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TRANSCRIPT
a WHO plan
fOr
BurnpreventiOn
andCare
Geneva, Switzerland 2008
WHO Library Cataloguing-in-Publication Data
A WHO plan for burn prevention and care. 1.Burns - prevention and control. 2.Wounds and injuries. 3.Fire prevention and protection. 4.Health programs and plans. 5.Developing countries. I.World Health Organization.
ISBN 978 92 4 159629 9 (NLM classification: WO 704)
© World Health Organization 2008All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncom-mercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]).
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organi-zation concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps repre-sent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
Printed by the WHO Document Production Services, Geneva, Switzerland.
This document was prepared following a Consultation Meeting on the Prevention and Care of Burns, which was held on 3–4 April, 2007 at WHO headquarters in Geneva, Switzerland. This meeting was a collaborative effort of WHO and the International Society for Burn Injuries (ISBI), in association with a number of other partners. Among those present and contributing were:
Rajeev Ahuja (Lok Nayak Hospital, India), Hendrina Jacomina Albertyn (Red Cross Children’s Hospital, South Africa), Kidist Kebede Bartolomeos (WHO/VIP, Switzerland), Welsly Bodha (Euro Skin Bank, the Netherlands), Gudula Brandmayr (Safekids Worldwide, Austria), Pascal Cassan (French Red Cross, France), Meena Nathan Cherian (WHO/EHT, Switzerland), Wilma de Benavides (Institute of Plastic Surgery and Burns, Bolivia), Mohamoud El-Oteify (Assiut Burn Centre, Egypt), Wijaya Godakumbura (Safe Bottle Lamp Foundation, Sri Lanka), S. William A. Gunn (Interna-tional Association for Humanitarian Medicine, Switzerland), Chapal Khasnabis (WHO/VIP, Switzerland), Etienne Krug (WHO/VIP, Switzerland), Jacques Latarjet (Centre Hospitalier St Joseph et St Luc, France), Grace Lo (IFRC, Switzer-land), David Mackie (Red Cross Hospital, the Netherlands), Colin Mathers (WHO/MHI, Switzerland), Andrew McGuire (San Francisco General Hospital, USA), David Richard Meddings (WHO/VIP, Switzerland), Charles Mock (WHO/VIP, Switzerland), Nhu Lam Nguyen (National Institute of Burns, Viet Nam), Alana Officer (WHO/VIP, Switzerland), James Partridge (Changing Faces, England), Michael Peck (Arizona Burn Center, USA), Tom Potokar (Welsh Centre for Burns and Plastic Surgery, Wales), Eva Rehfuess (WHO/PHE, Switzerland), Ronald Siarnicki (Phoenix Society, USA), Colin Song (Singapore General Hospital, Singapore).
The document was finalized by:Charles Mock Department of Violence and Injury Prevention and Disability, WHO, Geneva, SwitzerlandMichael Peck Director of International Outreach, Arizona Burn Center, Maricopa Medical Center, Phoenix, AZ, USAMargie Peden Coordinator, Unintentional Injuries Prevention, Department of Violence and Injury Prevention and Disability, WHO, Geneva, Switzerland Etienne Krug Director, Department of Violence and Injury Prevention and Disability, WHO, Geneva, SwitzerlandRajeev Ahuja Head, Department of Burns & Plastic Surgery, Lok Nayak Hospital, New Delhi, IndiaHendrina Albertyn Red Cross Children’s Hospital, Cape Town, South AfricaWelsly Bodha Director, Euro Skin Bank, Beverwijk, the NetherlandsPascal Cassan National Medical Advisor, French Red Cross, Paris, FranceWijaya Godakumbura President, Safe Bottle Lamp Foundation, Rajagiriya, Sri LankaGrace Lo Senior Health Officer, International Federation of Red Cross and Red Crescent Societies, Geneva, SwitzerlandJames Partridge Chief Executive, Changing Faces, London, EnglandTom Potokar Welsh Centre for Burns and Plastic Surgery, Swansea, Wales
The World Health Organization thanks Ann Morgan for editorial assistance, Claire Scheurer for administrative sup-port, and Lynn Hegi for design of the cover and layout.
The World Health Organization wishes to thank the American Burn Association, Baskent University, the European Burns Association, the International Association of Firefighters, the International Society for Burn Injuries, the Japa-nese Society for Burn Injuries, and the Turkish Burn and Fire Disaster Society for their financial contributions which made the publication of this document possible.
Suggested citation:Mock C, Peck M, Peden M, Krug E, eds. A WHO plan for burn prevention and care. Geneva, World Health Organiza-tion, 2008.
This document is available on the following web site: http://www.who.int/violence_injury_prevention.
aCknOWledgements
fOreWOrd
Dr Etienne KrugDirector
Department of Violence and Injury Prevention and Disability, WHO
Burns constitute a major public health problem, especially in low- and middle-income countries where over 95% of all burn deaths occur. Fire-related burns alone account for over 300 000 deaths per year, with more deaths from scalds, electricity, chemical burns and other forms of burns. However, deaths are only part of the problem; for every person who dies as a result of their burns, many more are left with lifelong dis-abilities and disfigurements. For some this means living with the stigma and rejection that all too often comes with disability and disfigurement.
In high-income countries, much has been achieved in terms of reducing the burden of injury from burns. Implementation of proven interventions, such as smoke detectors, regulation of hot water heater temperature and flame retardant children’s sleepwear, has meant that mortality rates from burns have steadily declined over the past 30–40 years. However, such strategies have yet to be widely applied in low- and middle-income countries, and consequently mortality rates remain relatively high, especially among the poorer members of society. Likewise, the benefits of advances in burn treatment and care (which have led to higher survival rates and improved functional recovery of burn victims in most high-income countries) have yet to make much of an impact in most low- and middle-income countries.
The World Health Organization (WHO) has been working collaboratively with the International Society for Burn Injuries (ISBI) and other partners to develop strategies to improve the prevention of burn injuries worldwide, but especially in low- and middle-income countries. The goal is to promote the development of the spectrum of burn control measures, to include improvements in burn prevention and strengthened burn care, as well as better information and surveillance systems, and more investment in research and training. We hope that the broad-based strategic plan presented in this document will catalyse burn prevention and care efforts globally and will assist the many people and agencies worldwide who are currently working to prevent burns and improve the care of burn victims in their communities.
AcknowledgementsForeword
part I. BaCkgrOund
1. Introduction...............................................1
2. Burns : prevalence and risk factors..............2
3. Preventability..............................................3
4. The challenges in addressing burns............4
5. Confronting the challenges........................6
5.1 WHO’s role
5.2 The role of other agencies
part II. tHe WHO plan 1. Advocacy.................................................12
2. Policy.......................................................14
3. Data and measurement...........................15
4. Research..................................................16
5. Prevention...............................................17
6. Health-care services for burn victims.........18
7. Capacity building.....................................20
8. Conclusion...............................................22
References....................................................23
taBle Of COntents
Mortality rates due to burn injuries vary by as much as a factor of 10 across the different regions of the world. Not surprisingly, rates are lowest in high-income countries where, as a result of a range of interventions such as promotion of the use of smoke detectors, the lowering of temperatures of hot water heaters, the installation of sprinkler systems, and the promotion of flame-retardant children’s sleepwear, as well as the development of safer buildings and household fuels and appliances, the number of deaths due to burns, both fire-related burns and other forms of burn injury, has been drastically reduced over recent decades. Progress in this area has been assisted by improved data gathering systems, new and more stringent legislation, social marketing and advocacy. Advances in the treatment and care of burn patients have also contributed to a lowering of burn mortality rates in many high-income countries. In addition, developments in burn care have improved functional outcomes for a great number of burn victims, which coupled with increased emotional and practical support from burn survivor groups, have meant that many burn survivors manage to lead full, meaningful lives despite their injuries.
This is in stark contrast to the situation in the majority of low-and middle income countries. Here, many of the improvements in burn prevention and care which have benefited those living in high-income countries have yet to be widely adopted, and thus mortality rates due to burns remain unacceptably high. In order lower the burden of suffering from burns worldwide, the World Health Organization (WHO) has joined with the International Society for Burn Injuries (ISBI) and several other partner agencies to develop and promul-gate burn prevention, care and recovery programmes. As a first step, in April 2007, WHO convened its First Consultation Meeting on the Prevention and Care of Burns. The principal objectives of this meeting were to identify WHO’s role in addressing the public health problem associated with burns, to develop an outline global strategy for prevention and treatment of burns, and to advise WHO on how best to develop its programme on burns.
