Annals of the M.B.C. - vol. 1° - n° 1 - September 1987

THE PREVENTION OF ACCIDENTAL BURNS AT HOME:
A PROPOSAL FOR A NEW PROTOCOL

Brienza E, Di Lonardo k Minervini C, Portincasa -K

Università di Bari
Istituto di chirurgia d'urgenza e chirurgia plastica - Cattedra di Chirurgia plastica
Chief: Prof. Dioguardi D.


SUMMARY. A statistical survey carried out by the authors in four Bum Centres in Southern Italy in the years 1983-85 showed that:
    + the home was the most frequent site for accidental burns
    + the population groups most exposed to bums were children aged 0 to 14 years, and adult women.
Considering that prevention is possible in 90% of cases, the authors have prepared a programme of social education aimed at reduc the frequency of accidental bums in the home.
On the basis of statistical findings two "TARGET POPULATIONS" were identified:
1) INFANTS AND CHILDREN (0-14 YRS)
2) ADULT WOMEN.
For Target 1 the programme provides for
    + CAMPAIGN IN KINDERGARTENS, NURSERY SCHOOLS, PRIMARY AND SECONDARY SCHOOLS
    + CAMPAIGN ON TV DURING AFTERNOON PROGRAMMES
    + CAMPAIGN IN PUBLICATIONS FOR CHILDREN
For Target 2 the programme provides for
+     PREPARATION OF INFORMATIVE LEAFLETS, PAMPHLETS, POSTERS TO BE DISTRIBUTED IN PLACES MOST FREQUENTLY     VISITED BY THIS TARGET GROUP I.E., BANKS, SUPERMARKETS, CHEMIST'S SHOPS, BABY GOODS SHOPS
    + CAMPAIGN ON TV AT PEAK VIEWING HOURS
    + CAMPAIGN IN MAGAZINES AND NEWSPAPERS
Considering the extreme usefulness of the programme both socially and from the cost/benefit viewpoint, the authors believe that it can be
realized without great difficulty in all cuontries of similar social structure.

The prevention of accidental burns at home: a proposal for a new protocol

For the victim a bum lesion represents an extremely traumatizing illness, both physically and psychologically.
In the acute phase the patient is subjected to long and stressful periods of hospitalization with repeated surgery, often followed by further operations to remove scar tissue that has formed.
This causes the patient great suffering and interferes, sometimes irrevocably, with his return to a normal social and working life.
The problem is all the more dramatic among children. At this age the bum lesion has extremely serious after-effects that are both physical (disfiguring and disabling scars) and psychological, with profound effects on the inner stability of the child and the other members of his family.
Another important factor is the enormous social cost of the immediate and long-term treatment that these patients require.
Faced with such a reality, many burn surgeons have become aware of the importance of a programme of social prevention as a means for reducing the frequency of accidental bums. It has indeed been shown that appropriate prevention could be successful in over 90% of cases (2, 4, 5, 6, 8, 10, 11).
We thus think it may be useful to express our own opinion with regard to the creation of a programme of prevention of accidental bums in the home.
For such a prevention programme to be fully effective, it is extremely important to identify the situations at risk, the age ranges of the population most exposed, and the ways of getting the prevention programme across (1, 5, 7, 9, 10). Obviously there can 'be no single standard campaign of information - each country presents variable factors; even regions within ne and the same country, such as
- social and economic conditions
- educational level
- impact of mass media
- customs and usages
- environmental factors.

A pilot research project carried out in four Burn Centres in Southern Italy in the years 1983, '84 and '85 showed that the age range most atYected was be tween 0 and 14 years (44.9%), compared to 40.2% for adults (15-50 years) and 14.9% for the elderly (over 50 years) (Fig. 1).
Regarding the places where accidental bums most frequently occur, with respect to age, it was found that among children - both boys and girls - the highest percentage of bums occurred in the home.
The same finding was true also for adult women, while adult men had more accidental burns at work.Also among the elderly, the home was the most frequent site of bum accidents (Fig. 2). We assessed the most frequent causes of acciden tal bums, with relation to age. Among children the most frequent causes were boiling liquids, in particular water (Fig. 3).
The main reason for the high accident rate among &A children is the failure on the part of the parents to observe the most elementary standards of safety and care in the interest of the children (e. g. boiling liquids in containers within easy reach of the child).
The second most frequent cause of bums is in-flammable substances (surgical spirit, petrol, ether). These substances are frequently rashly used to revive barbecue fires and open fires in the home.

Fig. 1 Fig. 1
Gr000021.jpg (8170 byte) Fig. 2
Fig. 3 Fig. 3

With regard to bums by fire, a very common cause in our region is burning coal, especially in the hinterland areas, due to the use of open braziers to warm the house.
Chemical and electric bums constitute a significant percentage only among accidents at work and, in view of the comparatively low degree of industrialization in southern areas, they are rather infrequent (Fig. 4).
In the light of the above findings it is clear that:
a) the home is the most frequent site for the occurrence of accidental bums;
b) the age ranges most affected by bums are 0-14 years (both sexes) and adult women (15-50 years).
For these reasons we therefore examined the possible strategies to reach what we defined as the "TARGET POPULATIONS" i
. e. infants, children and adult women.

