Severe burn patients have a ‘golden hour’ for optimal treatment

Patients with severe burns have a ‘golden hour’ when optimal treatment and handling can mean the difference between life and death, says an Australian burns expert.

The concept of the ‘golden hour’, explained by Professor Peter K. M. Maitz, arises from the fact that the initial pathophysiological response of the body is “quite strong and in that hour, the resuscitation, stabilization and assessment of burns patients is quite special.”

Maitz told Medical Tribune that many burns patients are not treated optimally immediately and that by the time they reach hospital “it is difficult to correct things that had been missed.” Maitz is chair of Burn Injury and Reconstructive Surgery, and director of the Burns Unit at Concord Hospital in Sydney, Australia.

In Australia, the WHO puts the annual injury rate due to burns at 2 percent, or 400,000 patients. “Fortunately, the vast majority are minor burns.” In Malaysia, some 40,000 patients are treated at hospitals for burns annually. Of these, 10 percent (4,000) have severe burns.

Causes of burns are the same everywhere, noted Maitz. Adults often present with flammable liquid burns because “people burn rubbish and build barbeque fires.” Children, on the other hand, are prone to scalds due to their inquisitive nature.

He noted that practices common to different areas also lead to subsets of burns unique to such areas. For example, electrical burns are more common in places such as South Africa and Bangladesh, where the quality of electrical installation is poor and electricity theft rampant. “Statistically, up to 40 percent of burns in adult males in Bangladesh are electrical burns.” In contrast, only 3 percent of burns in Australia are electrical in nature.

Burns course now available here

Maitz was here with members of the Australian and New Zealand Burns Association (ANZBA) Limited to conduct the Emergency Management of Severe Burns (EMSB) course at Universiti Kebangsaan Malaysia Medical Centre recently (UKMMC).

The course is based on a ‘train the trainer’ system, whereby the best attendees are given extra training so that they can conduct the course themselves.

Maitz said one of the many aims of the course is the formation of a self-sufficient Malaysian burns faculty within 3 to 5 years and, thereafter, to spread to the rest of the country. EMSB is copyrighted and ANZBA maintains the rights to the course. However, Maitz said only a nominal amount is charged for the license fee. The charge and copyright are merely to guarantee that the course is not changed.

UKMMC and ANZBA have signed a 3-year agreement to run the course in Malaysia. Maitz said the course content is not rigid and can be adjusted to meet local needs. However, any adjustment requires prior discussion with, and approval from, ANZBA.

The ‘train the trainer’ concept also allows the EMSB course to be sustainable, inexpensive and easily transmitted to the rest of the country.

He thanked the sponsors - Petronas and the Australian Malaysian Institute - for their willingness to contribute to the success of the program, and said that he hoped they will continue their support in the future.

Source: Medical Tribune