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Fredrik Huss MD, Ass Prof Director of Burn Center Dept of Plastic and Maxillofacial Surgery Uppsala University Hospital Uppsala, Sweden Burns in Sweden

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Fredrik Huss MD, Ass Prof Director of Burn Center Dept of Plastic and Maxillofacial Surgery Uppsala University Hospital Uppsala, Sweden Burns in Sweden Fredrik Huss MD, Ass Prof Director of Burn Center Dept of Plastic and Maxillofacial Surgery Uppsala University Hospital Uppsala, Sweden Burns in Sweden Uppsala 36000 Stockholm Linköping 1300 400 Malmö Hospital treated Mortality 1952-2013 Assessment • According to ATLS and/or ABLS – A airways – B breathing – C circulation – D disability – E expose and examine – F fluid resuscitation • Re-assessment Burn assessment • Depth • Extent • Location • Age – Concommitant injuries – Previous illnesses Extent • Rule of palm • Rule of 9 • Charts Extent Depth Full thickness burn <50°C - 5 min TEMP 52 °C - 1,5 - 2 min 57 °C - 10 seconds 60 °C - < 5 seconds DURATION Depth Superficial Superficial Conservative Dermal Deep Full thickness Surgical Depth • History • Appearance • Capillary refill • Sensory Superficial (sun) burn Superficial dermal burn Deep dermal burn Full thickness burn Wound treatment • Escharotomy • (Tangential) excision + transplantation • Conservative treatment Escharotomi Carl-Evert Jonsson, Brännskador Almqvist & Wiksell 1985 Skin transplantat Huss -04 Abuse and/or neglect Injuries and deaths by fire • A major global health problem • >300 000 deaths annually • 90% of burns in LMICs • Still a problem also in HICs • Residential fires the largest category of fatal fires (75%). • Known risk groups (very young, elderly, males, etc) • Burn centers/experts are rare not only in LMICs, also in HICs Socioeconomic development affects every aspect of life • Average mortality rate in HIC vs LMIC differ by a factor 3 (57:106 and 249:291 (women:men) per 1000 respectively). • Access to physician differ by a factor 10 (27.9 and 2.9 physicians per 10,000 inhabitants). (Human Development Reports 2015) • Burns more common in pop with lower socioeconomic status and delayed developmental growth. • Lack of basic safety education. • Majority of burns are preventable. • Measures such as educational programs, smoke alarms/detectors, controlled hot water… Published epidemiological studies (2001-2016) Worldwide trends in burns What can be done? • Education! • According to development status, countries need different approaches • According to groups of individuals, need different approaches and specialized interventions • A demand for both human and technical solutions 43 44 Recent fire/burn mass casualty incidents Town and city fires 2000s • 2002 – Lagos armoury explosion causes fire which killed at least 1,100 people • 2002 – Edinburgh Cowgate fire • 2002 – Rodeo-Chediski fire • 2003 – Canberra bushfires fire that killed 4 and destroyed over 500 homes • 2006 – Day Fire, Los Angeles and Ventura counties in California. • 2007 – 2007 Greek forest fires, large fire in Greece • 2008 – Camden Market Fire, which caused severe damage to one of North London's most famous shopping districts. • 2009 – February Black Saturday Bushfires – Victoria, Australia, 173 deaths, refer to separate page • 2009 – Kenyan oil spill ignition kills at least 111. 2010s • 2010 – 2010 Dhaka fire kills 117 people in the Nimtali area of Old Dhaka, Bangladesh • 2011 – Devastating fire in Manila, Philippines leaves about 8,000 people homeless and 9 injured in a Makati City squatter community. • 2012 – Hurricane Sandy: A six-alarm fire caused by hurricane damage destroyed 121 homes in Breezy Point, Queens, New York • 2013 – Yarnell Hill Fire: Over 13 square miles, destroyed over 100 homes, and 19 members of the Granite Mountain Hotshots were killed in action • 2013 – Lac-Mégantic derailment: Over 30 buildings in the town centre were destroyed in a train derailment, explosion and fire which caused 46 confirmed deaths. The fire made the event the deadliest train accident in Canada's history since 1864 • 2013 – Boardwalk fire in Seaside Heights & Seaside Park, New Jersey, U.S.A. At least 19 buildings destroyed, 30 businesses lost, no major injuries • 2014 – Valparaíso wildfire in Chile – wildfire destroying several areas of Valparaíso, Chile killing at least 13 people • 2014 – Lahore supermarket fire in Pakistan – in Anarkali Bazaar, Lahore. The fire killed at least 13 people • 2015 Tianjin Port fire and explosions August 12, killing at least 173 people, damaging 300 buildings and over 10000 vehicles. Fire set off two major explosions and numerous secondary detonations. • 2016 - Fort McMurray fire in Alberta, Canada - started 1 May and is currently still burning (May 26) • 2016 - A four alarm fire occurred on May 5, 2016 in Spring Branch, Texas Building or structure fires 2000s • 2000 – Immigration Tower fire, Wan Chai, Hong Kong, 2 killed and 48 injured on August 2 • 2000 – Tiantang cinema fire in