Better Care for Burn Victims

Of all bodily injuries, few are more traumatic than burns. By searing through flesh and muscle, destroying nerves and blood vessels, and setting up a fertile breeding ground for infection, burns can cripple, disfigure and kill. Last year alone, approximately 7,500 Americans, 1,800 of them under age 15, died of burns. Although this toll is fearsome, the number of burn deaths has remained relatively constant while the population has increased, and the recovery rate from serious burns has improved significantly. The reason: better care for burn victims.

Since 1947, twelve U.S. hospitals have opened well-equipped burn centers to carry on research and teaching programs and provide victims with the specialized treatment their injuries require. Another twenty hospitals have established smaller "burn units" in which only burn victims will be handled, while at least 46 others have instituted specific courses of treatment for burn patients. All of the institutions are making use of several recent advances in burn-treatment techniques:

>Topical creams or burn dressings containing silver sulfadiazine and sulfa derivatives are being used in addition to the traditional method of sterilization--bathing burns with 0.5% silver nitrate solution. The new dressings cut the rate of infection by pseudomonas bacteria--once the primary cause of burn deaths--in half. In addition, Dr. Irving Feller of the University of Michigan burn center in Ann Arbor has developed a treatment that combines infusions of blood plasma from immunized donors with shots of anti-pseudomonas vaccine. The treatment, which has been in use since 1965, has cut the infection death rate from 32% to 9%.

>Better wound coverings have also improved burn victims' prospects by preventing excessive loss of essential fluids, which lowers resistance. Doctors, who routinely take skin from animals and cadavers to cover serious burns, are now using the victim's own skin. Physicians at the Brooke Army Medical Center in San Antonio use skin patches taken from unburned areas of the patient's body. Stretched so that they cover as much as nine times their original area, the dressings help prevent the formation of scar tissue and hasten the growth of new skin.

> Some of the worst aftereffects of burns--scars and crippling skin contracture--have been minimized or eliminated by techniques now in use at the Burns Institute of the Shriners Hospital for Crippled Children in Galveston, Texas. There, doctors have found that prompt application of lightweight plastic casts keeps burned flesh from contracting as it heals; pressure bandages kept in place 24 hours a day control the buildup of scar tissue and prevent the formation of disfiguring welts. As a result, burn patients who might once have had to undergo a long series of corrective and cosmetic operations can now avoid surgery in three out of four cases.

Despite such advances, doctors continue to stress that prompt first aid--before the victim reaches the hospital--can reduce both the scope and the seriousness of many burns. The best treatment, they agree, is to cool the burn immediately. Prompt immersion in cold water, says Dr. John Moncrief of the University of South Carolina, has the same effect on a burn as on a lighted match: it "puts out the fire." Equally important, the burn is prevented from spreading, thus minimizing both the damage and the discomfort, maximizing the prospects for recovery.

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