On fire? Stop, drop and roll, urge doctors

By Irfan Aligi

KARACHI: Over 90 percent of the burns cases reported at Civil Hospital Karachi (CHK) every year are related to domestic accidents and the majority of them have been previously maltreated or treated by inexperienced hands, CHK Burns Centre Head and plastic surgeon Dr Shariq Ali told Daily Times while chatting after a seminar on ‘Burns in Family Practice’ organized by Dr Essa’s Laboratory and Diagnostic Centre (EL&DC) on Saturday.

“We cannot treat all burn injuries and the burn centers are not a proper solution to the problem. There is a need for awareness programmes so that people learn that burn injuries have the most physical and social repercussions on the victim. They are not cheap to treat either,” said Ali.

The CHK receives and provides medical assistance to more than 700 patients with major burn injuries each year as in-patients, while 4,500 to 5,500 cases are dealt with in the OPD. Of these, 60 percent of the cases are to do with women involved in cooking accidents in the kitchen or others. For 10 to 12 percent of these cases, it is hard to tell how and why the cases took place, he added.

Artificial skin is available and a sheet of 10 by 10 inches costs around Rs 80,000. At this rate, a patient with 70 percent of his body burned needs at least Rs 5.8 million for surgery. Unfortunately, there are no rehabilitation centers to treat patients with severe burns, noted Ali.

Initially, people try to treat burns at home, or take them to the nearest medical centre where inexperienced hands complicate their injuries. People should know the basics, that in case of catching fire, they should not run but stop, drop and roll on the ground to minimize exposure to the oxygen in the air, which creates forced combustion. Tap water should be poured on the burned areas as soon as possible, described Ali. The doctor added that prescribing painkillers such as diclofenic acid to a burns patient can often be a bad idea as they sometime add to the stress of a person already suffering from anxiety. Doctors sometimes overlook this fact.

He suggested the use of narcotics for alleviating pain but their use is not always legal, in which case a doctor should administer morphine, an ideal painkiller. Doctors should also make sure that a burnt patient receives a 100-percent-high-flowing supply of oxygen as the supply from an oxygen cylinder only contains 24 percent oxygen, he added.

He criticized the use of certain medicines, cautioning especially against prophylactic antibiotics during the initial stages. However, in cases where the initial treatment leads to contamination, these antibiotics can and should be administered.

Topical use of ointments containing one percent silver should also be used with extreme caution when dealing with infants and children upto three years of age. The topical use of silver combinations on exposed areas such as the face should not be encouraged as it creates pigmentation problems and the skin turn might turn dark because of this, he warned.

Replying to a question on therapy using natural ingredients, he said that there are many indigenous items that might prove medically beneficial to burns patients such as potato peel and banana peel dressings, but these should be sterilized or else complications including infections can easily occur.

The government should promulgate a citizens’ safety ordinance to prevent electrical, industrial and chemical burns, because hundreds of ‘kundas’ (illegal electric connections) have resulted in amputations on dozens of patients who have suffered high voltage electric shocks. There are hundreds of LPG and CNG shops in Karachi, he said, where accidents can occur.

Dow University of Health Sciences Assistant Prof. Dr Ehmeral Ibran said that dozens of burns patients suffer serious complications because of inexperienced doctors and such patients are referred to CHK when it is too late.

The majority of such patients opt for amputation in the end to save their lives. These patients are now facing severe social problems as their faces and limbs have been disfigured. Physiotherapy is one of major components of burns treatment, which is ignored here, he regretted.

Dr Asif Zaman Khan appreciated Dr Farhan Essa’s contribution on behalf of the EL&DC of wavering 50 percent of the fee to all referrals. Former Pakistan Medical Association President Prof. Dr Haseeb Alam, Dr Farhan Essa, and CHK Burns Center’s Dr Nasir also addressed the seminar.

Source: Daily Times, 27/7/2008

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