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12burn PDF
12burn PDF
Burns are among the worst forms of physical and psychological injury in children. Majority of pediatric
burn injuries occur at home and affect children less than 5 years old. A review of the Philippine General
Hospital-Burn Center records covering the period of January 1, 2000 to February 28, 2002 revealed 205
cases of pediatric burns (aged less than 18 years old) admitted in this institution. More than half (52.68%)
of the patients incurred burns secondary to scalding, 33.66% of the burns were secondary to flame burns
while 13.66% incurred electrical burns. The mean age of patients was 5.35 years old. 48.78% belonged to
the infant and toddler group (aged 2 years old and below), while those aged above 2 years to 17 years old
accounted for 51.22%. Less common forms of burn injury in children are from fires, firecrackers, explosions,
and electric shock. Low socioeconomic status is a risk factor for burn injury. Prevention strategies that
have been effective globally were based on community-awareness campaigns, anti-smoking campaigns,
responsible media, and the installation of residential smoke detectors. This policy statement aims to
provide appropriate recommendations for the prevention of burn injuries among the pediatric population.
KEYWORDS: burns, scald, flame burns, electrical burns, firecracker-related injuries, smoke detectors,
fire safety measures
URL: http://www.pps.org.ph/policy_statements/burn.pdf
to adults and domestic burns accounted for 75% of all medical attention, which can result to death. To avoid
admissions.6 The Canadian Hospitals Injury Reporting and firecracker-related injuries, the DOH launches a yearly program
Prevention Program (CHIRPP) prepared model vignettes to called Oplan: Iwas Paputok. 10 The Firearms and Explosives
illustrate typical mechanisms for common child injuries. One Division of the Philippine National Police has banned the
such vignette effectively illustrates the typical pediatric dancing firecracker, also known as watusi, from the market.
scalding injury: A 10-month-old infant was crawling around Watusi has been reported to be potentially lethal once
the kitchen as her father was preparing breakfast. ingested. Thirteen cases of watusi poisoning and 2 deaths
Unobserved, the infant makes her way to a pot of hot coffee were reported from 50 hospitals from 1999-2001.11 Republic
sitting near the edge of the table. Curious, she reaches for Act 7183 was approved in 1992 to regulate and control the
the coffee pot, spills the contents on her arm, and suffers a manufacture, sale, distribution, and use of firecrackers and
minor burn over the trunk. The scenario mentioned is usually other pyrotechnic devices consistent with public safety, order,
caused by a temporary lapse in the parents attention and hot and national security, as well as the enhancement of cultural
liquids being within reach of youngsters.7 traditions.12
A study done in the Philippine General Hospital (PGH) Fires and explosions have immense health, social, and
showed that majority (53%) of the 141 cases seen at the Burn environmental costs. Fires cause 1% of the global burden of
Unit from January 1, 1986 to December 1, 1989 were due to disease. Smoking and cigarettes cause 10% of fire deaths
home accidents.8 A review of PGH-Burn Center records by worldwide. It is estimated that cigarette lighters cause one
Catindig, et. al. covering the period of January 1, 2000 to million global, child-playing fires annually. Fires caused by
February 28, 2002 revealed 205 cases of pediatric burns (aged smoking cost the world an estimated $27.2 billion in 1998. Fire
<18 years old) admitted in this institution. This demonstrates tolls in the U.S. have decreased along with an observed decline
an increase in the number of burn patients belonging to these in smoking.13 In the Philippines, a national smoking prevalence
age groups, from an average of 40 cases per year in 1990-1994 survey done in 1995 showed that 33% of adults over 18 were
to 94.5 cases for January 2000 to February 2002 (140% increase)9. regular smokers.14 Cigarette lighters in the Philippines are not
In the same study, more than half (52.68%) of the patients required to be child proof and residential smoke alarms are not
incurred burns secondary to scalding, 33.66% of patients mandatory.2
sustained injuries secondary to flame burns while 13.66% of
patients incurred electrical burns. The mean age of patients The prevention of deaths from fires hinges on
was 5.35 years old. 48.78% belonged to the infant and toddler preventing asphyxiation from smoke inhalation. Smoke
group (aged 2 years old and below) while those aged above 2 detectors are successful in reducing the risk of death from
years to 17 years old accounted for 51.22%.9 residential fires by 70%. Free distribution of smoke alarms
in communities likewise reduce burn mortality by 80% and
