Abstract: Analysis of the Causes of Burn Related Deaths at Kimberley Hospital

ANALYSIS OF THE CAUSES OF BURN RELATED DEATHS AT KIMBERLEY HOSPITAL

M.Giaquinto-Cilliers, T.Mathe, S. Sheik, T. Van Wyngaard, D.Lourens

Kimberley Hospital Complex

OBJECTIVES: To analyze the causes of deaths resulting from burn injuries at Kimberley Hospital Burns Unit (KBU).

BACKGROUND: According to the document on Modernization of Tertiary Services in South Africa (2003), the average mortality rate in the country for adults is 10.2% and 4.1% for children. The most common causes of deaths are sepsis related, despite advances in general burn care. There are few Burn Units in the country, and most of them lack specialized equipment, trained staff and adequate number of beds to cope with the demand for the treatment of burn patients.

METHOD: A retrospective audit of the forensic reports from June 2005 to June 2011 obtained after the death of patients who sustained burn injuries admitted at Kimberley Hospital Burns Unit (KHBU) was done. Data collected included the final cause of death and the gender of patients. A detailed analysis of the reports was the base for this study.

RESULTS: Sixty three death reports were analyzed. 30 were from male patients, 33 from female. Four reports were from children below 18 years of age. The most frequent cause of death found was septicemia with multi organ failure (MOF). The lungs were the organs most affected by sepsis, with bronchopneumonia and pulmonary oedema resulting from the macroscopic finding of consolidation of lung parenchyma and congestion.

DISCUSSION: Septicemia was the leading cause of deaths at KBU despite a more aggressive surgical approach to the treatment of burn wounds. There was a slight trend away from the number of organs involved in the MOF in the last reports, in comparison to the earliest reports studied.

Abstract: Outreach Programme to Improve Burns Management in the Northern Cape Province: Pilot Project

OUTREACH PROGRAMME TO IMPROVE BURNS MANAGEMENT IN THE NORTHERN CAPE PROVINCE: PILOT PROJECT

M.Giaquinto-Cilliers, T.Mathe, S.Sheik, G.Kanakang

Kimberley Hospital Complex

OBJECTIVES: To utilize the outreach program via the Air Mercy Services (AMS) to: 1) Map the quality of care given to burn patients and 2) train health care professionals in the Northern Cape Province (NCP) on burns prevention and burns management, in order to improve the referral of patients to Kimberley Burns Unit (KBU), and provide better quality of care to burn patients within the Province.

BACKGROUND: The NCP is the biggest Province in South Africa in land mass and the distances between major towns to the referral tertiary centre, Kimberley Hospital Complex (KHC), are long and result in delays in patients reaching adequate treatment by road transport/ambulances. The AMS is based in Kimberley, and the outreach programme is used to fly out some specialists to the major distant towns, and fly in patients in need of emergency care. KBU is the only referral centre for burn patients within the NCP and most referrals reflect the lack of experience of health care personnel in the management of burn injuries. Education on burn injuries is needed in order to: improve the referral of patients who need admission in a burns unit, improve the pre-hospital management of burns, improve the acute treatment of burns, improve the outpatient care and to promote burns prevention.

METHODS: From 13^th July to 17^th August 2011, a team consisting of one or two doctors and one or two nurses were taken by the AMS to five main towns of the main districts of the NCP: Calvinia and Springbok (Namakwa District), Upington (Siyanda District), Kuruman (John Taolo Gaetsewe District) and De Aar (Pixley Ka Seme District). Nurses were responsible for lectures given to home based care givers on measures to prevent burns. Doctors were responsible for the training given to Emergency Medical Services (EMS) personnel on pre-hospital management of burn injuries and the acute management of burn injuries and outpatient treatment of burns training given to medical and nursing staff. General written guidelines were given on the occasion of the training.

RESULTS: 91 care givers were trained in burns preventative measures and they were requested to implement the measures amongst their communities. Fourteen staff members from EMS, 12 doctors and 59 nurses were trained, and the sessions were interactive.The mapping of available beds for treatment of burn injuries has shown that in most regional and district hospitals, patients are admitted in general wards with no dedicated equipment or trained staff. One dedicated room for admission of burn patients was available in Calvinia. A dedicated burn ward with ten beds in Upington and two beds in Kuruman are planned for 2012-2013. The majority of district hospitals and community health centers in the Province lack equipment for the management of burn wounds (electrical dermatomes, manual dermatomes), skills to handle the equipment (medical officers trained in skin grafting) and advanced dressings to speed up the wound healing process.