Liquids Inflammable Fire Chemical
Eletrical
others
TOTAL
Domestic 52.2 10.7 12.3 1.6 76.6
Work 1.9 6.2 6.0 2.1 16.2
Road 0.1 2.5 1.0 0.5 4.1
Others 0.7 0.8 0.9 0.5 2.9

CAUSES - SITE OF INCIDENT (%)

Such a campaign musthave the greatest possible impact on these "TARGETS", bearing in mind the continual physical and psychological variations between the age ranges.It is therefore necessary to use appropriate language so as to stimulate the interest of the child without arousing in him the curiosity to explore the forbidden.
However, it is the parents who, above all, must be made aware of the problem so that they can train their own children.
However, it is the parents who, above all, must be made aware of the problem so tht they can train their own children.

A proposal for a Campaign of prevention of accidental burns in the home

The following is a proposal for the creation of a campaign of prevention of accidental bums at home.

Objective

The prevention campaign is aimed at what we define as "TARGET POPULATIONS":
    CHILDREN AGED 0 TO 14 YEARS
    ADULT WOMEN

Strategy

The realization of such a campaign must take into account two fundamentally important problems if it is to be really effecive:
a) the need to use language appropriate to the "population" of infants and children,. considering the continual physical and psychological developments in this age range;
b) the most advantageous possible cost/benefit ratio at the moment of actual realization of the campaign.
The most effective means of reaching the "TARGET POPULATIONS" are, in our opinion:

    Target 1

    + CAMPAIGN IN KINDERGARTENS, NURSERY SCHOOLS, PRIMARY AND JUNIOR SECONDARY SCHOOLS
    + CAMPAIGN ON TV DURING AFTERNOON PROGRAMMES
    + CAMPAIGN IN PUBLICATIONS FOR CHILDREN

    Target 2

    + PREPARATION OF INFORMATIVE LEAFLETS, PAMPHLETS, POSTERS TO BE DISTRIBUTED IN PLACES MOST FREQUENTLY VISITED BY THIS TARGET POPULATION I.E
    BANKS
    SUPERMARKETS
    CHEMIST'S SHOPS
    BABY GOODS SHOPS
    + CAMPAIGN ON TV AT PEAK VIEWING HOURS
    + CAMPAIGN IN MAGAZINES AND NEWSPAPERS

This programme will be realized with the collaboration and financial backing of regional and provincial institutions involved, and, if available, of private associations with humanitarian objectives (Rotary Club, Lions etc.).

Programme
Target (1) children aged 0 to 14 years

    A) CAMPAIGN IN KINDERGARTENS
    Information will be directed mainly at the mothers.
    Periodic meetings will be held at which specialist physicians and Italian Red Cross assistants will describe clearly and effectively all risks in the home, ways of preventing the commonest accidents, and basic first aid.
    Colour slides, leaflets and other illustrative material must be used to integrate this campaign.

    B) CAMPAIGN IN NURSERY AND PRIMARY SCHOOLS
    It is certainly more difficult nowadays to stimulate children's interest in a problem such as domestic accidents and a totally new approach is required. This TARGET is exposed to all sorts of new stimuli - electronic games, computerized cartoons etc. - in view of which the school campaign will make use of
        - puppet theatres for children up to 5/6 years
        - mimes who will "tell" different stories for children between 6 and 10 years.
    All this will need the support of pedagogists, specialist physicians and Italian Red Cross assistants.

    C) CAMPAIGN IN JUNIOR SECONDARY SCHOOLS
    For the I I to 14 year age-range, educational programmes can be prepared in collaboration with the teaching staff responsible for civic education, during school hours.
    Simulations can be carried out with the aid of technical teachers, the local fire brigade and specialist physicians.
    The pupils themselves in this case can help to produce posters, folders and colour slides.

    D) TV CAMPAIGN
    Television is beyond any doubt the most effective way of stimulating the interest of this target group.
    Information can be put across through cartoons, films etc. on both national and regional TV channels, as well as local networks. In this way the message can be made simple and clear and thus more likely to achieve effective results.

    E) PRESS CAMPAIGN
    Our programme can also be promoted by the press. The attention of children can be drawn by using the same characters as in cartoons and TV series and showing them in comic strips. A competition can be organized on the theme, with prizes being awarded for the most deserving and most meaningful drawings or paintings. These could then be used for the preparation of a travelling exhibition in the schools.

Target (2), adult women.

    A) INFORMATIVE LEAFLETS, PAMPHLETS AND POSTERS
    The information directed at this target group must be carefully prepared if it is to be fully effective.
    All aspects of a programme of information must be assessed, and it must be borne in mind that means of communication prepared for children must at the same time involve also mothers.
    It is also clear that mor,:- detailed information will be required about ways of prevt,.Jing accidents and about the need to train children.
    Propaganda material will be distributed in places most frequently visited by women (banks, chemist's shops, supermarkets, baby goods shops).