Firecracker-related injuries are also important causes of injuries by 74%. Legislation requiring smoke detectors in
burns in the Philippines. It has been a yearly tradition for every home is virtually impossible to enforce. However, its
most Filipinos to welcome the coming of the new year with existence does increase the proportion of homes with
firecrackers and fireworks. Statistics show that most of the working detectors, and will thereby still be able to decrease
firecracker-related injuries are seen during Christmas Eve, New the number of deaths from residential fires.15 Public awareness
Years Eve, and New Years Day when children pick up campaigns such as Safe Kids Week 2001 in Canada
unlighted or unused firecrackers. According to the National disseminated burn safety information via the media, 5000
Epidemiology Center of the Department of Health, 1,568 cases retail stores, and 348 community partners. The four key
of firework-related injuries were reported in January 2000 while messages were: (1) lower water heater temperature, (2) make
there were 1,325 cases in January 2001. 9 The National Capital sure your child is safe in the kitchen, (3) keep hot liquids
Region (NCR) has the most number of firecracker-related away from your child, and (4) check smoke alarms regularly.
injuries, as reported from 1997 to 2001. Within the NCR, Manila The campaign was able to reach 14% of parents on a
was found to have the most number of reported cases of nationwide scale. Parents exposed to the campaign were 1.5
firecracker-related injuries followed by Quezon City, Las Pinas, to 5 times more likely to remember the key messages compared
Mandaluyong, Kalookan, Navotas, Marikina, Pasig, and to unexposed parents. On evaluation, the campaign appeared
Valenzuela. 10 The Department of Health (DOH) discloses that to increase burn safety knowledge and behavior change in
even without hospitalization, treatment for ordinary blast exposed parents.16 Community-based intervention programs
injuries alone costs a minimum of P1,000. Hospitalization which targeting child burns can be effective and sustainable in the
requires surgery for firecracker-related injuries can amount to long term.17
P5,000 depending on the severity of injuries, complications,
and subsequent operations. It has been reported that most Knowledge of fire safety measures may also go a long way
victims of firecracker-related injuries do not seek prompt in preventing burn injuries. The Philippine College of Surgeons
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Burn Injury Prevention PPS Policy Statement
(PCS) has excellent recommendations in their PCS Trauma children less than 5 years old, of the risk of burn
Manual (see Table 1). injuries, its causes, and prevention.
2. Physicians should teach or provide information on
Table 1. Fire Safety Measures (adapted from Philippine proper first aid for burn injuries to parents of high-risk
Trauma Manual)18 children. Immediate cooling of burns with tap water is
recommended.
A. Always have a fire extinguisher available in your house. 3. Physicians should make the patient and the community
aware of all the health hazards of tobacco (cigar/
B. Measures to prevent fire cigarette) smoking, including their role in causing a
1. Electrical wirings should be inspected and circuits substantial proportion of fires.
should not be overloaded. 4. Preparation of accessible information on pediatric burn
2. Remove accumulations of leaves and paper around injury prevention should be undertaken and wide
your house. dissemination among PPS members should be
3. Do not store any flammable liquid near the stove. encouraged. Monitoring of cases and causes of burns
4. Do not use alcohol or gasoline to start a fire. should also be accomplished to form the basis of a
5. Put off all candles and lights before going to bed. prevention program.
6. Do not place candles where the wind, children, pets
,and other moving objects may topple them. Role of Parents and Caregivers (referred to as Parents)
7. Lamps should not be placed near curtains or other
objects that could easily catch fire. 1. Parents should strictly prohibit children from picking
8. Crush cigarette butts before throwing them. up firecrackers in the streets, whether used or unused,
9. Do not smoke in bed. especially during and after Christmas and New Years
10. Keep matches or flammable materials away from Eve.
children. 2. Parents are urged to avoid purchasing firecrackers
and are also encouraged to report establishments
C. When fire is at hand selling illegal firecrackers and other pyrotechnic
1. Call for help. devices.
2. Stay close to the floor. A wet cloth over your face 3. The use of properly installed residential smoke
may help breathing. detectors and alarms is highly recommended. The
3. Close doors and windows behind you to reduce the acquisition of fire extinguishers should also be
spread of fire. advised.