The present document is a direct result of the consultation meeting, and as such represents the culmination of a concerted effort by burn experts worldwide to formulate an evidence-based global strategy for burn prevention and care. It begins by summarizing the nature of the public health problem related to burn injury worldwide, articulating the disease burden, risk factors, knowledge gaps, and the main challenges that lie ahead. Part I also outlines WHO’s unique combination of skills and expertise that make it well placed to take a lead role in the development of burn prevention and care. The main body of the docu-ment, Part II, is devoted to setting out the strategic plan for burn prevention and care that has emerged from this consultation process. The approach adopted has much in common with WHO’s other injury prevention activities, for example, in the field of road traffic injury prevention and in relation to the impacts of intentional injury (violence) on health. Publica-tion of world reports on these issues (1, 2) has increased awareness of the nature and scale of the impact of injuries on public health worldwide. Likewise, the publication of WHO’s Guidelines for essential trauma care (3) and Pre-hospital trauma care systems (4) has done much to raise awareness of the need for affordable, sustainable improvements in trauma care globally (see also section 5.1).
1. intrOduCtiOn
BaCkgrOundpart I
BURNPLAN2 World Health Organization
It is estimated that each year over 300 000 people die from fire-related burn injuries. There are more deaths from scalds, electricity, chemical burns and other forms of burns. Millions more suffer from burn-related disabilities and disfigurements, many of which are permanent but all of which have a cascade of secondary personal and economic effects on both the victim and their families.
The burden of burn injury is one that falls predominantly on the world’s poor. The vast majority (over 95%) of fire-related burns occur in low- and middle-income countries. Within this group of countries, not only are burn deaths and injuries more common in people of lower socioeconomic status but, among those who suffer severe burns, it is the most economically vulnerable that are the more likely to be thrown into further poverty as a consequence.
Fire-related mortality rates are especially high in South-East Asia (11.6 deaths per 100 000 population per year), the Eastern Mediterranean (6.4 deaths per 100 000 population per year) and Africa (6.1 deaths per 100 000 population per year). These compare with much lower rates of, on average, just 1.0 deaths per 100 000 popula-tion per year in high-income countries (see Table on page 3). This is one of the largest discrepancies for any injury mechanism.
Differences in burn mortality rates vary across different age groups and between the sexes. For instance, fire-related burns are the sixth leading cause of death among 5–14 year olds and the eighth leading cause death among 15–29 year olds from low and middle-income countries. In terms of the sex differences, women are usually at higher risk of burns than men, especially in the younger age groups: death from fires is the sixth leading cause of death among females aged 15–29 years. The highest rates of fire-related deaths are recorded in females from South-East Asia, where rates are estimated to be as high as 16.9 deaths per 100 000 population per year. Burns are one of the few injury mechanisms that have a higher death toll among women than men.
As previously mentioned, burns are also a leading cause of disability and disfigure-ment. It is estimated that fire-related burns account for 10 million Disability Adjusted Life Years (DALYs) lost globally each year (5). This figure includes people with burn wound contractures and other physical impairments which limit their functional abili-ties and thus their chance of leading normal, economically productive lives. How-ever, it excludes the impacts of disfigurements, which often result in social stigma and restriction in participation in society but which are more difficult to quantify.
Risk factors for burn injury differ according to region, but typically include alcohol and smoking, use of open fires for space heating, use of ground level stoves for cooking, the wearing of long, loose-fitting clothing while cooking, high set tem-perature in hot water heaters, and sub-standard electrical wiring. Many of these risk factors are eminently amenable to prevention efforts.
2. Burns : prevalenCe and risk faCtOrs
BURNPLAN 3World Health Organization
In high-income countries, much has been done to lower the burden of burn injury. Among the list of burn prevention strategies that have been developed and imple-mented are smoke detectors, regulation of hot water heater temperatures, flame resistant children’s sleepwear, and housing codes that assure safety of electrical wiring. The effectiveness of such interventions varies, but in many cases, notable successes have been recorded. For example, use of smoke detectors has been associated with a 61% reduction in the risk of death from residential house fires in the United States of America (6). Multifaceted community burn prevention strategies have decreased burn-related hospital admissions among Norwegian children by 52% (7). Moreover, burn prevention strategies have been found to be very cost-effective. A study conducted in the United States, for instance, demonstrated that every US$ spent on smoke detectors saves US$ 28 of health-related expenditure (8). These advances have been assisted by development of related surveillance systems, legislation, social marketing and advocacy.
Parallel developments in burn care have also contributed to the lowering of burn-related mortality and morbidity in high-income countries. Recent advances in burn care have included improved capabilities for the resuscitation of burn victims, better care of burn wounds (through techniques such as skin grafting), improved infection control and more effective rehabilitation programmes. Burn survivor groups have also played an important role, not only by providing much needed peer support but also through their campaigning and advocacy efforts, in particular, in relation to burn prevention and treatment. In addition, they have been instrumental in gaining legal protection for burn survivors from discrimination in the workplace and society.
EstImatEd numbEr of dEaths and mortalIty ratEsduE to fIrE-rElatEd burnsby Who rEgIon* and IncomE group, 2002
REGION Africa The AmericasSouth-East
AsiaEurope
Eastern Mediterranean
Western Pacific
WORLD
Income group
low/middle
high low/middle
low/middle
high low/middle
high low/middle
high low/middle
Number of burn deaths(thousands)
43 4 4 184 3 21 0.1 32 2 18 312
Death rate (per 100 000 population)
6.1 1.2 0.8 11.6 0.7 4.5 0.9 6.4 1.2 1.2 5.0
Proportion global mortality due to fires (%)
13.8 1.3 1.3 59.0 1.0 6.7 0.02 10.3 0.6 5.8 100
*Countries within each geographical region have been further subdivided by income level, according to the divisions developed by the World Bank.
Source: WHO Global Burden of Disease Database, 2002 (version 5).
3. preventaBility
BURNPLAN4 World Health Organization
It is evident, from the experience of the high-income countries, that it is possible to reduce burn mortality and morbidity through a combination of measures aimed not only at reducing the likelihood of a fire but also the severity and impact of a burn in-jury. While such strategies have been successful throughout much of the developed world, in the low- and middle-income countries, burn-related death rates remain un-acceptably high. Overcoming the barriers to the development and implementation of burn prevention, care and recovery programmes across the world, which would correct this inequality and lower the rates of death, disability and disfigurement from burns globally, will be a major challenge for WHO and its partner organizations.
The main barriers to the wider adoption of burn prevention have been identified as being in the following areas:
advocacy : There is limited awareness of the magnitude and cost of the burn problem among policy-makers and donors. An awareness that the current high rates of burn death, disability and disfigurement could be brought down by affordable and sustainable improvements in prevention and care is also lacking.
policy development : Many of the strategies that have helped to lower the burden of burns in high-income countries have been implemented through policy changes. However, many low- and middle-income countries have not yet developed burns policies, nor have they put into place action plans, legislation or regulations to address the problem of burns. Even when burn policies exist, enforcement is often inadequate.
data and measurement : It is generally acknowledged that accurate problem description is the key to planning effective interventions, yet in many less well resourced countries, data on burns are scarce and/or inaccurate. In some countries, a lack of reliable data on risk factors further hampers the development and enactment of effective burn prevention strategies, while in others, incomplete reporting of burn events leads to underassessment of the scale of the public health problem.
research : The reductions in burn mortality that have been seen in high-income countries have been achieved as a result of the application of scientifically-based programmes for prevention and care. The development and implementation of such interventions owes much to the quality and breadth of the research that underpins them. Needless to say, the research and the tools that have brought about such successes relate specifically to the situation and circumstances of high-income countries. Low- and middle-income countries, however, require interventions that are appropriate to their particular circumstances (see Prevention below). This means that interventions may need to be specifically developed, or at the very least, adapted to suit low-resource settings, a process which requires considerable research effort. Thus, in many countries, burn control is hampered not just by the lack of basic data, but also by lack of research infrastructure and capability to support the neces-sary intervention trials, economic analyses, programme effectiveness studies, social science research and health utilization analyses.
