||OFFICIAL INAUGURATION OF THE MBC
||CONCLUSION ON HIPPOCRATIC BEHAVIOUR IN THE TREATMENT OF WOUNDS AND BURNS
(Policratis - Greece)
The intention of this paper is not to solve positively today problems of wounds and bums, but to point out that Hippocrates, 2500 years ago, faced sufficiently similar problems by placing medicine on a strictly scientific level. In the large collections of his many writings, which amount to 100, many are interesting, describing methods of curing diseases. His knowledge of surgery of the head is reported in detail, and an operation in the lower eyelids is depicted distinctly. Regarding bums, by close observation of their surface appearance, he could estimate their condition. His efrorts in local treatment aimed to keep them clean and dry, in some cases by applying soft and soothing emollients and in more serious cases, more drastic substances; these methods proved to be helpful.
His ideas in medicine and surgery were followed for many years and constituted the anticipation of modem knowledge. Hippocrates because of his important contribution has justifiably been recognised as the legislator and the father of medicine.
||LES BRULURES DANS LA VIE DOMESTIQUE A ALEP
(Dayoub - Syrie)
The authors take into consideration the main causes of burns in Syria.
Domestic accidents represent 7011/o of the total number of burns. Children are most frequently involved, followed hN huscwives.
Particular stress is laid on the inadequacy of' first aid therapy and on the need to prepare new young medical stafl'(0y means of speciali/:uion
courses) in order to improvc the socio-sanitary level in the country.
||BURNS INJURIES IN EGYPT - INCIDENCE AND MANAGEMENT
(Reda Mabrouk - Egypt)
Burn injuries in Egypt represent a major problem as compared with heart diseases, malignancy and road accidents. St~ili,-,tic:il studies reveal that about 0.1% of the total population are affected by major burns. Death rate is still high, about 30%. Of the saved 1)~tlieiil,; 36% need later reconstruction. Domestic causes are responsible for 75% of the injuries, the rest are caused by industrial and road A report was presented to the Ministry of Public Health in 1984 showing these facts. It discussed the prophyiactic measures and the ffit.), expenses of treatment which could not be afTorded by individuals. It emphasized the responsibility of the government and organizations for burn management. The authorities, agreeing with the report, have adopted a plan for prophylaxis and have started burn units and centres in different localities depending on the population and statistical studies of' the injury incidence.
||EPIDEMIOLOGICAL DATA ON BURN INJURIES IN GREECE: A STATISTICAL EVALUATION
(Iannovich - Greece)
4114 burn patients were treated during 1986 in 60 hospitals in Greece (65.2% of all hospitals) and the results of this survey are analyzed. The distribution of burns is directly related to the density of the population. There is a higher incidence in male patients, in children 1-5 years (chiefly scalds) and the age group of 20-40 years. With regard to occupation
it is highest in labourers and craftsmen. The main cause of bums is scalds followed by fire bums and sunburns. The majority were minor burns (60.5%) while extensive burns amounted
to 14.8%. This survey proves the absolute necessity for the immediate construction of two burn units in Greece, one of which is already in progress in Athens.
||EPIDEMIOLOGY AND PREVENTION OF BURNS IN CHILDREN
(Barisoni - Italy)
Epidemiological data concerning 708 burned children (age 0- 11), admitted to the Bum Unit in Verona during the years 1976-1987 are presented. The efficacy of a prevention programme in 1981/83 in primary and nursery schools is presented and discussed.
||THE PREVENTION OF ACCIDENTAL BURNS AT HOME: A PROPOSAL FOR A NEW PROTOCOL
(Brienza - Italy)
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 BURNS IN PEDIATRICS: 10 YEARS' ACTIVITY IN THE CESENA AREA
(Landi - Italy)
In 1987 and 1978 a domestic burns prevention campaign was organised in the area of Cesena and 10 years later the epidemiological data were compared and reported.
A substantial reduction of bum morbidity was observed in the resident population, but not in the non-resident population.
The morbidity reduction was very important in resident children, in accordance with the campaign purposes.
||EDUCATION FOR PREVENTION OF BURNS IN THE NEGEV DISTRICT OF ISRAEL
(Rosemberg - Israel)
A detailed epidemiological surv,-y of more than 800 hospitalized burn victims every year at the Soroka University Hospital defined small children and their parents as the highest risk group, with home accidents the most common cause. The differences between the Bedouin (the Arab, desert nomads) and the Jewish population resulted in establishing and implementing two different preventive projects for these two communities.