    B) TV CAMPAIGN
    Short mini-serials can be prepared on the subject of prevention and training to be shown during peak viewing hours and/or after children's programmes.

    C) PRESS CAMPAIGN
    The same subjects and the same characters used in the TV campaign will appear in daily newspapers and periodicals.

Realization of the campaign

TIME REQUIRED
The complete programme will take 6 to 8 months for realization and actual performance.

ORGANIZATION
A working commitee will have to be set up, consisting of:
        + a scientific and technical commitee including the promoters of the programme and technical/ scientific experts;
        + an executive commitee to put the programme into operation.

CONCLUSION
On the basis of our studies we are convinced of the necessity of an educational campaign directed at "TARGET POPULATIONS" in order to achieve effective prevention of accidental bums.
Our message is aimed at high risk categories identified on the basis of epidemiological studies carried out in our region.
Considering-the high social value of such a programme, also in terms of cost/benefit ratio, we believe that it can be realized without great difficulty in all countries and areas that are socially similarly exposed to the same risks.

 

RÉSUMÉ. Une enquête statistique réalisée par les auteurs dans 4 Centres pour les Brûlés dans l'Italie Méridionelle pendant les années 1983-85 montre che
    + c'est la maison l'endroit plus fréquent pour les brûlures accidentelles
    + les groupes de population plus exposés aux brûlures sont les enfants âgés de 0 jusqu'à 14 ans, et les femmes adultes.
Vu che la prévention et possible en 90% des cas, les auteurs ont préparé un programme d'éducation sociale avec le but de réduire la fréquence
des brûlures accidentelles dans la maison.
Sur la base des résultats statistiques on a identifié deux "POPULATIONS CIBLE":
1) LES ENFANTS (0-14 ANS)
2) LES FEMMES ADULTES.
Pour le premier groupe le programme indique:
    + CAMPAGNE DANS LES ECOLES MATERNELLES, LES ECOLES ELEMENTAIRES ET SECONDAIRES
    + CAMPAGNE EN TELEVISION PENDANT LES PROGRAMMES DE L'APRES-MIDI
    + CAMPAGNE DANS LES PUBLICATIONS POUR LES ENFANTS.
Pour le second groupe:
    + PREPARATION DE PROSPECTUS, BROCHURES ET AFFICHES D'INSTRUCTION POUR DISTRIBUER DANS LES LIEUX  PLUS    FREQUEMMENT VISITES PAR CE GROUPE, C'EST-A-DIRE:
        BANQUES
        SUPERMARCHES
        FARMACIES
        BOUTIQUES ET MAGASINS QUI VENDENT LES OBJETS NECESSAIRES AUX BEBES
    + CAMPAGNE EN TELEVISION PENDANT LES HEURES DE GRAND PUBLIC
    + CAMPAGNES DANS LES REVUES ET LES JOURNAUX.
Vu l'extrême utilité du programme et socialement et du point de vue coût bénéfice, les auteurs croient qu'il peut être réalisé sans grande difficulté dans tous les pays ayant une structure sociale semblable.


BIBLIOGRAPHY

  1. Glasheen W.P., Attinger E.D., Anne A. et al.: identification of high risk population for serious bum injuries. Burns, 9; 3 193/200, 1983.
  2. Gunay Medha: bums prevention in Europe. A report of a study tour 1982. Burns, 9; 5 312/317, 1983.
  3. Bowger B.H., Aldwell F.T., Baker J.A., Walls R.C.: Statistical methods to predict morbidity and mortality: self assessment techniques for bums units. Burns, 9; 5 318/326, 1983.
  4. Scatafassi S.: Burn prevention. Organization of information as a social service. Riv. Ital. Chir. Plast. 3, 253/258, 1981.
  5. Apesos L, Dawson BK, Law E.J.: Comparative statistical methods in the analysis of bum victims. Burns, 6; 81, 1980.
  6. Tapp T., Abude E., Brindza E., Ferendzi K_ Kincs M_ Lincsel E.: The health education of in-patients on the prevention and first aid of burns. Burns, 5, 92/93, 1978.
  7. Keswani M.H.: A decade in the field of bum prevention. Burns, 5 5/7 1978.
  8. 'Ya H.O., Ohmori S.: Most bums are preventable. Burns, 5, 8/11, 1978.
  9. 'Ya H.O.: The characteristics of bums of the elderly and the preventive measures for burns. Med. Accident, 12, 610 1978.
  10. Gordon P.G., Pressley T.A.: The tire hazard of children's night wear; the Australian experience in developing clothing fire hazard standards. Bums, 5, 12, 1978.
  11. Gardner AW., Foster S.: Teaching safety, accident prevention and first aid in school. Burns, 2, 204/206, 1976.
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