4. tHe CHallenges in addressing Burns
BURNPLAN 5World Health Organization
prevention : Some of the strategies developed in high-income countries would successfully address the risk factors present for burns in some low- and middle-income country settings, particularly urban environments of middle-income countries. These include strategies such as smoke detectors, regulation of hot water heater temperature, and enacting and enforcing housing codes to make electrical wiring safer. However, in low-income countries, especially in rural areas and among the urban poor, the epidemiologic pattern of, and risk factors for, burns differ markedly from those that characterize the high-income countries and thus very different strategies are going to be required. In this regard, some of the factors that are of prime concern include (9–11):
the use of cooking pots on ground level (pots on ground level are more readily •knocked over, and can increase the risk of scald burns, for example, among tod-dlers and young children);
the use of open wood fires; •
the use of kerosene (paraffin) stoves and lamps (these can be easily knocked over •and then ignite);
the wearing of loose fitting cotton clothing which can ignite while cooking on an •open fire (a risk factor for women in Asia).
It is clear – given that approximately two billion people worldwide cook on open fires or very basic traditional stoves – that in order to reduce the number of fire-related burn deaths worldwide, evidence-based strategies to address these particular risks are going to be needed. At the time of writing, the peer-reviewed medical literature contained no reports from low-income countries documenting the successful implementation of burn prevention strategies, i.e. of interventions that have resulted in a decrease in burn rates. However, there have been some promising pilot projects addressing some of the above risk factors, such as efforts to promote safer paraffin stoves in South Africa and safer, more stable paraffin lamps in Sri Lanka.
services : The type of burn care that is routinely available in high-income countries is currently beyond the reach of the vast majority of the world’s poor. Inequity in service coverage means that someone with a moderate level per cent body burn would most likely die in a low- and middle-income country, but would be saved in a high-income country. Similarly, in low- and middle-income countries, those who suffer even a fairly small per cent body surface area burn injury to the extremities will often develop sig-nificant disabilities from burn wound contractures; in high-income countries this could be prevented with simple physical therapy (physiotherapy) and rehabilitation methods, and in some cases, reversed by reconstructive surgery (12). It is to the detriment to the health of many that rehabilitation capabilities, whether for burns or other disabling inju-ries, are among the least developed capabilities in the spectrum of trauma care in many low- and middle-income countries (13). Inequities are also evident in the availability of support networks: whereas burn victims support groups play an active role in providing peer support and assisting in the recovery of burn victims in high-income countries, such groups are almost entirely absent in low- and middle-income countries.
4. tHe CHallenges in addressing Burns
BURNPLAN6 World Health Organization
capacity : Burn prevention activities demand a workforce with a wide range of skills and expertise: epidemiologists are needed to analyse data on burns and their risk factors; clinicians are needed to understand the broader trauma system issues as they relate to strengthening burn care; and public health practitioners, psychologists and media experts among others are required to design, implement and evaluate successful and sustainable burn prevention programmes. All of these professionals, along with representatives of nongovernmental organizations (NGOs), civil society and members of the public, need to acquire skills in advocacy in order to help raise the profile of burns and ensure its place on the agenda of governments, international agencies and donors. Critically, many low- and middle-income countries lack adequate numbers of skilled personnel who can undertake the work that needs to be done to move forward in burn prevention.
In recent years, WHO has been actively involved in promoting burn prevention and care worldwide through a range of special projects and activities. These include the development of a Burn Kit and various training materials (e.g. the TEACH-VIP training modules cover burn prevention), plus a number of subject-specific publications (e.g. the Burn Fact Sheet). Several of WHO’s guidance documents include details on burns, among them the Injury surveillance guidelines (14) and Guidelines for essen-tial trauma care (3). Moreover, the forthcoming World report on child and adolescent injury and violence prevention will contain a separate chapter on burns. Although much of WHO’s burn work is coordinated by the Department of Violence and Injury Prevention and Disability, other WHO departments have played active roles in promoting burn prevention. The Public Health and Environment Department, for example, has been engaged in projects to evaluate and promote safe improved stoves, while the Essential Health Technologies Department has been instrumental in the development of burn care training materials, such as those included in Surgical care at the district hospital (15) and the Integrated management of emergency and essential surgical care (IMEESC) tool kit (16).
In 2007, WHO called upon leading burn experts from around the world to guide the further development of its burn prevention programme and to address the above-noted challenges. The First Consultation Meeting on Burn Prevention and Care allowed WHO to draw on the knowledge of many dedicated individuals, and also collective expertise of international organizations such as the ISBI, in developing its 10-year plan for burn prevention and care.
The proposed Burn Plan relies on WHO’s normative, facilitative and coordinating role in public health (see below). The plan also addresses WHO’s own organizational priorities. WHO Director-General, Dr Margaret Chan, has stated that she wants to use WHO’s impact on improving health among two of the world’s most vulnerable
5. COnfrOnting tHe CHallenges
BURNPLAN 7World Health Organization
groups, women and people living in Africa, as an indicator of the organization’s suc-cess. It should thus be noted that burns are a particular problem in these two groups: burns are the only major injury mechanism for which the death rate is higher among women than men; while the burn rates in Africa are among the highest in the world.
WHO is the United Nations specialized agency for global health. Its objective is the attainment of the highest level of health by all peoples of the world. WHO is governed by 193 Member States, representatives of which meet each year at the World Health Assembly to decide on the direction of WHO’s work. The World Health Assembly thus provides a unique platform for the discussion of major public health issues and plays a central role in the development and implementation of strategies for disease preven-tion, measurement and analysis, research, capacity development, service provision and advocacy. In all of these areas, WHO has the capacity to organize, to provide technical support and advice and, through working with its multiple partners, to increase the level of preventive effort worldwide.
Injury control and trauma care have been discussed at a number of recent World Health Assemblies with the result that several resolutions mandating WHO to work in the area of violence, trauma care, disability and rehabilitation have been adopted. WHO’s efforts in the areas of burn prevention and care will follow the public health approach and will attempt to address the knowledge gaps, inequalities and inequities that have been identified. Within WHO, work programmes will seek to make links be-tween injury prevention and other areas of endeavour, such as environmental health, health systems development and clinical care. These will require WHO to engage with a wide range of agencies and NGOs and also with broader economic and social issues, such as poverty and poverty reduction.
WHO’s Department of Violence and Injury Prevention and Disability acts as a facilitat-ing authority for international science-based efforts to promote safety and prevent injuries and mitigate their consequences as major threats to public health and human development. It does this by:
raising awareness and advocating for increased human and financial resources;•
collating, analysing and disseminating global data;•
promoting and facilitating :•
the improved collection of data•
the adoption of best practice•
prevention and control at the country level•
the provision of services for victims and survivors•
teaching and training;•
fostering multidisciplinary collaboration among concerned global, regional and •national organizations.
5.1 WHO’s rOle
BURNPLAN8 World Health Organization
In the recent past, the Department of Violence and Injury Prevention and Disability has had substantial success in using documents such as this as a means of collecting and synthesizing available information on a given topic. More importantly, such ef-forts serve as a starting point for a longer-term consultative process, the ultimate aim of which is improvements in the degree and quality of injury prevention and trauma care efforts at the regional and country level. The main components of the overall process are illustrated in Figure below. This model has been employed to good effect in the cases of violence, road traffic injuries, child injury prevention, and emergency and trauma care provision (1–4, 17). It will also form the basis of WHO’s work on burn prevention and care. It is a fundamental precept of the model that the work on burn prevention and care is done in partnership with countries and other agencies.
addrEssIng thE burdEn of Injury: a Who approach
1 Plan and other associated planning documents such as the world reports on traffic injury prevention and on violence.
consultativeprocess
plan 1
modelregion/country
programmes
regional/country
programmes
funding
advocacy
technical support(guidelines, best practices)
political support(World health assembly,
united nations general assembly
and others)
BURNPLAN 9World Health Organization
Given the multisectoral and multidisciplinary nature of burn prevention and care, strong partnerships and international cooperation will be required to successfully implement the proposed plan. This includes all of the groups that have been involved in the consultative process to establish the plan, as well as others. All of these can play a role in advocacy and raising the profile of burn prevention and care globally and in individual countries. Each partner organization has its own particular skills and areas of expertise which it can bring to the collaboration, as follows:
the International Society for Burn Injuries (ISBI), Interburns and other professional •groups: such groups can help to strengthen the practice of burn care within their own profession, especially in low- and middle-income country settings;
National Red Cross and Red Crescent Societies and other similar groups: aid groups •tend to focus on the most vulnerable members of society (including women and children) and also are in a good position to promote pre-hospital care, first-aid training and injury prevention;
firefighters: firefighters have much practical experience in on-the-ground preven-•tion work within their jurisdiction;
international NGOs, such as Safe Kids Worldwide: Safe Kids Worldwide targets •burns along with other childhood injuries in its advocacy work;
WHO collaborating centres, especially those focusing on burns: the research •capability of WHO collaborating centres will help to identify the risk factors for burn injury that are particular to the areas and countries they serve, and thereby add to the body of knowledge and understanding that underpins the development of effective prevention programmes;
burn survivor groups, such as the Phoenix Society and Changing Faces: survivor •groups, who by speaking on behalf those disabled and disfigured by burns, can contribute much to the process of raising awareness of the needs of burns victims;
hospitals, community groups, and local burn societies: these groups and institu-•tions are positioned to be the leaders of burn prevention and care activities in their areas;
communities: their involvement in and ownership of burn prevention and care •programmes will assure the sustainability and success of such programmes.