Generally, the campaign's goal is to increase awareness of the damage caused by home accidents and burns and to teach prevention and first-aid skills. In the Jewish sector, instructiona. group meetings led by trained plastic surgeons have been organized by the Center For Research and Development of Advanced Services in Plaitic Surgery.
Teachers, parents and pupils from kindergartens to secondary schools as well as groups within the community take part in the project. A comprehensive audio-visual program has been prepared to suit various socio-economic and age groups.
In the Bedouin sector, the survey found that the highest population at risk is children up to age of 10 and their mothers (80% of the burn population). These target groups may be approached "en bloc" only at the kindergarten, schools and Kupat Holim clinics (which have become the meeting place for the Bedouin women).
Due to the specific problem of changing deep-rooted behavioral patterns of the conservative Bedouin society we decided to start the project with the young children and reach through thcm the adults. We train Bedouin teachers (one in every kindergarten and school) to carry out this campaign within their schools and communities.
The preliminary evaluation protocol assesses understanding and memory. The long-term evaluation will be based on a five-year epidemiological study.
||10 YEARS OF BURNS IN CHILDREN: A STATISTICAL STUDY WITH A VIEW TO A PREVENTION CAMPAIGN
(Amico - Italy)
The Authors have carried out i statistical analysis of bums in childreen aged 0-12 years admitted to our Bums Centre in the decade 1975-84.
The data were processed on an Olivetti M20 Personal Computer.
Tha analysis shows a total number of 3858 children treated for burns, 1788 after admission to the Centre and 2070 in the Day-hospital.
There were 36 deaths.
The commonest burning agent was water.
The age-range most affected was pre-school.
The florne was the most frequent scene of bum accidents.
Other data taken into consideration were: sex, B.S.A., place of origin, site of bum, self discharge, relationship between death from bums and aetiological agent, patients arriving some tim( after the bum lesion and the total number of days of hospitalization.
This collection of data has enabled the Authors to set up a programme for a prevention campaign.
They express the hope that in a subsequent ijivestigation the present data will be considerably reduced.
||ANALYSIS OF 745 HOSPITALIZED BURN PATIENTS
(Haberal - Turkey)
From 1 January 1979 to 1 January 1987, 745 burned patients were hospitalized. Of the patients, 55.84 per cent were under 15 years old (birth to 6 years: 70.20 per cent; j-15 years: 29.80 per cent) and 44.16 per cent were over 15 years. The causes of burns in the over 15 years gioup were: Flame, Electrical, Scalding, Liquefied petroleum (LP), Gas explosion and others. The burn causes in the under 15 years group were: Scalding, Flame, Electrical, Hot meals, and others. After being resuscitated, these patients were treated with systemic antibiotics, local chemotherapy and silver-nitrate-incorporated amniotic membrane. Despite all medical efforts, 255 (34.h per cent) of the hospitalized patients died as a result of various complications.
||APPROCHE EPIDEMIOLOGIOUE DES BRULURES
(Marichy - France)
L'analyse statistique de 1593 br?l?s (adultes et enfants) entre 1979 et 1983, compar?e aux ?tudes similaires r?alis?es depuis 1963 dans le m?me service, permet de suivre l'?volution dans le temps de la population br?l?e, des agents et m?canismes des br?lures, des facteurs causals. Il s'agit toujours d'une population tr?s jeune (m?diane ? 21 ans); la majorit? des accidents ont lieu ? domicile (46%). Les facteurs de risque l?tal (gravit? de la br?lure, ?ge, sexe, tares, complications...) sont appr?ci?s. Le risque de complications augmente avec l'?ge, le sexe et l'importance de la br?lure. Les complications infectieuses sont les plus fr?quentes. Les causes de d?c?s sont surtout infectieuses et respiratoires. Ce travail permet, enfin, d'?valuer globalement l'efficacit? de la th?rapeutique: ? gravit? de br?lure comparable, le taux de mortalit? (12,3%) est inf?rieur ? celui de l'?tude pr?c?dente.
