You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Burns

Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?

 

More background on our blogging team

19 Jun, 15 | by Bridie Scott-Parker

Blog 3: So today I wanted to share some more background on our blogging team. As an applied social psychologist, I find this information very interesting indeed!

What excites you about being part of the Injury Prevention social media editorial team?  

Sheree Bekker: The invaluable conversation that has sprung up around scholarly work through the collaborative power of social media and blogs inspires me to no end. I tend to find more relevant scholarly content through Twitter than through traditional platforms, and Injury Prevention has played a big part in that. As researchers, I believe that we should own our voice on social media, and constructively add value to this conversation.

David Bui: Through my studies in medical school I have seen the costs of injuries to society and individuals worldwide.  This is a great opportunity to harness the underutilised power of Social Media in health promotion and Injury Prevention, across multiple disciplines and multiple borders.

Angy El-Khatib: Being a part of the Injury Prevention social media editorial team is a great opportunity personally and collectively. By being a part of the social media editorial team, I am able to stay up to date on various topics within the realm of Injury Prevention while acquiring different perspectives from individuals from different backgrounds, disciplines, and locations. I’m also excited to be able to potentially increase readership and engage readers to create a conversation around the latest Injury Prevention research and ideas.

Klara Johansson: I am very interested to explore ways to share and disseminate knowledge and research results, outside the “old-school”, regular channels. I look forward to learning from my new co-editors, who all seem to be great communicators.

Joseph Magoola: The opportunity to work and collaborate with a variety of scholars on the injury prevention platform is nothing short of exciting. It also excites and inspires me to have an opportunity to represent Africa since low and medium income countries bear the brunt of the injury burden.

Julian Santaella-Tenorio: It is really exciting to be part of this team and to have a space to communicate and express ideas on ways to improve injury prevention, and to discuss about new studies and topics relevant to this field. I am very motivated to learn more and continue growing as a researcher as I walk through this experience.

What are you passionate about?

Sheree Bekker: Intersectional issues drive my life’s work, and my aim is that my research is, and always will be, an extension of that.

David Bui: Passionate about bringing people and ideas together.

Angy El-Khatib: I am passionate about translating scientific evidence and research into public health action. My goal is to improve the health and wellbeing of myself as well as my community. Outside of my work, I am passionate about health, fitness, and wellness.

Klara Johansson: Open discussions and innovative research in collaborative teams with high scientific ambition + high levels of tolerance and kindness; I also enjoy making difficult subjects understandable to students and the general population. Passions on my free time: nature, gardening, books, movies, writing fiction, playing music (clarinet, harmonium, piano, accordion).

Joseph Magoola: Writing on my social media accounts (facebook, twitter and my blog) as a way of reaching out to the masses. I am also interested travelling a lot, especially by road and as such, ensuring road safety is part and parcel of my aims to contribute towards reducing the carnage of our roads.

Julian Santaella-Tenorio: I am passionate about things that can make people have a better, healthier and happier life. I am inspired by ideas challenging previous knowledge, creative thinking finding answers from different angles, and the power of multidisciplinary groups. That is why I am passionate about public health research.

 

I hope you are looking forward to hearing from our bloggers, starting next month!

Preventing clothing-related burns in children

16 Dec, 14 | by Bridie Scott-Parker

Burn injuries are dreadful for any person of any age, but arguably they are most horrific for our most vulnerable: children. In Australia as in many other countries, we have mandatory standards which regulate the design and labelling of children’s nightwear. Having grown up in a rural area where we heated our house (our melted marshmallows and burnt our toast) via an open fireplace, I am well aware how quickly clothing can catch fire. Therefore preventing these injuries is of vital importance. To prevent, we must understand, therefore I was pleased to see an interesting article by Harvey, Connolley and Harvey (see http://www.ncbi.nlm.nih.gov/pubmed/25435488).

The authors examined the clothing-burn-related hospitalisation data for the entire state of New South Wales from 1998-2013 inclusively, and report the following clothing-related burn statistics:

* 18% of burns were nightwear-related (despite our mandatory legislation)

* exposure to open flame the most common mechanism (open fire, cooking)

* 25% of clothing-related burn hospitalisations occurred amongst children aged 5-14 years

* nightwear-related burns decreased by approximately 7% per year, compared to other clothing (reduction of approximately 2% per year)

* accelerant use was reported in 27% of cases

Whilst difficulties with coding data in official records were identified, which leads to underestimation of the clothing-related burns burden for all persons, including children, the authors note the reduction in burns as a result of the mandatory legislation introduced in 1987. Further legislative efforts targeting all clothing, and education of parents and extended family members regarding clothing-related burns risk for children is also recommended, and these findings can help us all in our injury prevention efforts as we keep safe over the festive season.

Hot ash burns – are we making progress?

6 Jul, 14 | by Bridie Scott-Parker

One of the best parts of being able to blog for Injury Prevention is being able to reflect upon my own experiences (personal and professional) as I learn about the research of other injury prevention researchers. I suppose today’s blog has left me feeling a little frustrated, however, that maybe we aren’t making as much progress as we could be.

This morning I came across a paper summarising the hot-ash burns experience of 50 children in Western Australia in 2011 and 2012 (see the research of Martin, Rea, McWilliams, and Wood at http://www.ncbi.nlm.nih.gov/pubmed/24280525), and this immediately led to the resurfacing of a memory from my own childhood.