5.2 tHe rOle Of OtHer agenCies
BURNPLAN 11World Health Organization
This part of the present document sets out what WHO, in consultation with its partner organizations, sees as the important steps towards the goal of decreasing the rates of burn and burn-related death, disability and disfigurement globally. It is the result of an extensive process of consultation with numerous organizations and individuals concerned with burn prevention and care, including those who participated in the First Consultation Meeting on Burn Prevention and Care, which was held on 3–4 April 2007. It focuses on those key areas where WHO has a particular contribution to make in relation to burn prevention and care.
A 10-year plan (2008–2017) was developed in order to direct WHO’s efforts at a country, regional and global level, the principal objec-tives behind the framework being:
to build understanding of the nature, •extent and preventability of burns;
to achieve the strongest possible impact •by fostering and building partnerships to address burns;
to foster and build capacity to undertake •effective interventions and to evaluate their effectiveness.
Implementation of the strategic plan will require the involvement of all three admin-istrative levels of WHO (i.e. the country and regional offices as well as headquarters), partner organizations and national govern-ments. While ministries of health are central to this effort, the engagement of other government departments will also be an important part of the work. Indeed, a wide range of sectors will need to be consulted. The involvement of NGOs, networks and advocacy groups, including those concerned with research, health service delivery and evaluation, and disability and rehabilitation, is also going to be essential (see Part I, section 5.2).
Actions to prevent burns and to improve treatment options for victims do not stand alone. Consequently, this plan has been linked to broader efforts in strengthening health systems, environmental improvements, data improvement and capacity development.
The WHO Burn Plan has seven main components which correspond to the challenges in burn prevention and care (see Part I). These are listed in the adjacent box, and described in greater detail in the tables below. In each case, a plan and the expected products and outcomes are identified.
the burn plan1. ADvOcAcy
•Raisingawareness•Promotingandsupportingaction•International,multisectoralcooperation
2. POLIcy•Effectiveandsustainableburnpreventionandcarepolicies•Actionplans,legislation,regulations,enforcement
3. DATA AND MEASuREMENT•Magnitudeandburden•Riskfactors
4. RESEARch•Setagendaofpriorities•Promoteandfostertrialsofpromisinginterventions
5. PREvENTION•Stronger,moreeffectiveburnpreventionprogrammes•Morecountrieswithnationalburnstrategies
6. SERvIcES•Strengthentreatmentservicesavailable•Acutecare•Rehabilitation•Recovery
7. cAPAcITy buILDING•Sufficientknowledgeandskilltoeffectivelycarryoutallof the above components of the Burn Plan
at a glancE
tHe WHO planpart II
BURNPLAN12 World Health Organization
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to
ach
ieve
th
ese
go
als
and
th
e sp
ecifi
c p
rod
uct
s an
d o
utp
uts
th
at w
ill b
e p
rod
uce
d b
y th
ese
actio
ns.
So
met
imes
on
e ar
ea o
f wo
rk c
orr
esp
on
ds
to o
ne
ou
tpu
t. S
om
etim
es s
ever
al
area
s o
f wo
rk a
re in
terr
elat
ed a
nd
th
us
lead
to
th
e sa
me
set
of o
utp
uts
. In
su
ch c
ases
, th
e ar
eas
of w
ork
are
list
ed t
og
eth
er in
th
e sa
me
row
as
are
thei
r co
rres
po
nd
ing
ou
tpu
ts. T
he
final
co
lum
n o
f th
e ta
ble
(tim
elin
e),
ind
icat
es t
he
timet
able
for
com
ple
tion
of e
ach
of t
he
pro
du
cts
and
ou
tpu
ts.
1. a
dv
OC
aC
yg
Oa
ls
Rais
e aw
aren
ess
of t
he
imp
act
of b
urn
s an
d t
he
po
ten
tial f
or
pre
ven
tion
am
on
g p
olic
y-m
aker
s an
d d
on
or
agen
cies
. •
Pro
mo
te a
ctio
n o
n b
urn
pre
ven
tion
an
d c
are
thro
ug
h t
he
fost
erin
g o
f po
litic
al w
ill a
nd
th
e g
ener
atio
n o
f res
ou
rces
. •
Dev
elo
p a
nd
fost
er in
tern
atio
nal
, mu
ltise
cto
ral c
oo
per
atio
n o
n b
urn
pre
ven
tion
an
d c
are.
•
Red
uce
stig
ma
and
em
po
wer
peo
ple
wh
o s
uff
er f
rom
dis
figu
rem
ent
afte
r b
urn
inju
ry.
•
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
EPr
om
ote
aw
aren
ess
of b
urn
pre
ven
tion
an
d c
are
amo
ng
•
po
licy-
mak
ers
and
do
no
r ag
enci
es.
Ad
voca
te fo
r re
sou
rces
for
bu
rn p
reve
ntio
n a
nd
car
e •
amo
ng
mu
lti- a
nd
bi-l
ater
al d
on
ors
, fo
un
dat
ion
s, n
atio
nal
g
ove
rnm
ents
, lo
cal a
gen
cies
an
d t
he
priv
ate
sect
or.
Key
mes
sag
es, t
o b
e u
sed
to
rai
se a
war
enes
s an
d
•th
e p
rofil
e o
f bu
rn p
reve
ntio
n a
nd
car
e o
n t
he
wo
rld
agen
da.
Up
dat
ed fa
ct s
hee
ts, a
web
site
an
d o
ther
ad
voca
cy
•to
ols
, su
ch a
s p
ost
ers
and
do
cum
ents
, fo
r b
urn
p
reve
ntio
n a
nd
car
e.
Stat
emen
ts in
su
pp
ort
of b
urn
pre
ven
tion
an
d c
are
by
•p
olit
ical
an
d o
pin
ion
lead
ers.
Glo
bal r
evie
w o
f tre
atin
g a
nd
pre
ven
ting
bu
rns
•
Ch
apte
r o
n b
urn
s fo
r in
clu
sio
n in
WH
O’s
•W
orld
rep
ort
on
child
inju
ry p
reve
ntio
n.
Iden
tifica
tion
of a
hig
h p
rofil
e ch
amp
ion
or
spo
kesp
erso
n
•fo
r b
urn
pre
ven
tion
an
d c
are.
20
08
–20
09
20
08
–20
09
20
08
on
war
ds
20
09
on
war
ds
20
08
20
09
on
war
ds
BURNPLAN 13World Health Organization
Ad
voca
te fo
r th
e in
clu
sio
n o
f bu
rn p
reve
ntio
n a
nd
car
e •
activ
ities
by
foca
l po
ints
in m
inis
trie
s o
f hea
lth.
Incl
usi
on
of b
urn
pre
ven
tion
an
d c
are
in t
he
activ
ities
of
•m
inis
try
of h
ealth
foca
l po
ints
on
inju
ry c
on
tro
l.2
00
8 o
nw
ard
s
Ad
voca
te fo
r th
e in
clu
sio
n o
f bu
rn p
reve
ntio
n a
nd
car
e in
•
inte
rnat
ion
al fo
ra r
elat
ing
to
hea
lth in
gen
eral
an
d in
jury
co
ntr
ol i
n p
artic
ula
r.
Sess
ion
s o
n b
urn
pre
ven
tion
an
d c
are
in in
tern
atio
nal
•
fora
on
hea
lth a
nd
inju
ry.
2
00
8 o
nw
ard
s
Imp
rove
co
mm
un
icat
ion
am
on
g t
ho
se w
ork
ing
in t
he
bu
rn
•fie
ld g
lob
ally
.