Jiaozuo, Henan, China, killed 74 on March 29 • 2000 – Xiamen, Fuji electric factory, killed 8 females • 2000 – Qingzhou chicken processing plant fire, Qingzhou, Shandong, China, 38 workers killed on April 22 • 2000 – Enschede fireworks disaster, Enschede, Netherlands, 22 killed (including 4 firemen) on May 13 • 2000 – Fireworks factory fire, Guangdong, China, 36 killed on June 30 • 2000 – Fire on Ostankino Tower, Moscow • 2000 – Childers Palace Backpackers Hostel fire in Childers, Queensland, 15 killed in arson attack on June 23 • 2000 – Dongdu Commercial shopping center fire in Luoyang, Henan, China, killed 309 on December 25 • 2001 – Kyanguli Secondary school fire, Machakos, Eastern Province, Kenya, 68 killed on March 26 Continued • 2001 – Erwadi fire incident, Tamil Nadu, India, 25 killed on August 6 • 2001 – Manor Hotel fire, Quezon City, Philippines, 75 killed on August 17 • 2001 – Myojo 56 building fire, Tokyo, Japan, 44 killed by arson on September 1. • 2001 – September 11 attacks — Two airliners deliberately flown into the World Trade Center Twin Towers in New York City, sparked fires on multiple floors. Over 2000 people die as a result of the fires and the subsequent collapse of the towers. • 2001 – Volendam New Years fire during a New Year party in De Hemel cafè in Volendam, Netherlands killed 14 and injured 200 • 2001- Several houses caught fire after American Airlines flight 587 crashed into a Queen's neighborhood, all 265 on the plane and 5 people on the ground died. • 2001 – Mesa Redonda fire, Lima, Peru, 291 killed on December 29 • 2002 – Shree Lee International footwear factory fire, Agra, Uttar Pradesh, India, 42 killed on June 26 • 2002 – Heppi Karaoke bar fire, Palembang, South Sumatra, Indonesia, 42 killed on July 9 • 2002 – Ho Chi Minh City ITC fire, Vietnam, over 60 killed, over 100 missing and 500 injured in a luxury department store fire and collapse • 2002 – Sidi Moussa prison fire, El Jadida, Morocco, killing 50, on November 2 • 2002 – La Coajira nightclub fire at Caracas, Venezuela, 47 killed on December 1 • 2003 – Greenwood Nursing Home fire in Hartford, Connecticut, killed 16 on February 26 • 2003 – Daegu subway fire in Daegu (South Korea) • 2003 – Nursing home fire in Nashville, Tennessee, killed 14 on September 25 • 2003 – The Station nightclub fire 96 died at the scene; 4 died from injuries at local hospitals in West Warwick, Rhode Island • 2003 – Peoples' Friendship University of Russia fire, Moscow, Russia, 36 killed on November 24 • 2004 – Zhongbai Commercial Plaza fire, Jilin, northeastern China, killed 53 on February 16 • 2004 – San Pedro Sula prison fire, Honduras, killed 103 on May 17 • 2004 – Momart warehouse fire, numerous significant contemporary work of arts destroyed by fire, 24 May 2004, Leyton, East London. • 2004 – Sri Krishna Aided Higher Secondary School fire, Kumbakonam, Tamil-Nadu, India, killed 94 on July 16 • 2004 – Ycuá Bolaños supermarket fire, Asunción, Paraguay, kills 370, injures 500 on August 1. • 2004 – República Cromagnon nightclub fire in Buenos Aires kills 194, injures 714 on December 30. • 2005 – The Windsor Tower Building Fire (Spain), February 14–15 • 2005 – Beni Suef Cultural Palace fire in Egypt and kills 46 on September 5. • 2005 – Aardman Animations storage depot fire, 10 October • 2005 – 11 die in a fire at the detention center of Amsterdam Schiphol Airport on October 27. • 2005 – Hertfordshire Oil Storage Terminal fire, a major explosion at Hertfordshire Oil Storage Terminal in Hemel Hempstead, Hertfordshire injures 43 on December 11. • 2005 – Liaoyang City Central Hospital fire, Liaoyang, Jilin, China, 39 killed on December 12. • 2006 – KTS Composite Textile factory fire, at Chittagong, Bangladesh, 65 killed, 100 injured on February 24. • 2006 – Kolkata leather factory fire kills at least nine people in India on November 22. • 2006 – Moscow hospital fire kills 46 December 9. • 2006 – Fire at a store in Ormoc City, Philippines kills 24 • 2007 – Nursing home fire at Kamyshevatskaya, Krasnodar, southern Russia, killed 63 on March 19 • 2007 – Penhallow Hotel fire at Newquay, Cornwall • 2007 – Charleston Sofa Super Store Fire in Charleston, South Carolina; 9 firefighters were killed on June 18 Continued again • 2007 – Warehouse fire in Atherstone-on-Stour, Warwickshire when 4 firefighters were killed • 2007 – Warehouse fire in Mexico City, Mexico, killed 5 people • 2008 – Fire at Korea 2000 refrigerated warehouse while under construction, Icheon, Gyeonggi-do, South Korea, 40 killed on January 7 • 2008 – Namdaemun fire with collapse at Seoul, South Korea on February 10. • 2008 – Historic Quebec City Armoury roof and interior destroyed by fire, Quebec, Canada, on April 4 • 2008 – Four-story Rosamor Furniture factory fire, Lissasfa, Casablanca, Morocco, killed 55 on April 25 • 2008 – Historic Alma College in St. Thomas, Ontario, Canada burnt down by arsonists on May 28 • 2008 – Texas Governor's Mansion heavily damaged during
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