AAPI to standardize burns care in India

Rita Dutta - Mumbai

With more than 1,20,000 deaths occurring due to burns injury every year in India, burns experts of American Association of Physicians of Indian origin (AAPI), a consortium of 30,000 Indian physicians based in the US, are formulating protocols to be followed for management of burns patient. The guidelines will standardize the type of resuscitation, selection of the intravenous fluid, antibiotic strategy, nursing care, infection control, timing for the surgical procedures, the extent and nature of surgical procedures and referral network entailed in burns management.

In the pilot study, AAPI is likely to select around 12 burns units from 32 burns units in the country from various zones, which would be earmarked as AAPI’s ‘Burn Centres of Excellence’ to help implement the standard protocol and disseminate information on burns care to the medical community.

The ten-member task force of burns experts of AAPI has handpicked six burns surgeons in India to form their co-ordinating committee in India. Says Chennai-based burns surgeon Padmashree-winner Dr Mathangi Ramakrishnan, chairman, AAPI’s co-ordinating committee, “Because the management of burns is varied in the absence of uniformity in the management protocol, standardization will bring about a meaningful approach to the problem.”

Experts say that the guidelines would give a boost to poor success rate of burns victims in India, which ranges from 30 to 55 per cent, in comparison with 70 and 90 per cent in US and China respectively, for victims with 50 per cent burns in their body surface area.

According to M L Hanumadass, chairman, task force for burns care in India, AAPI, and former director at the US-based Cook County hospital, “There are no basic guidelines for the treatment of burns in India. We would Indianise the standards followed in the US, keeping in mind the cost-factors.”

The experts committee is strategizing to upgrade the infrastructure for tackling the burns cases in the primary and secondary centres, with more than 70 per cent burns cases being from the rural belt. In the absence of proper infrastructure most of the burns cases from PHCs and SHCs are referred to tertiary centres. Because of lack of proper networking system and late referral, which is as acute as three months for severe burns, a sizeable section of patients either die or reach specialists in irreversible stage of shock. Hence, the guidelines would lay a three-tier approach to burns referral, whereby small burns can be managed at taluka and district headquarters hospital level and major salvageable burns be referred to the burn units in the metropolis after initial care.

AAPI is also laying special emphasis on devising proper infection control guidelines. Says Dr Arvind Vartak, HOD, Eric Kharas Burns Research Unit, Masina hospital and B J Wadia hospital and a member of AAPI’s co-ordinating committee, “Infection for burns victims is ten times higher than any other disease. If infection is not properly controlled, a first degree burn can deteriorate to become a second degree and consequently a third degree burn.” AAPI would also be training paramedical personnel, especially nurses for management of burns patients.

The committee is also working towards forming a national burns registry, to gather epidemiological data on burns, for which it has already submitted an MoU to union minister of health, Shatrughan Sinha, requesting for all burns cases to be made reportable.

AAPI would seek the help of NGOs like National Academy of Burn Injuries and Burn Association of India to establish a national burn registry. Says burns surgeon Dr P K Bilwani, Sterling hospital, Ahmedabad, “National epidemiological data would help in chalking national programmes on prevention and treatment on burns.” Experts say that it is important to have burns prevention programme to control burn related deaths.

APPI is also working towards developing emergency trauma service at Mumbai, Pune and Ahmedabad, which include well-equipped ambulances and training of para-medical staff, nurses and physicians at the primary and secondary level. Says Dr S Balasubramanium, chairman, task force, disaster and trauma management, AAPI, “Burns victims can be saved with right people and right equipment.” The AAPI-funded emergency trauma service in Pune has started functioning with four well-equipped ambulances at Dinanath Mangeskar hospital.

The guidelines will be finalised after national consensus and no time frame has been set for the same. The committee would approach the government for legislation, after the acceptance of the standardization schedule in the various burns units across the country.