Fost
er c
olla
bo
ratio
n a
mo
ng
org
aniz
atio
ns
that
are
co
nce
rned
•
with
bu
rn p
reve
ntio
n a
nd
car
e, in
clu
din
g W
HO
co
llab
ora
ting
ce
ntr
es a
nd
oth
er in
ters
ecto
ral n
etw
ork
s.
Fost
er t
he
invo
lvem
ent
of N
GO
s in
th
e p
rom
otio
n o
f bu
rn
•p
reve
ntio
n a
nd
car
e in
itiat
ives
.
A r
eso
urc
e d
irect
ory
of t
ho
se w
ork
ing
in t
he
bu
rn fi
eld
. •
An
inte
rnat
ion
al n
etw
ork
of b
urn
su
rviv
ors
an
d b
urn
•
surv
ivo
r g
rou
ps.
An
exp
and
ed n
etw
ork
of c
olla
bo
ratin
g c
entr
es•
1 ,
emp
has
izin
g lo
w- a
nd
mid
dle
-inco
me
cou
ntr
ies.
Re
gio
nal
mee
ting
s o
f th
ose
invo
lved
in b
urn
pre
ven
tion
•
and
car
e.
20
08
–20
09
20
09
on
war
ds
20
09
on
war
ds
20
09
on
war
ds
Wo
rk w
ith jo
urn
alis
ts a
nd
th
e m
edia
to
incr
ease
th
eir
inte
rest
•
in a
nd
invo
lvem
ent
with
bu
rn c
on
tro
l.
Incr
ease
d n
um
ber
of a
rtic
les
app
earin
g in
th
e m
edia
•
on
th
e b
urd
en o
f bu
rns
and
ad
voca
ting
for
po
ten
tial
solu
tion
s.
20
08
on
war
ds
NG
O, N
on
go
vern
men
tal o
rgan
izat
ion
.
1. C
olla
bo
ratin
g c
entr
es c
urr
ently
incl
ud
e C
entr
e d
es B
rulé
s, H
osp
ital S
ain
t-Lu
c, L
yon
, Fra
nce
an
d t
he
Med
iterr
anea
n C
ou
nci
l fo
r B
urn
s an
d F
ire D
isas
-te
rs (
MB
C).
Ad
diti
on
al in
stitu
tion
s, p
artic
ula
rly t
hos
e fr
om
low
- an
d m
idd
le-in
com
e co
un
trie
s, w
ill b
e en
cou
rag
ed to
bec
om
e W
HO
co
llab
ora
ting
cen
tres
o
n b
urn
s in
th
e fu
ture
.
BURNPLAN14 World Health Organization
2.
pOli
Cy
gO
al
Incr
ease
th
e en
actm
ent
and
imp
lem
enta
tion
of e
ffec
tive,
su
stai
nab
le b
urn
pre
ven
tion
an
d c
are
po
licie
s w
orld
wid
e, in
clu
din
g a
ctio
n p
lan
s, le
gisl
a-•
tion
, reg
ula
tion
s an
d e
nfo
rcem
ent.
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
EIn
corp
ora
te b
urn
pre
ven
tion
an
d c
are
into
nat
ion
al a
nd
loca
l •
hea
lth p
lan
s an
d in
jury
co
ntr
ol p
lan
s.
Sup
po
rt t
he
dev
elo
pm
ent
of a
pp
rop
riate
po
licy
and
leg
isla
tion
•
for
bu
rn p
reve
ntio
n a
nd
car
e b
y co
un
trie
s.
Polic
y st
atem
ents
an
d g
uid
elin
es o
n b
urn
pre
ven
tion
•
leg
isla
tion
, reg
ula
tion
s an
d e
nfo
rcem
ent.
Ap
pro
pria
te in
form
atio
n t
o s
up
po
rt p
olic
y •
reco
mm
end
atio
ns,
su
ch a
s es
timat
es o
f co
st-e
ffect
iven
ess
of b
urn
pre
ven
tion
an
d t
reat
men
t st
rate
gie
s.
20
08
on
war
ds
20
08
on
war
ds
Incr
ease
th
e n
um
ber
of c
ou
ntr
ies
that
hav
e an
d a
re
•im
ple
men
ting
leg
isla
tion
an
d p
olic
ies
on
bu
rn p
reve
ntio
n,
such
as
po
licie
s o
n s
mo
ke d
etec
tors
, set
tem
per
atu
res
of
ho
t w
ater
hea
ters
, flam
e re
sist
ant
child
ren
’s sl
eep
wea
r, fir
e an
d e
lect
rical
co
des
, saf
e st
ove
s an
d R
edu
ced
Ign
itio
n
Pro
pen
sity
(RIP
) cig
aret
tes,
in lo
catio
ns
wh
ere
thes
e w
ou
ld b
e ap
pro
pria
te.
Incr
ease
d n
um
ber
of c
ou
ntr
ies
that
rec
eive
an
d u
tiliz
e •
gu
idan
ce fr
om
WH
O o
n p
olic
ies,
str
ateg
ies
and
re
gu
latio
ns
on
bu
rn p
reve
ntio
n a
nd
car
e.
Incr
ease
d n
um
ber
of c
ou
ntr
ies
with
nat
ion
al h
ealth
•
insu
ran
ce p
lan
s th
at in
clu
de
bu
rn p
reve
ntio
n a
nd
car
e.
20
08
on
war
ds
20
09
on
war
ds
BURNPLAN 15World Health Organization
3.
da
ta a
nd m
ea
surem
en
tg
Oa
l
Faci
litat
e an
d e
nh
ance
th
e co
llect
ion
, an
alys
is a
nd
dis
sem
inat
ion
of d
ata
on
bu
rns
(incl
ud
ing
dat
a o
n m
ort
ality
, mo
rbid
ity, h
ealth
imp
acts
, dis
abili
ty
•an
d a
sso
ciat
ed c
osts
) at
the
cou
ntr
y, r
egio
nal
an
d g
lob
al le
vels.
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
EIm
pro
ve G
lob
al B
urd
en o
f Dis
ease
(GB
D) e
stim
ates
an
d
•n
atio
nal
dat
a o
n b
urn
dea
ths
and
dis
abili
ties.
Id
entifi
catio
n o
f exi
stin
g c
ou
ntr
y-le
vel b
urn
su
rvey
an
d
•su
rvei
llan
ce d
ata
for
use
in G
BD
est
imat
es.
20
08
on
war
ds
Pro
mo
te t
he
incl
usi
on
of b
urn
-rela
ted
qu
estio
ns
in n
atio
nal
•
Dem
og
rap
hic
an
d H
ealth
Su
rvey
s (D
HS)
an
d o
ther
su
rvey
s.
A s
et o
f key
qu
estio
ns
wh
ich
co
uld
be
incl
ud
ed in
form
s •
for
surv
eilla
nce
an
d in
qu
estio
nn
aire
s fo
r su
rvey
s su
ch a
s th
e D
HS.
20
08
–20
09
Pro
mo
te t
he
incl
usi
on
of m
ore
det
ail o
n m
ech
anis
m o
f in
jury
•
and
det
ails
of t
reat
men
t fo
r fa
tal b
urn
cas
es r
eco
rded
in
mo
rtu
ary
dat
abas
es.
A s
et o
f key
qu
estio
ns
wh
ich
co
uld
be
incl
ud
ed w
ith d
ata
•el
emen
ts g
ath
ered
for
mo
rtu
ary
dat
abas
es.
20
08
–20
09
Har
mo
niz
e d
ata
gat
her
ing
, fo
r ex
amp
le, b
y W
HO
, nat
ion
al
•h
ealth
dat
a sy
stem
s an
d o
ther
gro
up
s, o
n t
he
bu
rden
of
bu
rns.
Stre
ng
then
hea
lth in
form
atio
n s
yste
ms
for
bu
rn d
ata,
•
incl
ud
ing
sta
nd
ard
izin
g d
ata
gat
her
ed in
a v
arie
ty o
f sp
ecifi
c ci
rcu
mst
ance
s, in
clu
din
g b
urn
ad
mis
sio
ns
(e.g
. tra
um
a re
gis
trie
s) a
nd
bu
rns
trea
ted
in e
mer
gen
cy d
epar
tmen
ts (e
.g.
min
imu
m d
ata
elem
ents
).