DISCUSSION: Feedback received was promising. A communication channel was opened to allow more interaction between the remote places and KBU, resulting in better triage of patients for further treatment and promoting reduction of costs associated with transport of patients for unnecessary consultations and admission. A blog with all the information and documentation was also created to strengthen that communication.

CONCLUSION: This pilot project in the NCP has shown that the training of professionals working in remote areas can be achieved through outreach opportunities and improvement of care will result in appropriate referrals to Kimberley Burns Unit. 

Abstract: Analysis of Burns Reconstructive Procedures in the Northern Cape Province

ANALYSIS OF BURNS RECONSTRUCTIVE PROCEDURES IN THE NORTHERN CAPE PROVINCE

M.Giaquinto-Cilliers, T.Mathe, S.Sheik, T.Van Wyngaard

Kimberley Hospital Complex

OBJECTIVES: To analyze the reconstructive procedures performed in the Northern Cape Province (NCP) in patients who sustained burn wounds and were previously treated in the Kimberley Burns Unit (KBU), aiming to improve the rehabilitation process of burn patients in the Province.

BACKGROUND: The rehabilitation of burn patients starts in the acute phase of the injury and includes active and passive physiotherapy, splinting of joints and extremities, early excision and grafting of the burn wound amongst other interventions. Despite the active intervention, minor and major deformities may develop, and further surgical reconstructive procedures must be performed in order to improve functional and cosmetic features and assist with the reintegration of the burn patients into their normal activities. The role of plastic reconstructive surgery is to perform the procedures through a realistic approach, combining timing and selection of techniques.

METHOD: A retrospective audit of surgical reconstructive procedures performed at Kimberley Hospital Complex from January 2006 to July2011was carried out. The ratio of reconstructive procedures done and the functional or cosmetic outcome was analyzed.

RESULTS: 2472 overall surgical procedures were performed in the period of the study. 61% of the operations were related plastic surgery procedures and 38.87% to acute treatment of the burn injury, including surgical debridement and skin grafting. From the total of reconstructive cases, around 10% were related to late reconstruction of burns related deformities. Amongst the reconstructive operations, the release of joint contractures was the most frequent performed in the following order: armpits, elbows, knees, fingers. Other procedures included: reconstruction of the eyebrows, ear reconstruction, release of contracted eyelids/lips, and correction of burn alopecia.

DISCUSSION: Despite the efforts taken to prevent deformities resulting from burn injuries, the occurrence of burn related deformities at Kimberley Hospital was high. Most patients do not search actively for functional reconstruction, as they rely on grants. Thirty percent of the NCP population relies on some type of grant, particularly disability grants.

CONCLUSION: To improve the rehabilitation of burn patients in the NCP, a better integration between physiotherapists, occupational therapists, burn surgeons and plastic surgeons is essential. The follow up of burn patients after the injury and the early referral to a plastic/ burn surgeon when deformities which can be corrected are detected, are the pillars to deliver good quality of burns reconstruction and rehabilitation of the burned patient in the Province.

South African Burn Society Conference 2011

The South African Burn Society Conference 2011 will be held in Cape Town from 10-12 November. This years conference focuses on Total Burn Care. Staff from Kimberley Burn Unit will be attending the conference as well as contributing to the programme. Kimberley Burn Unit will be presenting two papers:

• Analysis of the Causes of Burn Related Deaths at Kimberley Hospital
• Analysis of Burns Reconstructive Procedures in the Northern Cape Province

and one poster presentation:
Outreach Programme to Improve Burns Management in the Northern Cape Province: Pilot Project


Click here for the conference program and further details.
Abstracts of the papers presented by Kimberley Burn Unit will be published in subsequent posts.

Welcome

Welcome to Kimberley Burn Unit. This blog was created by the Burn Team at Kimberley Hospital Complex in the Northern Cape of South Africa. The aim of this blog is to provide much-needed information regarding management of the burn patient. As such, we have made available information regarding the burn services rendered by our Burn Unit as well current management protocols. We would like this to be an interactive forum where patient scenarios, management issues and new modalities/protocols can be discussed.


Please visit the tabs arranged at the top of this page where you will find information about our Burn Unit as well as management guidelines.


Please contact us at kimberleyburnunit@gmail.com


Yours in Health