4. Feel the door before opening it. If hot, keep it closed. 4. Parents are advised to place plug covers in all electric
5. Know the fire exits of any building you are in. outlets in their homes.
5. Cigarette lighters must be kept out of reach of children.
D. When your clothes catch fire 6. Parents should be especially watchful during food
1. Never run, it fans the flame. preparation and in the kitchen. Hot objects and liquids
2. Wrap yourself with a blanket. Drop to the floor and (including steam) should be out of the childs reach.
roll over briskly. Handles of hot pots and pans should not protrude
3. If there is nothing to wrap yourself in, just drop to outwards and must be directed inward.
the floor and roll over briskly. 7. The use of gas lamps at home should be discouraged.
4. Place yourself close to the floor in a horizontal
position to prevent smoke inhalation. Role of the Government
5. If there is water, douse yourself with it or roll over
spilled water. 1. Legislation and law enforcement should: (1) prohibit
6. If another persons clothing catches fire, use similar the sale of cigarettes and cigarette lighters to minors,
measures. (2) ban all tobacco advertisements from mass media,
and (3) make residential smoke alarms mandatory.
2. To avoid firecracker-related or blast injuries, especially
during Christmas and New Year celebrations, local
RECOMMENDATIONS governments are encouraged to conduct alternative
merry-making activities (such as the use of horns and
Role of Physicians and Other Health Care Professionals other noisemakers, holding concerts, and
competitions) or advocate for an organized fireworks
1. Physicians should counsel parents, especially of display (such as public display of pyrotechnics) in
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PPS Policy Statement Burn Injury Prevention
52
Burn Injury Prevention
analysis ofepidemiological factors. Philippine College 14. Smoke-free Kids. The tobacco industry in the Philippines.
of Surgeons. 2002. Unpublished. Available at http://www.smokefreekids.com.ph/
10. Department of Health (DOH) Press Release/16 December philippines.html. Accessed on September 8, 2003.
2001. Warning: ordinary blast costs P1,000. Available at 15. Rivara FP, Grossman DC, Cummings P. Injury prevention:
http://www.doh.gov.ph/press/December262001.htm. second of two parts. N Engl J Med. 1997;337: 613-8.
Accessed on September 23, 2003. 16. MacArthur C. Evaluation of Safe Kids Week 2001:
11. Department of Health (DOH) Press Release/25 November prevention of scald and burn injuries in young children.
2002. This Yuletide, rock the streets. Available at http:// Inj Prev. 2003;9:112-6.
www.doh.gov.ph/press/November252002.htm. Accessed 17. Yuerstad B, Smith GS, Coggan CA. Harstad injury
on September 23, 2003. prevention study: prevention of burns in young children
12. Republic Act No. 7183. Available at http:// by community-based intervention. Inj Prev. 1998; 1:176-
www.chanrobles.com/republicactno7183.htm. Accessed 80.
on September 24, 2003. 18. Philippine College of Surgeons. Fire Safety, In: Philippine
13. Leistikow BN, Martin DC, Milano CE. Fire injuries, Trauma Manual. Philippine College of Surgeons
disaster, and costs from cigarettes and cigarette lights: a Publication, Manila. 1994;7:i,5. Available at http://
global overview. Prev Med. 2000;31:91-9. www.pchrd.dost.gov.ph/pcs_publications/number_07/
toc.html#start. Accessed on August 15, 2003.
The publication of the Policy Statements of the Philippine Pediatric Society, Inc. is part of an advocacy
for the provision of quality health care to children. The recommendations contained in this publication
do not dictate an exclusive course of procedures to be followed but may be used as a springboard for the
creation of additional policies. Furthermore, information contained in the policies is not intended to be
used as a substitute for the medical care and advice of physicians. Nuances and pecularities in individual
cases or particular communities may entail differences in the specific approach. All information is based
on the current state of knowledge. Changes may be made in this publication at any time.
The activities of the Committee on Policy Statements were partly supported by educational grants from Dumex, Mead Johnson, and Nestle.
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