, known as the Haddon Matrix, to apply the principles of public health to the problem of road traffic safety. Since its introduction, it has been used as a means of developing ideas to prevent injury of all types. The matrix enables analysis of the contributing factors of the injury in relationship to the phases of the injury event. The contributing factors studied are:

a.
The host or injured person,
b.
The agent or vehicle,
c.
The physical environment,
d.
The social environment.

The identified phases of an injury event are:

a.
Pre-event: preventing the causative agent from reaching the susceptible host.
b.
Event: includes transfer of the energy to the victim. Prevention efforts in this phase operate to reduce or completely prevent the injury.
c.
Post-event: determines the outcome once the injury has occurred. This includes anything that limits ongoing damage or repairs the damage. This phase determines the ultimate outcome.

The resulting matrix provides a tool to identify strategies and priorities for injury prevention, areas of needed research, and how to best allocate resources ( Table 4.1 ). Haddon further described 10 general strategies for injury prevention and control ( Box 4.1 ). Both of these models can and should be applied to burn prevention because they highlight that society is capable of reducing injury and can do so at more than one stage of an injury event.

Table 4.1

The Haddon Matrix for Burn Control

Matrix adapted from Haddon W. Advances in the epidemiology of injuries as a basis for public policy. Public Health Rep. 1980;95:411–421.

Agent or Vector	Host	Environment	Physical	Social
Pre-event	Fire-safe cigarette	Control seizure	Nonslip tub surface	Legislation—factory preset water heater thermostats
Event	Sprinklers, smoke detectors	Flame-retardant cloths	Fire escapes	Fire drill education
Post-event	Water	First aid antibiotics	EMS	Emergency and rehabilitation services

Box 4.1

From Haddon W. Advances in the epidemiology of injuries as a basis for public policy. Public Health Rep. 1980;95:411–421.

General Strategies for Burn Control

Prevent creation of the hazard (stop producing firecrackers)

Reduce amount of hazard (reduce chemical concentration in commercial products)

Prevent release of the hazard (child-resistant butane lighters)

Modify rate or spatial distribution of the hazard (vapor-ignition-resistant water heaters)

Separate release of the hazard in time or space (small spouts for hot water faucet)

Place barrier between the hazard and the host (install fence around electrical transformers, fire screen)

Modify nature of the hazard (use low conductors of heat)

Increase resistance of host to hazard (treat seizure disorder)

Begin to counter damage already done by hazard (first aid, rapid transport, and resuscitation)

Stabilization, repair/rehabilitation of host (provide acute care; burn center and rehabilitation)

Public health is the effort organized by society to protect, promote, and restore the people's health. The public health model of injury prevention and control is divided into:

▪
surveillance,
▪
interdisciplinary education and prevention programs,
▪
environmental modifications,
▪
regulatory action, and
▪
support of clinical interventions.

Prevention strategies are commonly described as either passive or active. Passive or environmental intervention is a strategy that provides protection against injury and requires little to no cooperation or action from the individual at risk. Examples of passive burn prevention strategies include building codes requiring smoke alarms, sprinkler installation, and factory-adjusted water heater temperature. Active prevention measures are voluntary, and they emphasize education to encourage people to modify unsafe behavior. Examples are home fire drill plans and wearing goggles and gloves when handling toxic chemicals. Passive prevention is more effective because active prevention can be a very difficult strategy to maintain, especially over a long period of time ( Fig. 4.1 ).

Fig. 4.1, Strategies to reduce harm from injury.

Identified prevention strategies can also be classified as primary, secondary, and tertiary, and these are similar to the Haddon Matrix phases of injury. Primary prevention is preventing the event from ever occurring. Secondary prevention includes reducing the severity of injury via acute care of the injury. Tertiary prevention concentrates on preventing or reducing disability.

Burn Intervention Strategy

Prevention science has turned attention away from individual blame and the attitude that injuries are random “accidents” and toward the view that sociopolitical involvement is necessary. All burn injuries should be viewed as preventable. Prevention programs should target high-risk groups and also be implemented with patience, persistence, and precision. The current approaches to burn prevention will be discussed in the framework of the five E's of Injury Prevention: Epidemiology, Engineering, Enforcement, Education, and Evaluation ( Fig. 4.2 ).

▪
Epidemiology: identify the demographics and situations involved with burn injuries.
▪
Engineering: focuses on modification of the physical environment. Examples include fire-resistant upholstery and bedding, child-resistant multipurpose lighters, and insulated electric wire.
▪
Enforcement: influences behavior with laws, building codes, and regulations. Examples include requiring fire escapes and sprinklers/smoke alarms in motels, hotels, and homes.
▪
Education: influences behavior through knowledge and reasoning. Examples include fire safety education programs, public television programs.
▪
Evaluation: assessment of the impact of a prevention strategy and areas of success or reasons for failure.

Fig. 4.2, The five ‘E's of injury prevention.

Epidemiology

Prevention program planning begins with an assessment identifying the scope of the problem, the mechanisms of injury, and the populations at risk. With this information strategic designing and implementation can be directed at reducing the risk of injury or death. Epidemiologic data specific to burn injuries are accessible through multiple sources including the National Burn Repository, state and local health departments, and reports from the National Fire Protection Association (NFPA).

Overview of Burn Injuries in the United States

In the United States in 2014, the leading causes of injury deaths, in order of magnitude, were motor vehicle collisions, falls, drowning, and fire/burns. This same year, fire departments responded to an estimated 1,298,000 fires, which is an increase of 4.7% from the previous year. The American Burn Association estimates that, in 2016, there were 486,000 burn injuries that received medical treatment and 3275 fatalities due to fire or smoke inhalation. This represents a death due to fire every 2 hours and 41 minutes. Approximately 40,000 people were hospitalized because of a burn injury. More than 60% of the acute hospitalizations for burn injury were admitted to the 128 burn centers in the United States. These centers average more than 200 admissions annually, while the other 4500 U.S. acute care hospitals average less than three burn admissions per year. In addition to the human cost, fires in 2014 in the United States resulted in $11.6 billion in property loss.

Common Mechanisms of Injury

The most common mechanisms of burns leading to admission to a burn center in 2015 were fire/flame (43%), scald (34%), contact (9%), electrical (4%), and chemical (3%). The most common places of these injuries were in the home (73%), at work (8%), on the street/highway (5%), and in recreational areas (5%). The most common fire incident that firefighters were called for was outside fires, followed by structure fires and vehicle fires.

House fires are by far the leading cause of fire deaths. In 2014, residential fires represented 83% of fatalities. The leading cause of home fires from 2007 to 2011 was cooking equipment, whereas the largest share of home fire deaths was caused by smoking materials. Heating equipment was the second leading cause of home fires, deaths, and injuries. Sixty-four percent of the people killed and 51% of people injured in home fires were somehow involved in the ignition, such as leaving cooking unattended or a space heater or candle close to something flammable. About one-third (36%) of home fire deaths occurred while the victim was trying to escape and another third (34%) while the victim was sleeping. Only 3% of fire fatalities occurred while the person was engaged in fire control, but 35% of nonfatal injuries were sustained trying to control the fire. Smoke inhalation causes a larger share of deaths and injuries than do burns. From 2007 to 2011, 48% of fire deaths were due to smoke inhalation alone, 24% were due to both burns and smoke inhalation, and 28% were due to burns alone.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here