Burns season
Some time ago, while attending a congress, one of my colleagues remarked: “But Dr Struwig likes burns. He does them all the time.” My colleague had no idea how remote this was from the truth. I hate burns. Every trauma call that brings me another burn fills me with a sense of frustration.
This does not mean that I hate treating my patients with burns. I do so with dedication, with diligence, with compassion, with empathy. But I hate the impact this burn will have on the family of the victim – the inevitable cost implications, the guilt of being part of the accident, the life-long physical and emotional scars that are inevitably left behind.
A burn injury is almost always caused by an accident. And over the last 18 years I have seen a lot:
- Eggs boiled in the microwave exploding when the door is opened, causing devastating facial burns.
- Hot fat from a leg of lamb burning hands and arms when it is removed from the oven.
- Cooking oil splashing over hands and faces when frozen chips are added to boiling oil on the stove.
- Small children pulling a hot kettle, hot porridge or hot coffee and tea over themselves.
- Small children, carried on the hip, bumping hot water for their milk bottle out of someone’s hands.
- Unsuspecting children climbing into a bath of boiling water, sustaining devastating burns to their sensitive parts, their legs, their abdomens.
- Feet burned by hot coals doused with sand
- Hands and faces burned and scorched by using accelerants when starting a fire
- Feet burned by hot bricks where a fire starter was placed, and moved, without cooling down the area.
- Chemical burns from pool acid splashing into eyes, onto hands and skins
- Chemical burns from fine cement dust filtering into gum boots, mixing with water and sweat
- Electrical burns, sustained by electricians and by handymen at home
- Gas explosions, petrol station explosions, fuel fires, shack fires, house fires
- Hot oil splashing over an unsuspecting worker during an industrial accident
- Serious burns from staying too long in the sun
- Burns sustained in car accidents
- Hot water bottles bursting, leaking, breaking
- Hands on hot stove plates
Accidents can be prevented, but it requires sharing knowledge. It requires education. It requires mindfulness. Thinking before doing. Knowing before doing.
Prevent, don’t burn
- Close off access to the kitchen for children.
- Nobody should be holding the baby while preparing milk or food.
- Babies and children do not belong in the kitchen.
- Adding frozen chips or fish to oil will cause it to boil over and splash.
- The bell going “ping” on the microwave does not mean “open the door”. It means the desired time has passed. Open the door, use it as a shield and keep your face and hands away when you open the door, until you are sure it is safe to take out whatever you cooked.
- Use a timer when you place items in the oven, so that you don’t forget about them. Don’t peek into the oven with your face first. When you remove something from the oven, be calm, steady, well-protected. Pre-prepare an area where you are going to place what you remove from the oven.
- Don’t be obsessed with clearing away pots and pans from the stove top. Find something to place on the hot stove top to prevent the unsuspecting burning themselves when they place their hands on the stove.
- Coffee, tea and soup should ONLY be hot enough to drink or eat immediately – you should not need to let it stand for a while to cool off. If you like it hot, place it where your toddler running around cannot topple onto himself. Don’t hold the baby while you’re drinking your hot tea or coffee – their movements are often uncoordinated, unexpected and unplanned.
- Supervise your children when you let in their bath water – they can drown, but they can also burn.
- The number one rule of running a bath: open the COLD water first, then add the hot water, until you have the desired temperature, which should be body temperature for a child. Apply this rule to adults as well: I have treated adult patients with burn wounds sustained by stepping into a very hot bath, and not being able to get out of the bath.
- Be careful on hot days: I’ve seen children sustain second degree burn wounds from their siblings trying to spray them with “cold” water, which has reached boiling temperature in the garden hose lying in the sun.
- Learn how to make a fire. Also teach your children how to make a fire – not only your sons, but your daughters too. Petrol, spirits, benzine and turpentine serve a different purpose. They have not been placed on this earth to start a fire. And if you feel you have no other option, be safe. NEVER pour these substances on a fire and expect anything else but a fiery hell engulfing you. The safest option is to soak old newspapers or rags in the accelerant, and then adding these to the fire with the braai tongs – keeping you and your family more than an arm’s length from the fire.
- If you remove the braai grid from the fire, remember that the grid will still be hot. Place it out of reach, so that the unsuspecting will not be branded by your hot grid.
- If you had to make a fire in a river bed or on the beach, and you decide to follow the safety rule of covering the coals with sand to put out the fire, remember that beaches and rivers were made for carefree walking with bare feet, and others might not know that your man-made fire has now become an oven under the sand. Don’t cover the area with rocks and think you’ve done your job – those rocks become heat pebbles that will cause burns. Mark the area, shield it off, or douse the fire with water to ensure that all the heat is out.
- A fire starter is a brilliant tool for starting the fire, but if you move it from one area to the next, the area underneath will still be hot. Once again – shield it off, cool it with water, or banish those with bare feet from the area.
- Hot water bottles – don’t. You don’t need them. We live in the 21st century. There are other options. They should be banned.
You might have more ideas and more advice – feel free to add your advice to the post on my practice Facebook page, or email me on doctor@drdehanstruwig.co.za and I will add it on social media. The more advice, tips and tricks we can share, the more accidents we can prevent.
When it is too late
Accidents happen. What now?
Cool down. Cold water. Not ice. Cold. For as long as you can. Remove all clothing, especially if hot liquids splashed onto clothes.
It burns like hell when you cool down a burn. Let them scream, let them shout, let them hate you. Keep on cooling down. For at least twenty minutes. Longer if you can.
Don’t rush to the hospital. Don’t rush to the emergency unit. Cool the burn down.
Do not feed the person – food does not take the pain or the burn away. If surgery is required, it is best if it is done soon. Feeding the person will delay surgery with at least another six hours.
