Chapter 35: Burns

INTRODUCTION

Burn management continues to be a crucial part of trauma and critical care as severe burn injuries are encountered within the United States and globally. Burn management has evolved and advanced treatment modalities are utilized by countries with adequate resources. The American Burn Association (ABA) publishes updated guidelines periodically with these innovations to promote optimal burn care.

The recent pandemic resulted in the reallocation of resources and continues to put a strain on healthcare systems nationally and globally. Fortunately, the ABA has published protocols for crises or disasters which have potential for a significant number of burn injuries and a shortage in resources. Additionally, there are guidelines established by burn surgeons and healthcare workers who have worked in war zones where burn care also had to be performed under the constraints of limited resources. In this chapter, we will review the fundamentals of burn management and then focus on the guidelines for burn management in special conditions such as in a crisis.

EPIDEMIOLOGY

The ABA reports annual data showing approximately 486,000 burn injuries requiring medical treatment, 40,000 hospitalizations, and about 200 admissions per year in each of the 128 burn centers nationally.¹ Per 2015 data, the survival rate for hospital admissions is 96.8%.¹ While this data looks promising, this is representing a developed nation with specialized burn care centers and resources that can accommodate the number of burn injuries seen. The World Health Organization (WHO) provides international data that shows approximately 11 million burn injuries requiring medical treatment in 2004; with a higher incidence of burn injuries in underdeveloped and developing countries than developed countries.² Burn injuries have a higher mortality rate in these countries and they often lead to temporary or permanent disability in survivors.² Moreover, it is found globally that burn injuries correlate with the socioeconomic status; there is a higher incidence of burn injuries in people of low or middle socioeconomic status than high socioeconomic status.² These facts portray the unequal burden of burn disease globally and the need for further development of burn care in low resource conditions.

TYPES OF BURNS

The types of burns recorded at admission are categorized into thermal and non-thermal injuries. Most burn injuries are found to occur while at home.^1,2 Thermal injuries comprise fire or flame burns, scald burns from contact with hot liquids, and contact burns from touching hot objects. The ABA data demonstrates each of these incidences per year (Figure 35-1). This chapter will primarily focus on the assessment and management of thermal injuries as they constitute 86% of burn admissions nationally.¹ Non-thermal injuries constitute the remaining 14% of burn admissions (Figure 35-1). These comprise of electrical burns, chemical burns, frostbite, radiation, inhalation injuries only, skin diseases, and other types of unspecified burns.¹