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Burns are one of the most devastating injuries a person can sustain. These injuries constitute the second commonest cause of all trauma-related deaths in the…

Burns are one of the most devastating injuries a person can sustain. These injuries constitute the second commonest cause of all trauma-related deaths in the developing as well as the

developed countries. The burn injury represents an assault on all aspects of the patient, from the physical to the psychological. The visible physical and the invisible psychological scars

are long lasting and often lead to chronic disability. It affects all ages from babies to the elderly people.

Burns are a global public health problem, accounting for an estimated 180 000 deaths annually. The majority of these occur in low- and middle-income countries and almost two thirds occur in

the WHO African and South-East Asia regions (January 2018 estimates). So the burden of burn injury falls predominantly on the world’s poor (95% of deaths occur in low and middle income

countries). Fire- related burns account for a loss of 10 million disability adjusted life years (DALY) annually.

Developing countries have a high incidence of burn injuries, creating a formidable public health problem. High population density, overcrowding, poor housing, illiteracy, and other

attributes of poverty are the main demographic factors associated with a high risk of burn injury. And some of these risk factors for burns are not so easy to change. 

The exact number of burns is difficult to determine: judicious extrapolation suggests that in India, with a population of over 1 billion, over 1million people are moderately or severely

burnt every year with 1.4 lakh deaths (comes to one death every 4 minutes due to burns) and 2.4 lakh people suffer with disability. This high incidence makes burns an endemic health hazard.

Social, economic, and cultural factors interact to complicate the management, reporting, and prevention of burns.                          

Management of burns is a team approach. The complexity of the injury and the chronic nature of the sequelae of burns require an integrated multidisciplinary approach with long follow up.

Only such management can lead to the best outcome for burn patients. This team approach has brought dramatic change in the survival of burn patients. As such over the last several years,

mortality rates and the morbidity from burns have diminished greatly so much so that a mere survival of an extensively burnt patient is no longer considered a great outcome.

The fact that 90% of burn injuries are preventable has led to many attempts to decrease their incidence. Depending on the population of the country, burns prevention can be a national

programme. High-income countries have made considerable progress in lowering rates of burn deaths, through a combination of prevention strategies and improvements in the care of people

affected by burns. Most of these advances in prevention and care have been incompletely applied in low- and middle-income countries. Increased efforts to do so would likely lead to

significant reductions in rates of burn-related death and disability. The basis for all prevention is good epidemiological data to reveal specific causes of burns and at risk population,

both of which can be targeted. That is the reason for compulsory reporting of all burn admissions to a central registry, and these data could be used to evaluate strategies and prevention

programmes.

The most successful prevention strategies/ campaigns have targeted specific burn causes, vulnerable populations and training of communities in first aid. An effective burn prevention plan

should include broad efforts like improving awareness, developing and enforcing effective policy, describing burden and identifying risk factors, strengthening burn care, etc. This should

ensure that sufficient funds are available and lead to proper coordination of district, regional and tertiary care centers. The World Health Organization is promoting interventions that have

been shown to be successful in reducing the incidence of burns. The Organization is also supporting the development and use of a global burn registry for globally harmonized data collection

on burns and increased collaboration between global and national networks to increase the number of effective programmes for burn prevention.

The main aims of burn care are to restore form, function and “feeling”. Actually it is the degree of restoration to preburn level and “return to society” which is more important.  Burn

survivors are often left with disability and disfigurement that interferes with their future life. Rehabilitation measures such as physical therapy and addressing psychological issues can

assure a better life in burn survivors. In true sense, the rehabilitation of burns patients is a continuum of active therapy. There should be no delineation between an “acute phase” and a

“rehabilitation phase”; instead, therapy needs to be started from the day of admission and continues for years after he or she has left. The aim is to return patients, as far as possible, to

their preinjury levels of physical, emotional and psychological well being. For every member of the burn team, rehabilitation must start from the time of injury. Patients need to be

encouraged to work to their abilities and accept responsibility for their own management. Education is of paramount importance to encourage patients to accept responsibility for their

rehabilitation. A consistent approach from all members of the multidisciplinary team facilitates ongoing education and rehabilitation.

With the increased survival of patients with large burns comes a new focus on the psychological challenges and recovery that such patients must face. Most burn centers employ social workers,

vocational counselors, and psychologists as part of the multidisciplinary burn team. The psychological needs of patients with burn injuries are unique at each stage of physical recovery.

The long term stage of recovery typically begins after discharge from hospital, when patients begin to reintegrate into society. This is a period when patients slowly regain a sense of

competence while simultaneously adjusting to the practical limitations of their injury. Patients face a variety of daily hassles during this phase, such as compensating for an inability to

use hands, limited endurance, and severe itching. Severe burn injuries that result in amputations and scarring can have an emotional and physical effect on patients.

 Also patients must deal with social stressors including family strains, return to work, sexual dysfunction, change in body image, and disruption in daily life. Social support is an

important buffer against the development of psychological difficulty. Ancillary resources such as support groups and peer counseling by burn survivors can also be important services to burn

survivors. Adjustment difficulties that persist longer usually involve perceptions of a diminished quality of life, lowered self esteem and social withdrawal. Many patients face a lengthy

period of outpatient recovery before being able to return to work. As expected, patients who sustain larger burns take longer to return to work.  About half of the patients require some

change in job status.

Hence, we can conclude that a burn injury and its subsequent treatment are among the most painful experiences a person can encounter. The emotional needs of patients with burns have long

been overshadowed by the emphasis on survival. Patients undergo various stages of adjustment and face emotional challenges that parallel the stage of physical recovery. Adjustment to a burn

injury seems to involve a complex interplay between the patient’s characteristics before the injury, moderating environmental factors, and the nature of the injury and ensuing medical care.

Dr. P. Umar Farooq Baba is Assistant Professor, Department of Plastic Surgery, SKIMS, Srinagar