Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels

Abstract

Objective Humanitarian organisations care for burns during crisis and while supporting healthcare facilities in low- and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organisations are useful for describing surgical need otherwise unmet by national health systems. Methods Procedures performed in operating theatres run by MSF Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response and described. Results A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 – 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared to people requiring surgery in communities affected by natural disaster (aOR 1.94, 95%CI 1.46 – 2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill-set was required. Conclusion Unmet humanitarian assistance needs increased US$ 400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.

Blast injuries in children: a mixed-methods narrative review

“…Operative demands of paediatric burn victims are significant. Children aged 6 months to 3 years were between 4 and 14 times more likely than adults to require surgical input, reflecting the significant burden of burns (39% of this cohort compared with 2%–6% in adults73). While other conditions may be treated by a single operation, burns often require serial procedures,73 with an average of two operations per patient.…”

“…Children aged 6 months to 3 years were between 4 and 14 times more likely than adults to require surgical input, reflecting the significant burden of burns (39% of this cohort compared with 2%–6% in adults73). While other conditions may be treated by a single operation, burns often require serial procedures,73 with an average of two operations per patient. This creates a disproportionate operative volume in both adults and paediatric patients compared with other surgical emergencies 73…”

“…Cerebral haemorrhage and direct cranial damage following blast have been attributed as a leading cause of death in children, responsible for 46%–71% of fatalities 23 45 65 67 72. Creamer65 noted penetrating wounds to the head accounted for 44% of child deaths in the emergency department (ED), while open skull fractures with cerebral evisceration was documented in 88% of paediatric fatalities following the 1995 Oklahoma City bombings 73. While penetrating head injuries undoubtedly carry high mortality, Woods et al 74 noted that eight children survived to hospital discharge despite penetrating head injuries deemed initially unsurvivable, suggesting such are not unequivocally fatal.…”

“…While other conditions may be treated by a single operation, burns often require serial procedures,73 with an average of two operations per patient. This creates a disproportionate operative volume in both adults and paediatric patients compared with other surgical emergencies 7391…”

Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey

“…[16] Most wartime burns result from explosive devices, resulting breakdown of infrastructure and poor fire prevention practices. [2, 3, 17] In 2009, burns were responsible for 9% of all injuries in Baghdad;[2] death from explosions and electrocutions were common.…”