The Euro-Mediterranean Council for Burns and Fire Disasters

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Volume XXXV	Number 1	March 2022

Summaries

3	CATASTROPHES LIÉES À UNE EXPLOSION DE CAMIONCITERNE ENTRE 2000 ET 2020. DEUX GROUPES DISTINCTS (Le Floch R., Mahé P.J., Perrot P. - France) Les accidents avec explosion de camion-citerne font régulièrement la une des médias. Celui de Morogoro (Tanzanie) le 10 août 2019 (ayant tué au moins 89 personnes) a attiré notre attention. Nous avons effectué une revue de la littérature médicale (pauvre) et des médias pour répertorier et analyser ces accidents. Dans les pays à IDH élevé, on observe uniquement des accidents isolés, où les morts peuvent être peu nombreux. Dans les pays à IDH faible, on déplore fréquemment une catastrophe survenant après un accident «simple». Quand cet accident occasionne une fuite de dérivé raffiné, de nombreuses personnes viennent en collecter. Une étincelle déclenche un incendie, meurtrier par lui-même, débouchant régulièrement sur un BLEVE de la citerne, responsable d'une hécatombe. La prévention de ces accidents «doubles» reposerait sur des actions de fond visant d'une part à éviter l'accident initial mais aussi et surtout de faire en sorte que la population, pouvant subvenir à ses besoins, n'ait plus recours à l'essence gratuite pour usage et éventuellement revente destinée à simplement survivre.
18	EPIDEMIOLOGY AND OUTCOME ASSESSMENT OF HAND BURNS: A 3-YEAR RETROSPECTIVE ANALYSIS IN A BURN UNIT (Mata-Ribeiro L., Vieira L., Vilela M. - Portugal) A great number of burns affect the hands, either as part of a more extensive burn or as an isolated injury. These injuries can lead to physical, social and psychological consequences that may reduce quality of life and make difficult the return to work. The goal of this study was to investigate the main epidemiologic characteristics of adult patients with hand burns admitted to a dedicated burn centre, evaluate the outcomes of the treatment, and identify the predictors associated with the worst outcomes. This study found that a considerable amount of burn victims admitted had hand burns (41.5%). Males are more likely to be injured in general, but females are more prevalent in burns by hot liquids. The most common comorbidity was hypertension, followed by dyslipidemia and type II diabetes. Cooking is the activity associated with more accidental victims. Most injuries did not require surgical intervention. Approximately two-thirds of the patients did not have any important sequelae. The most common complications were scar disturbances (26%) and scar contractures (14%). The need for surgery, a higher number of surgeries and higher surface area burn were associated with the worst outcomes. It is imperative to establish a burn prevention education program nationwide, encompassing water temperature control in households, the use of anti-burn equipment, and the replacement of old electrical/ heating equipment.
26	NEONATAL BURNS - A ROMANIAN EXPERIENCE FROM A TERTIARY CARE BURN UNIT (Muntean A., Stoica I., Tatar R., Enescu D.M. - Romania) Burns in neonates is a unique pathology that poses management challenges, as, besides treating the burn injury, the medical team needs to be familiar with the unique physiology of the newborn. This study aimed to review our center's experience with the management of neonatal burns. A 7-year retrospective study of neonatal burns managed at a tertiary national referral unit in Bucharest, Romania, was performed. Patients were divided into two groups, preterm and term, based on gestational age. Collected data included demographics, treatment, complications and follow-up. Our center managed 13 neonates with burns (5 term and 8 preterm), with a mean age at injury of 8.6 days. All neonatal burns were thermal injuries. For preterm babies, all burns were iatrogenic, consisting of victims of a fire in a Maternity Hospital, while for the term group only one was iatrogenic. Burns were more extensive in the premature group (65% vs. 20% mean TBSA, p=0.0001). All premature patients had associated inhalation injuries. Surgical treatment was indicated for two term patients. Survival rate was 77% and was negatively influenced by inhalation injury, burn shock and TBSA >50%. In conclusion, the majority of hospitalized neonatal burns in Romania were the result of a fire disaster secondary to an infrastructure deficiency. Their management is complex, posing specific challenges, and needs to be led by a multidisciplinary team that can ensure an individualized continuum of acute burn care and recovery.
