David G. Greenhalgh, M.D., chief of burns at the Northern California Shriners Hospital and the UC Davis Medical Center, is an international leader in burn care, research and prevention. Here he addresses the importance of burn prevention awareness and education.
Each year the first week of February is designated as national Burn Awareness Week. This a special time when we need to focus on burn prevention. Burns are the one specialty where we do our best to put ourselves out of business. As matter of fact, all of the staff at Shriners Hospital are dedicated to preventing burns. No matter how good our treatment is, nothing is better than prevention when it comes to burns.
Risk of Scarring
Any burn that does not heal within two weeks is at significant risk for hypertrophic scarring. Once a scar is present it will never disappear. We do our best to make the scar look as good as possible but no “plastic” surgery will make it go away.
At Shriners Hospital and at the UC Davis Burn Center we make many efforts to prevent burns. We have published several papers that point out the risks of many different types of burns. Many prevention efforts are tied to education efforts – scald burns from hot soups; burns from children walking through campfires; hand burns from contacting irons, fireplaces, stoves; burns from car seat heaters, laptop computers, electronic cigarettes. In addition, we host education programs with schools to teach “stop, drop, and roll” when clothes catch fire and how to prepare the family for escaping house fires. In addition, we have educational programs for juvenile fire setters to teach children that matches are “tools” that should not be considered a toy.
Building Codes Save Lives
It turns out that education is not the most effective prevention strategy. When we asked parents of children who suffered accidental but preventable scalds, many parents admitted that they knew about the risks but took shortcuts or simply forgot about the risks. The most effective prevention efforts are those that people never think about because they are based on codes and laws.
Garage Water Heaters: Many prevention laws are based on past incidents, but the legislation is so effective that those fires now rarely occur. The classic example is the garage water heater that, by law, is raised 18 inches above the ground. The reason it is raised is that if gasoline spills on the garage floor and the water heater is set on the ground, the pilot light will ignite the vapors. If it is elevated, the vapors do not reach the flame and fires are never started.
Exit Doors: Another example stemmed from the Cocoanut Grove Nightclub disaster when dozens of people died because they were trapped as they attempted to leave — but since the doors opened inwards, and because there was a revolving door, they got trapped inside. This is why all revolving doors must have other doors next them and they all have to open outwards.
Other Prevention Efforts
The burn team, along with our firefighter colleagues have lobbied to support prevention laws at both the state and national levels. Last year we lobbied at the state level to restrict the sale of de-odorized butane to reduce the many explosions and burns that resulted from the manufacture of butane hash oil. That law passed the senate and house but was vetoed by our governor. We will continue that effort. At the national level firefighters and burn staff have lobbied to push for residential sprinklers and laws requiring gasoline tank flame restrictors.