Current logistics of acute burn care in Singapore.

ABSTRACT

OBJECTIVE: To study logistic requirements in acute burn care in Singapore and to correlate statistics on fire, unnatural deaths and burns. DESIGN: Fire data (from Singapore Fire Safety Bureau), mortality data (from Institute of Science & Forensic Medicine) and burn data (from Burns Centre, Singapore General Hospital) were studied. SETTING: Severe burn victims often require prolonged treatment. Useful data was obtained in a 1,500-bed restructured government hospital. PARTICIPANTS: All reported and investigated fire incidents, coroner enquiries of unnatural deaths and admitted burn patients. INTERVENTION General burn data obtained retrospectively from 398 burn admissions in 1988 and logistic burn data from 41 patients requiring fluid replacement regime. RESULTS: Fire data showed one burn admission in every 12 fires (398/4718), one burn death in every 314 fires (15/4174) or 55 unnatural deaths (15/828). Mortality data showed 15 burn deaths, two prior to admission, 7/13 admitted died of suicidal injuries and mortality rate was 3.3% (national annual average is 1.9%). General burn data showed adults 76% and children 24%, 31 male predominance; scalds (46%), fire (32%), explosions (11%) and others (11%). Seventy-eight patients (adults 58, children 20) required fluid resuscitation. Logistic burn data (average burn 35%, 28 partial thickness and 13 full thickness burns) were ALOS 19.5 days, 2.4 major operations per patient (range 2-7), 56 minor procedures and 2.9 L blood transfusion per patient (those who were operated required 3.8 L and those not operated, 1 L per patient). Blood investigations increased with severity and pattern of injury, Acinetobacter species was commonest microorganisms, antibiotics were used in 66% of patients and commonest burn dressings were tullegra (T/G), followed by T/G with silverzine. CONCLUSION: Data presented useful for correlation of fire, mortality and burn statistics, resource allocation and new burn facility establishment.