36	ANALYSIS OF OCCUPATIONAL RISKS IN THE PROFESSION OF A PARAMEDIC (Losonczi P., Hanis J. - Slovak Republic) When a paramedic embarks on the process of providing health care, he or she starts a long and difficult journey of professional and personal growth. The high level of complexity and responsibility inherent in the coordinated operation of rescue services while securing and carrying out activities and measures related to the provision of emergency care brings many unforeseen situations. By analyzing the risks of paramedic work, this paper seeks to identify the extent of necessary protective measures with the potential of increasing the safety of the profession.
41	RISK FACTORS FOR DEATH AND PROGNOSIS VALUE OF REVISED BAUX SCORE FOR BURN PATIENTS WITH INHALATION INJURY (Lam N.N., Minh N.T.N. - Vietnam) A retrospective study was conducted on 314 burn patients with inhalation injury admitted to the NationalBurn Hospital during the period 2015-2019.The resultsshowed that adult and male was predominant(81.9% and 77.7%), with burns mostly caused by flame (93.6%) and burn extent of 68.6±24.3% and deep burn area of 44.6±25.2% total body surface area. Rate of required mechanical ventilation patients was 95.22%. Common complications were multiple organ failure (41.9%), pneumonia (29.9%), ARDS (25.5%) and septic shock (23.8%), with a mortality rate of 85.4%. Multivariate logistic analysis indicated that burn extent and age were independent risk factors for death of patients with inhalation injury. SMR of rBaux score was 1.01 with AUC of 0.84, Youden index 113,sensitivity 82.09%,specificity 70.21%. The SMR of adult and elderly patients wasrelatively close to 1 (1 and .97 respectively). In addition, the AUC value for the elderly was highest (.95) followed by adult patients (.84). However, predicting the value of rBaux on children with inhalation injury was quite low (SMR=1.57;AUC = 0.4). There is a need to determine an optimal prognosis score for children with inhalation injury.
46	BLOOD INDICES IN ADULT ACUTE BURN: A WINDOW INTO MILIEU INTERIEUR - THE FUTURE BIOMARKERS? (Karki D., Dawson L., Muthukumar V., Aggarwal N. - India) Optimal treatment of sepsis in burned patients depends on early diagnosis and includes prompt administration of antimicrobials as well as management of hemodynamic alterations and other organ dysfunctions. The role of red blood cell distribution width (RDW) and platelet indices in prognosticating and identifying sepsis in acute burn patients is studied. This study was done as a prospective study over 18 months, including patients in the age group >18 or <60 years, with burns >20% and <70% TBSA, burn time to resuscitation time 24 hours or less and with thermal and scald burns. Data of 157 patients were analyzed and the following observations were made. The mean age of the study population was 31.36 years (18-59 years). RDW values were higher in the non-survivor group. Platelet count and plateletcrit were higher in the survivor group and the no sepsis group. Positive rising trends of platelet count and plateletcrit were seen in the survivor group. Day 1, 3, 7 values of RDW, platelet count and plateletcrit were significant in determining the outcome of the patient on mortality and sepsis related morbidity of the patient. RDW, platelet count and plateletcrit in combination can predict mortality and sepsis as early as the third day, thus giving a clinical advantage of initiating targeted treatment to the at-risk burn population before sepsis is detected clinically. This could better the outcomes in treatment of burn patients.