Incr
ease
qu
ality
of b
urn
dat
a fo
r u
se in
ris
k fa
cto
r an
alys
is t
o
•p
rovi
de
firm
sci
entifi
c b
asis
for
pre
ven
tion
effo
rts.
Gre
ater
use
of e
xter
nal
-cau
se c
od
es fo
r b
urn
s in
ho
spita
l •
dat
abas
es.
Stan
dar
d c
har
t fo
r b
urn
ad
mis
sio
ns,
wh
ich
wo
uld
•
be
use
ful f
or
clin
ical
car
e, r
eco
rd-k
eep
ing
an
d d
ata
gat
her
ing
(sep
arat
e o
nes
wo
uld
nee
d t
o b
e d
evel
op
ed
for
gen
eral
ho
spita
ls a
nd
for
bu
rn c
entr
es).
Up
dat
ed s
tan
dar
ds
for
bu
rn/t
rau
ma
reg
istr
y, w
hic
h h
ad
•b
een
incl
ud
ed in
th
e o
rigin
al B
urn
Kit.
Stan
dar
diz
ed q
ues
tion
nai
re fo
r d
ata
gat
her
ing
in m
ore
•
dep
th in
co
mm
un
ity s
tud
ies
or
for
use
in h
osp
itals
in o
ne-
time
stu
die
s.
20
08
on
war
ds
20
08
–20
09
20
08
–20
09
20
08
–20
09
Incr
ease
dis
sem
inat
ion
of d
ata
on
th
e b
urd
en o
f bu
rns
and
th
e •
ben
efits
of b
urn
pre
ven
tion
an
d t
reat
men
t st
rate
gie
s.
All
of a
bo
ve p
rod
uct
s an
d o
utp
uts
plu
s th
ose
list
ed in
•
advo
cacy
sec
tion
. 2
00
8 o
nw
ard
s
DH
S, D
emo
gra
ph
ic a
nd
Hea
lth S
urv
ey; G
BD
, Glo
bal
Bu
rden
of D
isea
se.
BURNPLAN16 World Health Organization
4.
rese
arCH
gO
als
Iden
tify
key
rese
arch
nee
ds
in t
he
field
of b
urn
pre
ven
tion
an
d c
are,
set
an
ag
end
a o
f prio
ritie
s, a
nd
en
sure
th
at in
form
atio
n o
n t
hes
e p
riorit
ies
is
•av
aila
ble
to r
esea
rch
ers,
go
vern
men
ts, d
on
ors
an
d o
ther
sta
keh
old
ers.
Pro
mo
te a
nd
fost
er t
rials
of p
rom
isin
g in
terv
entio
ns
for
pre
ven
ting
bu
rns,
esp
ecia
lly in
low
- an
d m
idd
le-in
com
e co
un
trie
s.
•
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
E
Dev
elo
p a
res
earc
h a
gen
da
for
bu
rn p
reve
ntio
n a
nd
car
e, to
•
incl
ud
e a
list
of h
igh
prio
rity
rese
arch
qu
estio
ns
and
po
ten
tial
rese
arch
pro
ject
s, a
nd
wh
ich
en
com
pas
ses
epid
emio
log
ic/
etio
log
ic a
spec
ts o
f bu
rn in
jury
, pre
ven
tion
pro
gra
mm
es a
nd
th
eir
eval
uat
ion
, clin
ical
car
e, o
utc
om
es, c
ost
ing
an
d c
ost
-ef
fect
iven
ess.
A t
ask
forc
e/n
etw
ork
of b
urn
pre
ven
tion
an
d c
are
•re
sear
cher
s, e
mp
has
izin
g p
artic
ipat
ion
of t
ho
se f
rom
low
- an
d m
idd
le-in
com
e co
un
trie
s.
Pub
licat
ion
of k
ey r
esea
rch
nee
ds,
a r
esea
rch
ag
end
a,
•an
d li
sts
of h
igh
prio
rity
rese
arch
qu
estio
ns
and
po
ten
tial
rese
arch
pro
ject
s.
A w
eb s
ite o
f res
earc
h p
riorit
ies
and
nee
ds
in t
he
bu
rn
•fie
ld.
200
8–2
009
2009
on
war
ds
2009
on
war
ds
Pro
mo
te a
nd
su
pp
ort
net
wo
rk(s
) fo
r in
form
atio
n e
xch
ang
e •
and
deb
ate
on
mat
ters
rel
atin
g to
bu
rn p
reve
ntio
n a
nd
car
e.
Pro
mo
te a
nd
pro
vid
e te
chn
ical
su
pp
ort
for
rese
arch
into
•
pro
mis
ing
bu
rn p
reve
ntio
n s
trat
egie
s.
An
exp
and
ed n
etw
ork
of c
olla
bo
ratin
g c
entr
es,
•em
ph
asiz
ing
low
- an
d m
idd
le-in
com
e co
un
trie
s, s
o t
hat
th
eir
invo
lvem
ent
in fo
rmu
latin
g r
esea
rch
qu
estio
ns
and
in c
on
du
cin
g r
esea
rch
to a
nsw
er t
hes
e q
ues
tion
s is
in
crea
sed
.
A s
et o
f mo
del
co
un
trie
s fo
r p
ilotin
g a
nd
eva
luat
ing
•
go
od
pra
ctic
es in
bu
rn p
reve
ntio
n a
nd
car
e.
2009
on
war
ds
2009
on
war
ds
BURNPLAN 17World Health Organization
5.
prev
en
tiO
ng
Oa
ls
Sup
po
rt t
he
dev
elo
pm
ent
of s
tro
ng
er a
nd
mo
re e
ffec
tive
bu
rn p
reve
ntio
n p
rog
ram
mes
in a
ll co
un
trie
s.
•
Incr
ease
th
e n
um
ber
of c
ou
ntr
ies
with
nat
ion
al s
trat
egie
s an
d p
rog
ram
mes
for
pre
ven
ting
bu
rns.
•
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
EPr
om
ote
kn
ow
n in
terv
entio
ns
in c
ircu
mst
ance
s w
her
e th
ey
•ar
e lik
ely
to w
ork
(e.g
. urb
an/m
idd
le in
com
e en
viro
nm
ents
), to
incl
ud
e sm
oke
det
ecto
rs, h
ot
wat
er h
eate
r te
mp
erat
ure
, fla
me
resi
stan
t sl
eep
wea
r, fir
e an
d e
lect
rical
co
des
, Red
uce
d
Ign
itio
n P
rop
ensi
ty (R
IP) c
igar
ette
s an
d fu
el t
ank
inte
grit
y.
Bes
t p
ract
ices
bo
okl
et, w
hic
h d
emo
nst
rate
s ef
fect
ive
bu
rn
•p
reve
ntio
n p
rog
ram
mes
, an
d is
aim
ed a
t p
ote
ntia
l bu
rn
pre
ven
tion
pra
ctiti
on
ers,
su
ch a
s p
ub
lic h
ealth
an
d o
ther
p
rofe
ssio
nal
au
die
nce
s.
20
08
–20
09
Co
mp
ile a
nd
pu
blis
h p
ilot
wo
rk d
emo
nst
ratin
g lo
wer
ing
of
•b
urn
rat
es fr
om
pre
ven
tion
wo
rk in
low
-inco
me
sett
ing
s.Ed
itoria
l in
th
e jo
urn
al
•Bu
rns
solic
itin
g a
rtic
les
on
bu
rn
pre
ven
tion
tria
ls in
low
-inco
me
cou
ntr
ies.
Pub
licat
ion
of r
epo
rts
of w
ell-e
valu
ated
pilo
t p
rog
ram
mes
•
on
bu
rn p
reve
ntio
n in
low
-inco
me
cou
ntr
ies,
wh
ere
thu
s fa
r ris
k fa
cto
rs h
ave
no
t b
een
wel
l ad
dre
ssed
an
d
pee
r-rev
iew
ed p
ub
licat
ion
s o
f su
cces
sfu
l bu
rn p
reve
ntio
n
pro
gra
mm
es h
ave
bee
n la
ckin
g.
20
08
20
08
on
war
ds
Imp
rove
ab
ility
of b
urn
pre
ven
tion
gro
up
s to
en
gag
e in
•
pro
gra
mm
e ev
alu
atio
n a
nd
mo
nito
ring
. Pr
imer
on
eva
luat
ion
an
d m
on
itorin
g o
f bu
rn p
reve
ntio
n
•p
rog
ram
mes
aim
ed a
t b
urn
pre
ven
tion
gro
up
s w
ork
ing
in
low
- an
d m
idd
le-in
com
e co
un
trie
s.