Do not give the person something to drink – it does not take the pain or the injury away. The same applies – you will delay surgery with at least another four to six hours.
You should have Burnshield in your house. If you don’t, put it on your shopping list. Keep some in your car and in your kitchen. Take it with you on holiday. Apply as directed on the burn area. Burnshield has a wide range of products, and Burnshield Hydrogel works well for sunburn (another preventable burn) too.
Now go to the emergency unit, to your general practitioner or your nearest clinic for further treatment or advice.
Don’t call me or my rooms. The correct person to consult is your general practitioner or emergency unit. They will do the proper assessment, and where necessary, they will treat the burns, or refer you to me for surgical intervention.
A word of caution
Do not underestimate a burn wound. A nick on the oven grill or iron is easily treated at home, but a more serious burn left untreated leads to bad scarring, infection, prolonged healing and costs a fortune to treat.
If you don’t feel anything in the burned area, it is NOT a good sign. In most cases it means the burn was so deep, that the nerve endings were destroyed. You will most likely need surgery to remove the dead tissue to prevent infection and ensure healing.
Do not remove the blisters on a burn. The blister acts as a biological dressing and prevents infection.
The longer you wait for a burn to be treated correctly, the longer you can expect to take to heal – early intervention is essential.
Seek medical advice from a primary care giver – not from your neighbours, family and friends or Dr Google. While old wives’ tales and folklore and witchcraft and at home remedies might work in the case of minor burns, they can cause devastating harm to larger burns, contributing to infection, scarring and complicating the healing process, often leading to prolonged hospital stay and major expense.
Are you prepared for the administrative burden when you suffer an accident?
My admin team knows best when it comes to managing the administrative burden of an accident. I have asked them to share some advice:
- You will need your medical aid card and ID of the main member.
You should always have a copy of this with you. When you go on a long-distance trip, make sure this is packed in the cubby hole of the car. Your child should have this in his bag at school/creche. Your carer should have access to it. Without it you unnecessarily delay treatment.
- You need to understand and know which accident and emergency unit or hospital you can go to. Medical aids cause a lot of confusion in this regard. They tell you that you can go to any hospital in case of an emergency. They also tell you that the costs will be covered in full. Not so.
The reason lies in the definition of an emergency.
The Medical Schemes Act 131 of 1998 defines an “emergency medical condition” as “the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a body organ or part, or would place the person’s life in serious jeopardy”.
Therefore exclude: most (minor) injuries to foreheads, brows, noses, chins, cheeks, arms, hands, and other body parts – if you are not bleeding profusely with no means to stop the blood, and your hand/arm/body part does not dangle on a thread; if you can still walk, breathe and communicate, even if writhing in pain from a burn and all other injuries – you need to go to the hospital which is the designated service provider for your medical aid. And it might be far from your home.
You will face high co-payments or be directed to your designated hospital by the Accident and Emergency Unit you arrive at. Yes, they will give you primary treatment and stabilise you, but you would have wasted lots of time sitting in a queue to be stabilised, and then turned away and directed to another hospital, where you will waste some more time while the administrative work is being done.
- The costs of your plastic surgeon, his anaesthetist and any other supportive services are not necessarily covered in full, even if you visit a designated hospital
Some more confusion to cope with: medical aids will force you to go to a designated hospital as service provider, however, this does not mean that the specialists in that hospital are designated service providers for your medical aid or the option you have chosen.
Do not expect your plastic surgeon or anaesthetist to inform you that they are not contracted in when it comes to an emergency. They have other things to focus on, like your health. In today’s world, you can expect that they are almost always NOT contracted to your medical aid. You are responsible for providing adequate funds for emergencies.
- GAP cover is affordable. Accidents are not planned events. GAP cover is additional insurance to help with these unplanned events. For a small fee per month, you can prevent having the additional burden of a traumatic event, however, remember that you need to be treated in hospital for most GAP cover products to pay out. Accident and Emergency Units are not in hospital treatment centres – you will therefore have to be admitted to hospital.
The road to recovery is almost always long - commit to it
If I am your plastic surgeon, you need to trust me as your partner in your recovery process. I will discuss your recovery process with you, but you need to arrive for all your follow up visits.
If you had surgery with me, you will be seen within a couple of days after discharge for your first wound check. During this appointment we check for infection and possible barriers to healing, we explain what was done and the way forward, we discuss what recovery you can expect. We discuss what you may and may not do. We set you up for successful recovery. This appointment does not cost anything. You will only be responsible for the payment of consumables and materials used during the dressing change.
We may deem it necessary to see you several times more – to check on your progress, to do more dressing changes, to re-evaluate the healing process. One of these visits may involve removal of sutures. If you had surgery with me, these appointments (no matter how many) do not cost anything. You will only be responsible for the payment of consumables and materials used during the dressing change.
I like to see you between four to eight weeks after your surgery to ensure that the outcome of surgery is what I expect it to be. Everything might be fine, but this is when I discuss the outcome with you, what you need to do the heal completely and what you need to do to prevent scarring or manage scarring. If you had surgery with me, these appointments do not cost anything.
Too many patients blame their doctors for unfavourable outcomes or unhappy experiences. Remember that you are responsible for your own health, and not arriving for follow up visits often sets you up for failure. It is during these visits that you will receive all the information you need to heal well. Attend them.
Special request for help: I want to include an article about dog bites in a future newsletter. If you, or anyone you know, can give us advice on how to prevent dog bites, how to behave around dogs, how to know when dogs will bite and what to do when a dog attacks, please contact Amori on manager@drdehanstruwig.co.za Prevention is better than a person mauled by a dog.
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