55	EFFECTS OF OXANDROLONE ON LEAN BODY MASS (LBM) IN SEVERE BURN PATIENTS: A RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED TRIAL (Gusti N.R.L., Saputro I.D., Rizaliyana S., Putra O.N. - Indonesia) In severe burns, hyper-metabolic conditions due to elevation of pro-inflammatory cytokines and stress hormones usually occur. Unregulated hypermetabolism can lead to muscle protein catabolism, inducing weakness, infection, and delayed wound healing. Oxandrolone is known as an anabolic agent with minor side effects. Thisstudy aimsto determine the effect of oxandrolone on lean body mass(LBM) in severe burn patients. A randomized, double blind and placebo controlled trial was conducted in the burn centre of the Dr. Soetomo Hospital. Severe burn patients who met the inclusion criteria were randomized into two groups, oxandrolone and placebo group. Oxandrolone was given with a dose 0.1 mg/kg twice a day for 14 consecutive days. Estimated lean body mass (eLBM) for each group was measured on admission (day 0) and day 14. Fourteen burn patients were enrolled in thisstudy. Lean body massreduced significantly from 48.69±7.71 to 46.70±7.96 in the placebo group (p-value 0.008) by independent t-test. There was no significant decrease of LBM in the oxandrolone group. Delta LBM (? eLBM) before and after treatment was 0.38±1.64 in the oxandrolone group, and -1.32±1.23 in the placebo group (p-value = 0.049). There were no adverse effects during the administration to the oxandrolone group. In severe burn patients, oxandrolone could prevent reduction of LBM compared to placebo and is relatively safe. These findings suggest the efficacy of oxandrolone in preventing muscle catabolism as a part of hypermetabolism in burn patients.
62	TRAITEMENT CHIRURGICAL DES BRIDES CERVICALES POST BRÛLURE: À PROPOS DE 47 CAS (Mahrouch M., Atiqui O.E., Yafi I., Benlaassel O.A., Zinedine S., Geouatri M., Sahibi M., Amrani M.D., Benchamkha Y. - Maroc) Lorsqu'elles sont mal prises en charge, les brûlures profondes du cou entraînent souvent des rétractions cervicales. Leur gravité est variable, allant de la simple bride verticale aux placards rétractiles majeurs. Elles ont un retentissement fonctionnel, esthétique et psychologique important. Le traitement chirurgical doit être adapté à chaque patient, en fonction du type et de l'étendue de la rétraction, et doit répondre à plusieurs objectifs : restaurer l'angle cervico-mentonnier, redonner une mobilité du cou, rétablir un aspect esthétique satisfaisant et permettre une réinsertion sociale. Au sein de notre structure, sur une période de 8 ans (2012-2020), nous avons pris en charge 47 patients souffrant de rétractions cervicales secondaires à des brûlures. La moyenne d'âge était de 22 ans. Les brûlures par ébouillantement sont les plus fréquentes chez l'enfant tandis que celles par flamme prédominaient chez l'adulte. La cicatrisation dirigée avait été le traitement initial chez la majorité de nos patients (58%). Les brides cervicales modérées et sévères (selon la classification d'Achauer) représentaient respectivement 30,6% et 38,8% des cas. Chez 94% de nos patients, la bride entraînait un retentissement fonctionnel avec une limitation de l'extension du cou associée à une déformation de l'angle cervico-mentonnier. Le traitement chirurgical a fait appel aux greffes cutanées dans 67,3% des cas, aux plasties locales dans 24,5% des cas et aux lambeaux dans 8,2% des cas. À long terme, les résultats fonctionnels et esthétiques sont jugés bons dans 83% des cas et moyens dans 8,5% des cas, tandis que 8,5% nécessitent une reprise chirurgicale. Les plasties (Z, IC, VY.) et les lambeaux locaux, avec ou sans expansion, sont indiqués devant des brides mineures. Dans le cas des brides sévères et majeures, les auteurs sont divisés quant au choix entre greffes cutanées et lambeaux. La rééducation post opératoire reste un pilier thérapeutique pour l'obtention de résultats satisfaisants.