20
09
on
war
ds
Pro
vid
e g
uid
ance
to
co
un
trie
s o
n b
urn
pre
ven
tion
•
pro
gra
mm
es a
nd
th
eir
eval
uat
ion
.
Pro
vid
e g
uid
ance
on
ho
w t
o in
teg
rate
bu
rn p
reve
ntio
n
•ac
tiviti
es in
to o
ther
are
as o
f hea
lth p
rom
otio
n.
Tech
nic
al s
up
po
rt t
o c
ou
ntr
ies
and
reg
ion
s to
dev
elo
p
•p
lan
s fo
r b
urn
pre
ven
tion
pro
gra
mm
es a
nd
th
eir
eval
uat
ion
.
A s
et o
f mo
del
co
un
trie
s fo
r im
ple
men
ting
an
d
•ev
alu
atin
g g
oo
d p
ract
ice
in b
urn
pre
ven
tion
.
20
08
on
war
ds
20
09
on
war
ds
BURNPLAN18 World Health Organization
6.
He
alt
H-C
are s
erv
iCes
f
Or B
urn v
iCti
ms
gO
al
Stre
ng
then
tre
atm
ent
serv
ices
for
per
son
s af
fect
ed b
y b
urn
s, in
clu
din
g a
cute
car
e, r
ehab
ilita
tion
an
d r
eco
very
, esp
ecia
lly in
low
- an
d m
idd
le-in
com
e co
un
trie
s.
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
EU
pd
ate
and
exp
and
usa
ge
of e
xist
ing
WH
O b
urn
gu
idel
ines
, •
such
as
the
clin
ical
car
e g
uid
elin
es c
on
tain
ed in
Inte
gra
ted
m
anag
emen
t of
em
erg
ency
an
d e
ssen
tial s
urg
ical
car
e (IM
EESC
) too
l kit
and
th
e re
sou
rce
gu
idel
ines
co
nta
ined
in t
he
Gu
idel
ines
for
esse
ntia
l tra
um
a ca
re.
Incr
ease
d u
se o
f exi
stin
g W
HO
bu
rn g
uid
elin
es.
•2
00
8–2
00
9
Ass
ist
the
Inte
rnat
ion
al F
eder
atio
n o
f Red
Cro
ss a
nd
•
Red
Cre
scen
t So
ciet
ies
and
oth
er s
take
ho
lder
s w
ith t
he
dev
elo
pm
ent
of t
rain
ing
mat
eria
ls o
n b
urn
pre
ven
tion
an
d
care
for
use
in fi
rst-a
id c
ou
rses
.
Sim
plifi
ed v
ersi
on
of t
he
Bu
rn F
act
Shee
t fo
r fir
st-a
id
•tr
ain
ing
, wh
ich
inco
rpo
rate
s b
oth
pre
ven
tion
an
d b
asic
fir
st-a
id m
essa
ges
.
20
08
on
war
ds
Stre
ng
then
bu
rn c
are
qu
ality
imp
rove
men
t p
rog
ram
mes
. •
New
WH
O t
rau
ma
qu
ality
imp
rove
men
t g
uid
elin
es,
•w
hic
h in
clu
de
bu
rn c
om
po
nen
ts.
20
08
–20
09
Incr
ease
sta
nd
ard
izat
ion
for
reso
urc
es a
t b
urn
cen
tres
. •
Stan
dar
ds
for
staf
fing
an
d e
qu
ipp
ing
bu
rn c
entr
es,
•in
clu
din
g s
tan
dar
ds
for
nu
mb
er o
f mo
re h
igh
ly-tr
ain
ed
bu
rn p
erso
nn
el (e
.g. b
urn
nu
rses
, bu
rn s
urg
eon
s), a
s w
ell a
s as
sess
men
t o
f nee
d a
nd
co
st-e
ffect
iven
ess
of s
uch
m
ore
hig
hly
-trai
ned
sta
ff.
20
08
on
war
ds
Incr
ease
acc
ess
of b
urn
vic
tims
with
dis
figu
rem
ent
to s
ervi
ces
•an
d c
om
pen
satio
n w
hic
h c
ou
ntr
ies
pro
vid
e to
dis
able
d
per
son
s b
ut
wh
ich
are
cu
rren
tly n
ot
avai
lab
le t
o d
isfig
ure
d
per
son
s.
No
rmat
ive
stan
dar
ds
defi
nin
g w
hat
leve
ls o
f •
dis
figu
rem
ent
corr
esp
on
d t
o w
hat
leve
l of d
isab
ility
. 2
00
9 o
nw
ard
s
BURNPLAN 19World Health Organization
Pro
mo
te im
pro
ved
acc
ess
to m
edic
al r
ehab
ilita
tion
ser
vice
s,
•in
clu
din
g p
hys
ical
, occ
up
atio
nal
an
d p
sych
oso
cial
ser
vice
s an
d s
ervi
ces
that
can
tak
e in
to a
cco
un
t th
e sp
ecia
l nee
ds
of
child
ren
.
Inte
gra
te b
urn
su
rviv
ors
into
th
e d
isab
led
rig
hts
mo
vem
ent.
•
Elem
ents
of r
elev
ance
to
bu
rn v
ictim
s in
corp
ora
ted
into
•
the
Med
ical
reh
abili
tatio
n g
uid
elin
es a
nd
th
e W
orld
re
por
t on
dis
abili
ty.
20
08
on
war
ds
Esta
blis
h g
reat
er n
um
ber
s o
f bu
rn s
urv
ivo
rs g
rou
ps
and
•
incr
ease
th
e u
se o
f exi
stin
g g
rou
ps.
A
bo
okl
et o
f cas
e st
ud
ies
(to
incl
ud
e as
man
y ex
amp
les
•as
po
ssib
le fr
om
low
- an
d m
idd
le-in
com
e co
un
trie
s)
des
crib
ing
th
e ex
per
ien
ce o
f bo
th b
urn
su
rviv
ors
an
d
bu
rn s
urv
ivo
r g
rou
ps,
to
incr
ease
aw
aren
ess
and
h
igh
ligh
t b
est
pra
ctic
es.
In
tern
atio
nal
ver
sio
ns
or
exp
ansi
on
s o
f bu
rn s
urv
ivo
r •
gro
up
s su
ch a
s Su
rviv
ors
Offe
ring
Ass
ista
nce
in R
eco
very
(S
OA
R) a
nd
Ch
ang
ing
Fac
es.
20
08
–20
09
20
09
on
war
ds
BURNPLAN20 World Health Organization
7. C
apa
Cit
y B
uil
din
gg
Oa
l
Stre
ng
then
th
e ca
pac
ity o
f peo
ple
in c
ou
ntr
ies
wo
rldw
ide
to e
ffec
tivel
y u
nd
erta
ke t
he
spec
tru
m o
f bu
rn c
on
tro
l act
iviti
es, i
ncl
ud
ing
ad
voca
cy,
•p
olic
y d
evel
op
men
t, d
ata
colle
ctio
n, r
esea
rch
, pre
ven
tion
an
d im
pro
ved
bu
rn-c
are
serv
ices
.
AR
EA
OF W
OR
KPR
OD
ucTS
AN
D O
uTPu
TS
TIM
ELIN
EIn
clu
de
bu
rn p
reve
ntio
n a
nd
rel
ated
act
iviti
es in
MEN
TOR-
•V
IP, t
he
WH
O m
ento
ring
pro
gra
mm
e fo
r in
jury
an
d v
iole
nce
p
reve
ntio
n.
Pro
vid
e se
ed fu
nd
ing
an
d t
ech
nic
al s
up
po
rt t
o n
etw
ork
s th
at
•p
rom
ote
inju
ry-re
late
d r
esea
rch
in h
igh
prio
rity
issu
es, s
uch
as
pilo
t b
urn
pre
ven
tion
pro
gra
mm
es in
low
- an
d m
idd
le-in
com
e co
un
trie
s.
Pro
mo
te t
he
pro
visi
on
of s
cho
lars
hip
s to
co
nfe
ren
ces
and
•
trai
nin
g p
rog
ram
mes
, su
ch a
s th
ose
usi
ng
TEA
CH
-VIP,
th
at w
ill
bu
ild c
apac
ity a
nd
fost
er c
olla
bo
ratio
n in
bu
rn p
reve
ntio
n a
nd
ca
re b
etw
een
co
un
trie
s an
d r
egio
ns.