As a young child (I was maybe five or six years old) I was shocked to hear that one of my friends, neighbours and best playmates had been seriously hurt during a camping holiday with her family. They had been camping, and just like every previous camping holiday, she had walked through the sand at the beach with her older brothers. The problem was that this sand was used to put out the fire which was used to cook the family’s dinner the previous night. Next day, it was if the fire hadn’t been extinguished in any way, and she sustained very serious burns to her feet.

that examined the exact same problem (eg., http://www.ncbi.nlm.nih.gov/pubmed/18182906; http://www.ncbi.nlm.nih.gov/pubmed/18789590), and made similar injury prevention recommendations.

More needs to be done if we are going to gain traction in the prevention of hot ash burns in our most vulnerable, our children.

Quebecers horrified by seniors fire deaths

9 Feb, 14 | by Barry Pless

At least 24 seniors in a private nursing home at L’Isle-Verte in eastern Quebec died when fire engulfed the mostly wooden residence. Many believe the deaths were preventable if several obvious measures had been taken. Most important (and most contentious) is the absence of a sprinkler system even though the provincial code requires them – but makes bizarre exceptions depending on the mobility of the residents. Another factor was the construction of wood. Ironically, a part of the building that was added recently and used different materials was not burned. Finally, the staffing at night when the fire occurred was reduced. For me the most baffling argument is one put forward by a fire prevention officer who claimed that smoke detectors were more important than sprinklers because people die of smoke inhalation, not of burns. True; but somehow the fact that sprinklers extinguish fires before they get to the smoking stage seems to have escaped this expert. She goes to suggest that  there is no “magic solution” to fires like that at L’Isle-Verte. I see this as an invitation to inaction. The solution is  not magic; it is basic science, solid technology, and injury prevention of the highest order. In case she somehow forgot, smoke comes from fire. She acknowledges that sprinklers prevent a fire from spreading, and then argues that what is needed is more smoke detectors not sprinklers! This is an astonishing observation, especially coming from someone with her responsibilities. Her remarks would certainly lend support to those who oppose establishing sprinkler systems in all homes, and especially in facilities serving the elderly and infirm. She implies we cannot insist on requiring both. It is like saying that for car safety you cannot have both brakes and mirrors; you must choose one or the other. Just because the cost of smoke detectors is much less than that of a sprinkler system is no reason not to require both. It is nonsense to say ‘smoke detectors are more important in saving lives’ and thereby imply that sprinklers are not needed. Her bizarre views should not be used as an excuse for avoiding the installation of these systems; they have proven to be highly effective and could save many many lives.

Children at risk of thermal hazards

22 Apr, 13 | by Bridie Scott-Parker

Readers may recall that in March I entered a post regarding hot water scalds, sharing the vivid memories I still have – 30 years later – of my cousin’s dreadful injuries. Whilst hot water remains a potential and significant source of injury to babies and small children, there are a variety of other thermal hazards which also place these vulnerable members of our community at risk. Some of these hazards are further explored in an article online first in Archives of Disease in Childhood (see http://adc.bmj.com/content/early/2013/04/15/archdischild-2012-302901.abstract).

Fire has long been recognised as a source of injury, and 96% of the 200 parents of children aged 0-4 years living in one of four disadvantaged areas in England reported having at least one smoke alarm (although only 95% of these alarms were in working order). An integral part of fire safety – a fire escape plan – was reported by only 42% of parents. In addition, eight in ten parents reported in the interviews that they had either matches or lighters in their home, with nearly a fifth of parents reporting that these were stored where children could reach them.  Injury prevention efforts thus should focus upon encouraging every resident to ensure their home is fitted with smoke alarms which actually work, and the first line of defence should focus upon preventing naturally-curious children from accessing matchers and lighters under any circumstance.

Interestingly the Authors recognise that popular fashion has resulted in a new potential source of thermal hazard in the home: hair straighteners. Seventy percent of parents interviewed reported that they had a hair straightener in their household, and one third of these were used every day. Only 12% of parents interviewed reported placing a hot hair straightener in a heatproof bag when not in use. The prevalence of hair straighteners suggests that targeted injury prevention interventions appear warranted, including the more widespread use of heatproof bags.

Most parents appeared to have a good knowledge of first aid for small burns, but nearly one quarter of parents would respond inappropriately and thus could inadvertently cause further harm to the child. An important part of injury prevention efforts is harm minimisation in the event of injury, therefore it is vital that any efforts educate parents and other caregivers regarding appropriate and effective first aid measures.

 

Controversial safety trade-off under consideration: burns vs poisoning

8 Feb, 13 | by Barry Pless

According to a report in FairWarning, California is proposing to weaken its fire safety standards by dropping the requirement for the use of flame retardants in U.S. couches and other furniture. The current standard stipulates that foam used in cushions be able to withstand a 12-second exposure to a small, open flame. To meet this standard manufacturers have been adding brominated or chlorinated chemicals to the foam. However, there has been growing concern that these chemicals may have adverse health effects including “reduced IQs, attention problems and other neurological effects in children exposed in the womb or during infancy.” The decision is significant because on the one hand about 95% of couches now contain the retardant thus reducing the chance of serious burns. On the other, the toxic effects, still unproven, are also serious. Governor Brown wants to “ improve fire safety while reducing exposure to toxic chemicals.” Editor: How should safety experts deal with a situation such as this?

Latest from Injury Prevention

Latest from Injury Prevention