Burns are thermal injuries to the skin or tissues caused by extreme temperatures (mainly heat), radiation, electricity or contact with chemicals causing death of variable amount of affected tissues.
According to World Health Organization (2015 Global health estimates), an estimated 180, 000 deaths occur each year from fires alone. However; more deaths occur from scalds, electrical burns, and other forms of burns, for which global data is not available.
It was further found that 95% of fatal fire-related burns occur in low- and middle-income countries. In addition to those who die, millions more are left with lifelong disabilities and disfigurements, often with resulting stigma and rejection.
Despite the continuous public health awareness to prevent these accidents among Rwandans, we still have a big challenge of burn injuries. Not a single week passes without admitting at least two new patients due to major burn injuries in our hospital. Most of these are children and nearly all of these incidences are due to preventable causes. Almost all of these preventive measures wouldn’t require any form of financial expenses: only simple vigilance by parents and guardians.
It is important to know that burn injuries can be difficult to treat and fatal, even in developed burn care centres. The complications that usually develop despite proper major burn management can be debilitating and lifelong both in terms of function, physical appearance and psychosocial impact.
Common venues of most burn accidents in our settings include; kitchen, bathrooms, hot liquid accidents anywhere in the house, candles. Other less frequent causes include; hot flat irons, smoking, camp fires, motor vehicle fire accidents, chemical accidents, as well as electricity.
However, some simple and seemingly obvious measures, when practiced at home religiously, would reduce the incidence of these burn injuries greatly, especially among children.
In the kitchen; inexperienced cooking is a leading cause of kitchen fires, hence, adequate training should be achieved before attempting to cook. Children should be prevented from entering the kitchen alone. Even when attended to, a minimum of one meter safe zone should be maintained by a barrier.
In the bathroom, water for bathing babies should be adequately checked to ensure that it isn’t hot for the baby; babies can sustain burns from water that seems just warm for the adult skin. Testing should be done with the adult’s skin just below the elbow, and not with the fingers or palms as these are not so sensitive to temperature. Small children should never be left alone in bath tubs.
Drinking or carrying hot beverages when holding a young child should be avoided. Don’t place hot beverages on low tables where children can easily reach them. If you have a toddler or small child at home, avoid using a dining tablecloth as these can be pulled on by children while playing and cause burns if hot substances were placed on the table.
Use candleholders that are heavy and large enough to hold candles. Never leave candles unattended. Candles should be avoided near beddings as these are a common source of fire when there is contact with the bed sheets, mattresses, and mosquito nets, leading to serious burn injuries.
Keep lighters and matches out of a child’s reach. Cigarettes are the most common ignition source, hence, smoking should be avoided inside houses and safe ash-trays used for smokers.
Iron burns are the most common cause of direct skin contact burns in children. A hot iron should not be left unattended at any time.
Chemicals should be kept in their original containers. Mixing of chemicals should be avoided to prevent explosions. Heavy rubber gloves should be used while handling these chemicals, and should all be kept out of reach of children.
Children should keep away from electric wires and sockets including insertion of anything such as charging equipment into sockets as these could be a source of electric burns.
Once a child or anyone has sustained burn injuries, there are some important basic first aid measures that can reduce the severity of burns once applied early at home or nearest health facility. These should be known by everyone.
First of all, one must ensure their own safety before intervening or else it could be fatal to both. Avoid immediate direct contact with a person who got electrocuted before turning off electricity source and wearing insulating garments. Then stop any active burning process by rolling the affected person flat on the ground, cut off their clothes (don’t aim to preserve the clothes). While using a fire extinguisher, the patient should be made to lie with the face to the ground and spraying done beginning from the head down to the toes to avoid burns to the face as well as suffocation.
Cool off only the burned area under running cold water for at least 20 minutes but don’t aim to cool the whole body (aim to keep the rest of unburned body surface warm). Avoid use of ice on burned areas as this worsens the burn injury. Avoid application of traditional remedies such as sugar, herbs, toothpaste, and et cetera, on the burned skin as these have no role and could be source of infection. Leave any blisters formed on the burned skin unbroken.
Seek immediate health care services, especially for burns of the head and neck regions as these could become fatal rapidly.
Dr. Ian Shyaka, Resident, Plastic Surgery,
Rwanda Military Hospital