ReviewLandmarks in burn prevention
Introduction
Burns by fire, hot liquids and contact with hot surfaces have been recognized as significant hazards for centuries. Historically many fire disaster catastrophes resulted not only in property loss but also in considerable loss of life [1]. The mortality from burn injuries is decreasing in economically developed countries due to the implementation of effective burn prevention programs and regulations, and improved burn treatment [2], [3]. For example, in the US, there have been significant declines in the national incidence of burn injury and medical care use for burns during the past two decades [4]. Even so, burn injuries are the fourth leading cause of unintentional injury death in the US and account for 3% of all injury deaths [5]. Between 1971 and 1991 in the US, the rates of decline in deaths attributed to fire and burns, and acute hospitalization for burn injury were about 50%, taking into account the 25% increase in the size of the US population [4]. These improvements coincided with advances in burn treatment and the promulgation of prevention programs. During this period, regional burn treatment centers were established in virtually every major population center, smoke detector use became widespread, and fire and burn prevention education was expanded substantially. In addition, stricter building codes were developed and applied, and the regulation of consumer products and occupational safety standards increased significantly [4], [6].
Notwithstanding the decreases in burn mortality in some countries, burn injuries continue to be a major public health problem in other countries, including economically developing countries [7]. For example, burn incidence and mortality have not declined in India [8], Greece, Italy, or Chile [9].
The objectives of this paper are to document landmarks in burn prevention worldwide and to suggest areas in which further efforts to prevent burn injuries may be effective.
Section snippets
Historical cases
Although decreases in burn mortality have been experienced by some countries such as the UK and the US, sadly, it often takes a major disaster before remedial action is initiated.
In the US, the 1942 Boston Cocoanut Grove nightclub fire was one of the worst public disasters in American history and remains one of the most important single events in the development of burn prevention and treatment of this century [10]. On the evening of 28 November, 1942, a fire at a popular Boston nightclub, the
Data sources and surveillance systems
The best care for burn injuries, clearly, is prevention. Therefore, well-conducted epidemiological studies, and accurate and timely statistics are crucial for understanding patterns and trends in burn injury incidence, causes, medical care use, and cost, each of which is necessary for designing effective prevention programs and for implementing influential legislative lobbying [1], [2], [15], [16].
Historically, fire/burn death rates have been the primary statistic for monitoring changes in burn
Prevention strategies
There are three main strategies to reduce harm from injuries: education, which primarily is an active measure requiring behavior/lifestyle change; and product design/environmental change, and legislation and regulation, both of which primarily are passive measures [2], [5], [6], [9], [16].
The approach to burn prevention most likely to be effective in a particular area should be based on sound knowledge of the prevalent etiological patterns of burn injury and must take into account geographical
Lower tap water temperature
Although hot water has long been known to cause burns, it was not until the 1970s that the epidemiology of tap water burn injury was studied in any detail. The article published by Feldman et al. in 1978 was one of the most influential articles concerning tap water burns in children [29]. Through clinical experience with scald burned patients in Seattle, and by thorough review of other sources of scald injury data, the authors confirmed that tap water scalds were common both in Seattle and in
Prevention of burns from residential fires
House fires are responsible not only for property loss but also for major burn injuries. Most residential fires are caused by smoking materials and lighters, heating equipment and electrical malfunction, cooking, and children playing with matches. Young children, the elderly and individuals who are differently abled are at highest risk for residential fire deaths [44], [45]. Effective public health strategies to reduce residential fire-related injuries include installation of a working smoke or
Prevention of clothing-ignition burns
Burn deaths among children had been unique among injury deaths because the rates for girls exceeded the rates for boys. This excess mortality was attributable to loose-fitting, easily ignited nightgowns and dresses [1], [46], [66]. A study by Young and Baker suggested that the dramatic change of female clothing styles, which included wearing pants (trousers) and close-fitting clothing, was associated with the reduction of clothing ignition mortality among girls [66]. In addition, the
Prevention of fireworks-related burns
Fireworks help celebrate holidays in many countries. Misuse of fireworks, however, has had tragic consequences. According to estimates provided by the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS), fireworks were involved in an estimated 8500 injuries treated in hospital emergency rooms in the US in 1998. About 5000 of these injuries occurred during the month of July either while celebrating the US Independence Day, the Fourth of July, or shortly
Prevention of product-related burns
Many burns are product-related and can be prevented by proper product design [76], [77]. Several examples of poor product design resulting in burn injury (for example, non-self-extinguishing cigarettes) have been discussed previously. Other examples include the following.
In Copenhagen, Denmark, surgeons conducted an epidemiologic study of all burn patients treated in burn units at general hospitals or by private physicians. The study found that 32 of the 35 electrical mouth burns in 1966
Chemical hazard control
While many chemicals primarily pose toxic risks, more than 25,000 chemical products causing burn injury have been identified [84]. Many of these chemicals are oxidizing agents, reducing agents, or corrosives [85]. The US Occupational Safety and Health Administration (OSHA) regulations require eyewash stations and showers in all facilities using potentially dangerous chemical products. In addition, educational programs stress copious cool water irrigation on injured areas immediately after
Electrical burns
Although burns caused by electricity account for a relatively small number of injuries, these injuries are often deep and require surgery, and can be extensive, especially if high-voltage or lightning is involved or if clothing ignition occurs [86], [87], [88].
For the common household current, such as electrical outlets and electrical wiring, the use of a Ground Fault Circuit Interrupter (GFCI) is beneficial, shutting off the electrical current to the outlet if a short or current leakage is
Education
Many burn prevention campaigns have been developed to educate the public about behaviors related to burn injury. Some educational programs, typically the more focused programs, have succeeded in lowering burn injury incidence and severity. Examples of educational programs to prevent burn injury include the following.
In India, there are approximately 100,000 deaths due to burn injury each year and 600,000 seriously burned persons requiring admission and treatment in a burn unit. Seventy-five per
Concluding remarks
Notwithstanding the landmarks in burn prevention discussed in this paper, it remains painfully clear that people living in poorer economic situations suffer disproportionately from burn injuries, as well as from many other types of injuries and diseases [17], [18], [19], [20], [44], [45], [100]. Thus, to prevent burn injuries, reduce burn care expenses, and relieve the social burden from long term disability, programs that alleviate poverty, overcrowding, family stress, and educational deficits
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