Dos and don’ts in burns and scalds treatment

According to the World Health Organisation over 96 per cent 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 often with resulting stigma and rejection. Globally, burns are a serious public health problem. An estimated 265,000 deaths occur each year from fires alone, with more deaths from scalds, electrical burns, and other forms of burns. WHO further reveals that the higher risk for females is associated with open fire cooking, or inherently unsafe cooking stoves, which can ignite loose clothing. Along with adult women, children are particularly vulnerable to burns. Burns are the 11th leading cause of death of children aged 1–9 years and are also the fifth most common cause of non-fatal childhood injuries. While a major risk is improper adult supervision, a considerable number of burn injuries in children result from child maltreatment. Because of the magnitude of the problem, WHO dedicates one week in May every year to enlighten the world about burns – the causes, preventive measures and treatment. Burns and scalds explained Magnifique Irakoze, a general practitioner at Muhima District Hospital, describes burns and scalds as damage to the skin caused by heat although both are treated in the same way. They are however different in the sense that a burn is caused by dry heat – by a hot iron rod or fire, for example, while a scald is caused by something wet, such as hot water or steam. While the levels of severity in burns and scalds may differ, people with low body immunity as well poorly treated patients may have life threatening effects. “People living with non-communicable diseases such as diabetes and poorly fed people usually have low immunity which may impede the healing process of burns and scalds.” Also, the kind of treatment that the patient receives contributes a lot to the healing process as poorly hydrated victims of burns or scalds or those exposed to infection may delay the healing or succumb to their wounds,” explains Dr Madelaine Mukeshimana, a nursing professor at University of Rwanda’s College of Medicine. Preventive measures The suffering caused by burns is even more tragic as burns are so eminently preventable. As such, Mukeshimana advises that one has to first have in mind the kinds of people that are prone to burns and scalds. “Children, the elderly, the disabled and mentally ill people can easily incur accidents that may cause burns and scalds,” she says. Although burns and scalds often occur in homes, it should be kept in mind that burn risks outside the home are also bound to occur, especially in work places with open flames, chemicals or superheated materials. Mukeshimana points at negligence as one of the risk factors. She calls for sensitisation especially of house helps who deal with heating items such as gas cookers and flat irons. Irakoze also advises that one should regularly check smoke detectors and change their batteries regularly, as well as avoid smoking in the house or in bed. “Blow out candles and store matches out of reach of children, keep candles at least 12 inches away from anything that can burn, and always blow them out when you leave the room or before you go to sleep,” she says. Also, items such as dish towels, plastic bags and long sleeves should be kept away from the heating surface. First aid In cases where the burns and scalds have already occurred, stopping the burning process as soon as possible should be the first step. This may involve removing the person from the area, drenching flames with water or smothering flames with a blanket, Irakoze advises. “However, caution should be taken so as not to put yourself at risk of getting burnt as well. Remove any clothing or jewelry near the burnt area of skin, including babies’ nappies. Don’t try to remove anything that’s stuck to the burnt skin as this could cause more damage,” she says. Mukeshimana further reveals that while burns and scalds may be treated according to the levels of severity, infection prevention is key, as infected burns and scalds can lead to life-threatening cases. “Cover the affected person with a clean cloth but avoid putting it on the injured area, as this will surely prevent hypothermia, a situation where a person’s body temperature drops below 35ºC (95ºF). They should then be immediately taken to hospital because delaying the victim can increase the risk of infection. “Furthermore, hydration is very important especially in cases where children are victims as burns and scalds tend to lose much water from their bodies. In this case giving the victims enough fluids will quicken the healing process,” she says. A doctor will then give stronger painkillers, if required. Scars, a long-lasting effect on the skin On the other hand, Francois Gahongayire, a dermatologist at King Faisal Hospital, Kigali, notes that preventive measures from burns and scalds are vital and should be taken seriously because of the effect they may have on the skin. She says a scar results from the biologic process of wound repair in the skin and other tissues. Most wounds, except for very minor ones, result in some degree of scarring. Sadly, even though scars can be treated, they cannot be permanently removed. The scars that are left after the injury are as a result of the healing process. The scars however leave a life time effect on the victim’s skin health, she explains. “Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and cause severe itching, tenderness, pain, sleep disturbance, anxiety, and depression,” she says. “They also affect the skin in the sense that the first tissue is lost and the victim is only left with a non-elastic tissue simply because the scar doesn’t have the characteristic of the first tissue. Contracture scars that are caused by the skin shrinking and tightening, usually after a burn, can restrict movement,” says Gahongayire.