Bu r n pr e v e n t i O n a n d Care -...

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)

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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


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


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


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


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


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)


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


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


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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


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

.


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


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.


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


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


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


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


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.


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.


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.


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.

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