Burns trauma in warfare – lessons in care and prevention

Dr Wiktor Teodor Pilch1, Dr Edward Gibson1, Mr Bernard Carney1

1The Queen Elizabeth Hospital, Adelaide, Australia

Abstract:

Background:

Over the ages fire has been one of the most devastating weapons utilised in war. The burden of fire trauma in warfare is significant for both civilians and combatants and this has led to changes in burns care and the development of numerous techniques and devices to reduce mortality and morbidity from combat related burn trauma. This study details the changing nature of burn trauma in warfare and humanities attempts to mitigate this.

Methods:

An extensive literature search of PubMed, Google Scholar and the National Archives of Australia was undertaken. Burns surgeons and Defence Force personnel were interviewed.

Results:

Significant developments and changes have emerged as better understanding of burn and human patho-physiology advanced. The first documented burns treatments date back to Ancient Egypt but it was the World Wars where a distinct change in the patterns of burn injuries was observed leading to rapid advances in medicine and burn care. Prevention has always been front of mind with the leather or metal armour of the past giving way to flame retardant clothing, body suits with in built tourniquets, and blast proof eyewear to protect eyes.

Conclusion:

Warfare and fire have, and likely always will, go hand in hand. Humanity’s response has typically trended towards preventative measures and it is only in more recent years that first aid and immediate medical care have improved with resultant dramatic decreases in morality and mortality. Preventative measures used in warfare may have some real world applications.


Biography:

I am currently a Surgical Resident within the Central Adelaide Local Health Network with a keen interest in Plastic and Reconstructive Surgery and Burns Trauma.

A scoping review of the incidences of basal cell and squamous cell carcinomas in burns survivors, and the efficacy of sun protection

Miss Andrea Mc Kittrick1, Ms Annie  Reeves1, Ms Alexandra  Lee2, Ms  Laurette Cloete2

1Department of Occuaptional Therapy, Royal Brisbane and Women’s Hospital, Herston, Australia, 2School of Allied Health, Australian Catholic University, , Banyo, Australia

Abstract:

Background:

Published incidences of cancer in burn scars is recorded back as far as 1930 and remains a concern today.  Incidences of Marjolin’s ulcers in the burn population result from a scar malignancy with an estimate that 1 in 300 is a carcinoma. The published evidence reports that the latency period for Marjolin’s ulcers is 20-40 years with the original burn injury occurring in childhood.  The aim of this scoping review was to determine incidence of SCC and BCC post burn injury and to determine the efficacy of utilising sunscreen with a sun protection factor (SPF) of 30+ or higher.

Methodology

This scoping review was comprised of three stages. Stage one investigated articles reporting on incidences of persons presenting with an SCC, BCC or Marjolin’s ulcer following a burn injury. Stage two involved a search to retrieve articles pertaining to sun care recommendations following burn injury. The search of stage three sought to find relevant literature exploring the efficacy of sunscreen with a sun SPF of 30+ or higher.

 

Results:

n = 10 for inclusion: 2 case series, 2 prospective cohort studies, 1 cross sectional study, 4 retrospective cohort studies and 1 systematic review. Sample size range from 10- 140 with the exception of the systematic review of published epidemiologic studies which had 16, 903 (Danish hospital) and 37, 095 (Swedish hospital). The extremities and the scalp were the most common sites of SCC or BCC.

Discussion:

To date the aetiology of cancer occurring in burn scars is not fully understood however a number of hypothesis exist including protracted wound proliferation, chronic irritation, reduced revascularisation and a compromised immune system.

Conclusion:

The authors would recommend future prospective longitudinal cohort studies in the burns population in countries with high skin cancer incidence specifically Australia.


Biography:

Andrea is the Advanced Specialist Occupational Therapist in Severe Burn Injuries at the Royal Brisbane and Women’s Hospital in Brisbane, Queensland. She graduated from Trinity College Dublin, Ireland in 2004.  She a Masters in Hand Therapy via University of Derby, United Kingdom in 2015. Andrea is currently enrolled in a PhD through The University of Queensland. She is the current chair of the ANZBA Allied Health committee, and is a casual academic at The University of Queensland and a session lecturer at Australian Catholic University.  Her special interests include hand burn injuries, critical care polyneuropathy and long term outcomes post burn injury.