68	REPAIR OF PALM BURNS OF THE HAND: A CONTRALATERAL INNER ARM BAG-SHAPED FLAP (Barbasse L., Serror K., Boccara D., Mimoun M., Benyamina M., Chaouat M. - France) Hands are one of the most often burnt parts of the body. Deep palmar burns are often the result of an electrical burn or a thermal burn from grasping a hot item. With a deep burn, joints, vasculo-nervous pedicles, tendons or bones can become exposed and lead to amputation. Different surgical repair methods are used depending on the area of the hand that is burnt. Most of the publications to date have described surgical techniques for dorsal hand burns. The abdominal bag-shaped flap is one of the main surgical techniques to cover dorsal deep tissue exposure. Bag-shaped flaps need time to achieve the vascular autonomy of the flap without any movement. Abdominal bagshaped flaps are particularly suitable for dorsal soft-tissue defects, while for palmar defects, it is an uncomfortable position to maintain for three weeks. A contralateral arm bag-shaped flap for palmar burns allows a comfortable position to be achieved as the upper burnt limb is positioned as if the patient has their arms crossed. Furthermore, as stated above, the contralateral arm bag-shaped flap has the advantage of allowing a flap to be used that is thinner than an abdominal bag-shaped flap.At the Saint Louis Burns Center, we recently treated two patients with deep palmar burns and deep tissue exposure. We performed a contralateral arm bag-shaped flap for both of these patients. In our experience, the use of the contralateral arm bag-shaped flap technique to cover palmar lesionsresulted in favorable postoperative progression, with complete closure of the lesions, good functional outcomes, as well as other advantages such as a hidden scar at the donor site. This technique allows amputation of fingers to be avoided when pedicles, joints, or tendons are exposed and when the burnt area of the palm is extensive and no other flaps can be used.
74	SÉQUELLES GRAVE DE BRÛLURE DES DEUX PIEDS : UN CAS PÉDIATRIQUE DE DÉFORMATION EXTRÊME DES ORTEILS (Abdellaoui H., Tazi M., Benmassoud Z., Balde F.B., Atarraf K., Afifi A. - Maroc) Les brides rétractiles post-brûlure au niveau du pied sont considérées comme graves en raison de leurs retentissement fonctionnel et esthétique potentiellement importants. Nous rapportons un cas pédiatrique âgé de 13 ans présentant des brides rétractiles au niveau des deux pieds, négligées depuis 10 ans et responsables d'une déformation très importante, avec désaxation marquée des orteils. Le patient souffrait d'une importante limitation des activités et d'une impossibilité de chaussage. La libération chirurgicale des brides par plusieurs plasties en Z associées à la réaxation des orteils luxés a permis d'obtenir un bon résultat avec un retour à une fonction quasi normale. La prévention des brides rétractiles et leur prise en charge précoce restent le meilleur moyen d'éviter des déformations grave et leurs conséquences chez un patient en croissance.
79	CRISIS MANAGEMENT AS AN IMPORTANT STARTING POINT FOR PREVENTING A PANDEMIC (Losonczi P., Mesáros M. - Slovakia) The COVID-19 disease pandemic, representing a worldwide problem, has moved the world population into a position it has not experienced since World War II. However, there is one difference: the problem has stricken not only Europe but the whole American continent, Asia and Africa. Solution to the problem can be divided into two levels, namely medical and social. At the social level, the only solution is crisis management, or simply prevention and crisis activities carried out by representatives of the governments, and the willingness of citizens to follow specific regulations. However, a combination of the estimate of risk and efficient regulations in compliance with medical care must pursue the sole aim, namely to stabilise and stop the spread of the coronavirus. One part of crisis management is represented by the proper documentation of particular procedures and the drawing of conclusions for the future. This paper is the result of conducting an institutional project at the University of Security Management in Kosice, and characterizes the position of the crisis management and rescue units in solving the pandemic in the Slovak Republic. In addition, the paper compares starting points of crisis management and measures taken by selected countries, and identifies the problem of the crisis management both at state and individual levels in Slovakia.

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