||EPIDEMIOLOGICAL INVESTIGATION OF BURNS TO THE HAND BETWEEN 1975 AND 1986 AT THE DIVISION OF RECONSTRUCTIVE PLASTIC SURGERY AND BURN THERAPY, PALERMO
(Conte - Italy)
The authors have carried out a study of burns to the hand treated-over a ten-year period in order to evaluate the rate and the extent of bum damage in relation to sex, age, aetiological agents, the initial type of clinical evaluation, first treatment and its earliness. They draw some useful conclusions for the pr,-paration of a campaign of prevention in the local territory, stressing the need for more precise information regarding the concept of the gravity of the acute bum, wider knowledge of the activities of Specialized Centres, a re-thinking of certain parameters of accident medicine in the territory, and the usefulness of an informative campaign in schools and work-places.
||ETUDE DES BRULURES ELECTRIQUES A ELECTRICITE DE FRANCE SUR UNE PERIODE DE 10 ANNEES
(Cabanes - France)
Le Comit? des Etudes M?dicales d'Electricit?-Gaz de France ?tudie les accidents ?lectriques depuis plus de 20 ans. Lors de la derni?re enqu?te, qui a port? sur dix ann?es, les br?lures ont ?t? observ?es dans 93% des accidents.
L'erreur humaine apparait comme le facteur ?tiologique pr?dominant de ces accidents car les mesures de s?curit? technique ont atteint, depuis de nombreuses ann?es d?j?, un tr?s haut niveau de qualit?.
Les br?lures ?lectriques sont localis?es le plus souvent au niveau des mains (70% des cas).
Les br?lures les plus fr?quentes sont les br?lures thermiques par arc ?lectrique. Elles s'observent surtout dans les accidents en basse tension. Les br?lures oculaires par arc sont, elles aussi, fr?quentes.
Les br?lures ?lectrothermiques dues au passage du courant sont plus rares.
Elles s'observent aussi bien dans les accidents en haute qu'en basse tension.
Elles peuvent ?tre graves du fait de leur extension en profondeur, des destructions tissulaires ?tundues et de leurs possibles cons?quences r?nales. Les br?lures ?lectriques ont laiss? des s?quelles invalidantes dans 23% des cas.
Elles ont ?t? la cause d'une mortalit? secondaire dans 1% des cas.
||FOREST FIRES AND THE PREVENTION OF BURNS: STUDY AND DEVELOPMENT OF A PROTECTIVE OUTFIT
(Magliacani - Italy)
Forest fires are not a rare event in Mediterranean countries and they present some peculiar characteristics which affect the types of risk involved, of which the main one is of course burning.The statistically most frequent accidents are lue to sudden flares of flame or by sudden change in the direction of the fire front where fire-fighting teams are at work. In such cases t ic temperature of the heat source reaches maximum levels that may be supposed to be in the region of 500'C; the time of exposure of the fi.-e-fighter is generally 20-30 sec.
We have accordingly designed protective clothing to avert the risk of burns or to limit their effect, taking into account the environmental and climatic conditions in which fires break out ard their characteristic physical features. This type of clothing has the following specifications:
- easy to wear and comfortable even when used for long periods
- protects all the body, and in particular those parts most at risk - face, hands, perineum etc.
- protection time sufficient to allow wearer to pass through fire front at the estimated temperature
- poor accumulator of heat
- allows wearer to feel gradual rise of temperature so that he is aware of imminent danger.
||THE PREVENTION OF BURNS IN CHILDREN (VIDEOTAPE)
(Ferrari - Italy)
A 15 - minute videotape is presented showing a series of situations - some acted, others illustrated with coloured drawings - in which children risk burn injury. The episodes have been reconstructed in order to attract the attention of the spectator and they show either scenes of family life or children playing together. Every episode ends with a very realistic reconstruction of the way the accident happens, with shots of the burned children which in it eir frank realism will certainly leave a marked impression on the viewer.
The commentary has been made deliberately (asy to follow and it stresses how often a child's imaginative ideas may lead to dramatic situations. The videotape is an attempt by those who pioduced it to propose, by means of the Mediterranean Bums Club, a common message on bum prevention in children, to all colleagues in the Mediterranean area.