Targ
et s
yste
ms
and
str
uct
ura
l su
pp
ort
with
a v
iew
to
en
surin
g
•su
stai
nab
le fi
nan
cial
su
pp
ort
an
d p
rom
otio
n o
f in
ters
ecto
ral
colla
bo
ratio
n.
Men
tors
an
d m
ente
es w
ho
are
esp
ecia
lly in
tere
sted
in
•b
urn
pre
ven
tion
an
d c
are
activ
ities
.
Bu
rn p
reve
ntio
n a
nd
car
e n
etw
ork
s in
low
- an
d m
idd
le-
•in
com
e re
gio
ns.
Prim
er o
n e
valu
atio
n a
nd
mo
nito
ring
of b
urn
pre
ven
tion
•
pro
gra
mm
es a
imed
at
bu
rn p
reve
ntio
n g
rou
ps
wo
rkin
g
in lo
w- a
nd
mid
dle
-inco
me
cou
ntr
ies.
Stre
ng
then
ed t
each
ing
mat
eria
ls a
nd
tra
inin
g c
apac
ity
•to
su
pp
ort
th
e d
eliv
ery
of s
ervi
ces
for
bu
rn v
ictim
s,
incl
ud
ing
acu
te c
are,
reh
abili
tatio
n a
nd
rec
ove
ry.
Incr
ease
d o
pp
ort
un
ities
for
tech
nic
al e
xch
ang
e o
n b
urn
s •
amo
ng
min
istr
y o
f hea
lth fo
cal p
oin
ts in
rel
evan
t fo
ra
(e.g
. reg
ion
al c
om
mitt
ee m
eetin
gs,
reg
ion
al c
on
sulta
tion
s o
n in
jury
-rela
ted
to
pic
s)
20
08
–20
09
20
08
on
war
ds
20
08
–20
09
20
08
on
war
ds
20
08
on
war
ds
Imp
rove
co
mm
un
icat
ion
an
d c
oo
per
atio
n b
etw
een
ISB
I, •
WH
O, I
nte
rbu
rns
and
oth
er s
take
ho
lder
s en
gag
ed in
th
e d
evel
op
men
t o
f bu
rn-re
late
d t
each
ing
aid
s an
d c
ou
rse
curr
icu
la.
Incr
ease
d h
arm
on
izat
ion
of b
urn
car
e tr
ain
ing
mat
eria
ls
•b
etw
een
th
e d
iffer
ent
gro
up
s.
Incr
ease
d u
se o
f th
ese
trai
nin
g m
ater
ials
for
refr
esh
er
•co
urs
es fo
r h
ealth
wo
rker
s at
all
leve
ls a
nd
for
use
in
sch
oo
ls o
f med
icin
e, n
urs
ing
an
d o
ther
rel
evan
t p
rofe
ssio
ns.
20
08
on
war
ds
20
08
on
war
ds
ISB
I, In
tern
atio
nal
So
ciet
y fo
r B
urn
Inju
ries.
BURNPLAN 21World Health Organization
This plan addresses work to be undertaken by WHO and other stakeholders globally. It is hoped that the plan will assist stakeholders in maximizing the effectiveness of their work and in garnering the funds needed to conduct their activities. However, it is important to emphasize that there is much that can be done with relatively little in the way of additional resources, especially in terms of advocacy. The adjacent list of products and outputs will be completed by WHO and its partners with existing resources and staff within the next two years.
the burn planTWO-yEAR PROGRAMME
1. ADvOcAcy
Update the burn fact sheets. • Update those components of the WHO web site that address •
burns.
2. POLIcy
Web-based compilation and analysis of national and local • policy on burn prevention and care.
3. DATA AND MEASuREMENT
Identify existing burn data for use in global burden of disease • estimates
Define key questions for surveillance and surveys • (e.g. Demographic and Health Surveys).
Define key questions for mortuary databases.• Create standardized charts for burn admissions.• Update forms and standards for burn registries from those•
previously in the Burn Kit (published by WHO in 1994).
5. PREvENTION
Compile a best practices booklet on burn prevention • programmes.
6. hEALTh-cARE SERvIcES FOR buRN vIcTIMS
Update and expand usage of existing WHO burn guidelines,• such as the clinical care guidelines contained in Integrated management of emergency and essential surgical care (IMEESC) tool kit and the resource guidelines contained in the Guidelines for essential trauma care.
BURNPLAN 22World Health Organization
8. COnClusiOnThe major gaps in burn prevention and care have been identified as being in the following areas:
advocacy : There is limited awareness of the problem, particularly among policy-makers and donors.
policy : Implementation and enforcement of policies to address the burn problem is limited.
data and measurement : Data on the magnitude of the problem, risk factors and economic consequences are either inaccurate or inadequate.
research : Research on the burden and risk factors for burns in the circumstances of low- and middle-income countries, as well as in relation to the evaluation of inter-vention trials or the cost-effectiveness of burn prevention and care strategies, is lacking.
prevention : (a) Inadequate application of known, effective prevention strategies, such as smoke detectors and regulation of hot water heater temperature, in environ-ments where they would likely be effective, such as urban areas in middle-income countries; (b) Insufficient scientific evaluation of strategies to confront the risk factors causing burns in low-income countries.
services : The application of effective burn care (including acute care, rehabilita-tion and long-term recovery of burn victims) in many low and middle-income countries is inadequate.
capacity : There are insufficient numbers of people trained in the skills needed to undertake the above spectrum of burn control activities.
WHO’s work in the area of burn prevention and care will follow the public health approach and, in so doing, will attempt to address the gaps and inequities identi-fied above. WHO and its partners are committed to promoting the development of multidisciplinary national strategic plans for burn prevention within countries by strengthening capacity and the level of training, and by supporting the collection of data, research and the development of appropriate interventions to strengthen the prevention and care of burns. In addition, WHO will be instrumental in pushing forward the agenda of burn prevention and care by advocating at a global and regional level and encouraging donors to support efforts to reduce the magnitude of the burden. Concerted multisectoral efforts, strong partnerships and international cooperation will be essential to take this agenda forward.
BURNPLAN23 World Health Organization
referenCes1. Peden M et al., eds. World report on road traffic injury prevention. Geneva, World Health Organization, 2004.
2. Krug EG et al., eds. World report on violence and health. Geneva, World Health Organization, 2002.
3. Mock C et al. Guidelines for essential trauma care. Geneva, World Health Organization, 2004.
4. Sasser S et al. Prehospital trauma care systems. Geneva, World Health Organization, 2005.
5. The injury chartbook: A graphical overview of the global burden of injuries. Geneva, World Health Organization, 2002.
6. Marshall SW et al. Fatal residential fires: who dies and who survives? Journal of the American Medical Association, 1998, 279:1633–1637.
7. Ytterstad B, Sogaard AJ. The Harstad Injury Prevention Study: prevention of burns in small children by a community-based intervention. Burns, 1995, 21: 259–266.
8. Haddix AC et al. Cost-effectiveness analysis of a smoke alarm giveaway program in Okalahoma City, Oklahoma. Injury Prevention, 2001, 7:276–281.
9. Ahuja RB, Bhattacharya S. Burns in the developing world and burn disasters. British Medical Journal, 2004, 329:447–449.
10. Lau YS. A insight into burns in a developing country: A Sri Lankan experience. Public Health, 2006, 120:958–965.
11. Albertyn R, Bickler S, Rode H. Paediatric burn injuries in sub-Saharan Africa – an overview. Burns, 2006, 32:605–612.
12. Forjuoh SN. Burns in low- and middle-income countries: a review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns, 2006, 32:529–537.
13. Mock C et al. Evaluation of trauma care capabilities in four countries using the WHO/IATSIC Guidelines for Essential Trauma Care. World Journal of Surgery, 2006, 30: 946–956.
14. Holder Y et al., eds. Injury surveillance guidelines. Geneva, World Health Organization, 2001.
15. Surgical care at the district hospital. Geneva, World Health Organization, 2003 (http://www.who.int/surgery/publications/scdh _manual/en/index.html, accessed 3 December 2007).
16. Integrated management of emergency and essential surgical care (IMEESC) tool kit. Geneva, World Health Organization, 2007 (http://www.who.int/surgery/ publications/imeesc/en/index.html, accessed 3 December 2007).
17. Scott I et al. Child and adolescent injury prevention: A WHO plan of action 2006–2015. Geneva, World Health Organization, 2006.