The ISBI Women’s Safety Initiative: reducing violence against women and girls by burning

Miss Yvonne Singer1, Rachel Kornhaber2,7, Lisa Martin3, Friji MT4, Shelley Wall5,8,9, Michael Peck6

1Victorian Adult Burns Service, The Alfred, , Australia, 2University of Tasmania, , Australia, 3University of Western Australia, Crawley, Australia, 4JIPMER, , India, 5Pietermaritzburg Metropolitan , , , 6Department of Surgery, Creighton University School of Medicine, , United States, 7National Burns Center, Sheba Medical Center, , Israel, 8Department of Surgery; College of Health Sciences, , , 9Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, , South Africa

Abstract:

The ISBI Prevention Committees’ Women’s Safety Initiative aims to reduce violence by burning, including acid attacks, against women and girls. Established in 2018, the groups objectives are to:

1. summarize the published evidence in the scientific literature, analyse data from existing databases worldwide, and develop a framework for ongoing data collections;

2. increase awareness by liaising with and providing recommendations to policy makers, religious leaders, law enforcement officials, healthcare professionals, educational establishments, and local communities; and

3. include real life stories from survivors who are willing to share their experiences.

This presentation will summarise the progress of part one of these objectives. Firstly, it will include a brief overview of the findings of the current peer reviewed literature review. The review seeks to determine the incidence, prevalence and contributing factors relating to violence by burning against women and girls including evidence of the effectiveness of prevention and awareness initiatives. The majority of the literature comes from low and middle-income countries. Secondly, the proposed strategy for collaboration between global burn registries will also be outlined encompassing the framework and strategy for stakeholder engagement. These two small steps are vital for the start of this long journey that seeks cultural change in the reduction of violence against women and girls across the world.


Biography:

Bio to come

The World Health Organization’s Global Burn Registry: Defining the problem of violence against women through acts of burning

Miss Yvonne Singer1, Michael Peck2, David  Meddings3

11. Victorian Adult Burns Service, The Alfred, , Australia, 22. The Arizona Burn Center, Department of Surgery, , United States, 33. Dept for Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, , Switzerland

Abstract:

WHO has launched the Global Burn Registry (GBR). Established in 2017, it is the first ever global platform for standardized data collection from burn survivors. It provides health facilities with a clear picture of the factors that contribute to burns and the populations at greatest risk in their settings, with a view to prioritizing prevention programs.

The ISBI Prevention Committees’ Women’s Safety Initiative aims to reduce violence by burning, including acid attacks, against women and girls. One of the Committee’s objectives is to analyze data from existing databases worldwide, and develop a framework for ongoing data collections

This presentation will take a preliminary dive into GBR data on behalf of the ISBI’s Women’s Safety Initiative, to analyze the incidence of violence against women and girls through acts of burning.  To date, 1856 patients with burn injuries from 13 low and middle income countries have been registered with the GBR. Forty percent were female, with approximately 20% being less than 18 years old. Descriptive analysis of females who sustained intentional burn injuries will be presented including demographic details, injury event characteristics and in hospital outcomes.

The presentation will paint further brush strokes to the picture defining the extent of the global problem of violence of against women and girls through burning, and in doing so, shine a light on the progress of the GBR, and it’s potential to inform prevention programs.


Biography:

Bio to come

ANZBA Prevention Project for Pharmacists’ Continuing Professional Development

Dr Lisa Martin1,2,3,7, Miss Karis Butler2, Ms Siobhan Connolly4,7, Ms Jackie Beaumont5,7, Dr Bronwyn Griffin6,7, Dr Helen Douglas3,7, Professor Fiona Wood3,7, Dr Jeremy Rawlins3,7, All members of the ANZBA Prevention Committee2

Abstract

Patients with a burn present to community pharmacies for a variety of reasons and are often reluctant to attend an Emergency Department or a General Practitioner for care. Pharmacists can find it difficult to persuade these patients that a higher level of medical care is required. In addition, pharmacists may lack training and practice in burn assessment, whether to treat or refer, and what advice to give to patients. Patients who delay seeking medical treatment are likely to have poorer outcomes, possibly due to lack of suitable antimicrobial dressings or delays to surgery.

For registration, pharmacists must complete 20 hours of continuous professional development annually.  Their professional body in Australia, the Pharmaceutical Society of Australia, publishes educational articles for accrual of CPD points in their academic journal, Australian Pharmacist. The ANZBA prevention committee identified the opportunity to connect with pharmacists to educate and empower them in the management of burn patients presenting to the community pharmacy.

This presentation details the pathway from conception to publication of “Assessing Burns in the Community Pharmacy”; a CPD educational article published in Australian Pharmacist in April 2019.


Biography

Lisa is a research fellow who has worked in burns research for the past ten years. Her nursing background was in critical care, followed by clinical trials and research nursing in general medicine and cardiology. She has recently completed a PhD in psychological recovery after adult burn and currently has secured funding for post-doctoral work to continue her work in this area.  She has a strong interest in burn prevention and is an active member of the ANZBA prevention committee.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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