Burn Injury From Smoking Electronic Cigarettes While on Supplemental Oxygen.

Many reports pertaining to burns from e-cigarette battery explosions exist, as do injuries from smoking conventional cigarettes while on home-oxygen therapy. However, literature regarding burn injuries from e-cigarettes while on oxygen therapy is limited. The heating coil of the device can rise to temperatures that facilitates ignition of oxygen. The purpose of this study is to describe and characterize this novel and under-reported mechanism of injury. This study was a descriptive review of 2013-2016 National Burn Repository (NBR) data, with a query for "oxygen," "O2," "electronic cigarettes," and various permutations/abbreviations/misspellings. Demographics, injury characteristics, and outcomes were reported. Also, a Google search for lay-press articles and a PubMed/Scopus search using similar terms was conducted to find literature. Of approximately 60,000 NBR entries, 8 records of injury while smoking e-cigarettes on oxygen were found. Patients were predominantly male, 63 ± 9 years old, with 3.4% ± 4 TBSA burns, and LOS of 5.8 ± 7 days (an LOS O/E ratio of 1.5). Two patients sustained full-thickness burns (0.5% and 11% TBSA). Three were intubated, with mean of 3.33 ventilator-days. Most injuries occurred at home (88%). All patients survived. A google search revealed five lay-press articles. Only three partially relevant scientific articles were found to only mention the phenomenon, without granular data. Although uncommon, smoking e-cigarettes on supplemental oxygen can result in injury without a lithium-ion battery explosion. Limitations in the database may have resulted in underestimation of injuries. A paucity of relevant literature exists, necessitating more research. Patients who receive home-O2 should be warned about this potential danger.

Burn Nurse Competencies: Developing Consensus Using E-Delphi Methodology.

Competency standards for nurses who specialize in the care of burn-injured patients are lacking. Currently, there are no nationally agreed on standards that define safe and competent burn nursing practice. In 2014, nurse members of the American Burn Association proposed the Burn Nurse Competency Initiative (BNCI) with the intent of establishing a core set of competency standards for burn nursing. The BNCI used the Delphi technique of consensus building with input from up to 178 registered nurse burn care experts. This article describes the multistaged consensus-building process used and provides a final list of competencies. These newly created competencies now define professional practice standards for burn nurses. Their creation completes one of the essential steps required for burn nursing to be recognized as a specialty.

"It Happened in Seconds" Firefighter Burn Prevention Program: Evaluation of a "Train the Trainer" Course.

Each year, there are approximately 100 firefighter fatalities and tens of thousands of injuries in the United States. 'It Happened in Seconds' is a firefighter burn injury awareness program offered to firefighters nationwide. The course focuses on situational awareness, personal protective equipment, and burn injury prevention. In order to create more instructors, a 'Train the Trainer' instructor course was developed to prepare experienced firefighters and healthcare providers from around the United States to teach firefighters in their respective communities. This study evaluates trainees' perception of the instructor course. Three instructor courses were held in a period between November 2013 and January 2015. Trainees were asked to complete both precourse/postcourse assessments and provide demographics. In both surveys, trainees rated their confidence to instruct firefighters about burn prevention and their awareness about firefighter-specific burn issues using a 5-point Likert Scale (1 = none and 5 = high). The postassessment asked if trainees thought the course should be mandatory for all firefighters. Pretest and post-test scores were compared using a Wilcoxon's signed-rank test. A total of 140 experienced firefighters and healthcare professionals completed the Train the Trainer course. The average age was 40 ± 9 years, and 41 were women and 99 men. The average trainee had 13.6 ± 9 years experience in his or her respective job and 11 ± 9 years experience in burn care. Trainees reported a significant increase in their confidence to instruct firefighters about burn prevention (2.9/5 precourse vs. 4.5/5 postcourse, P < .0001) and in their current awareness of firefighter-specific burn issues (3.2 precourse vs. 4.4 postcourse, P < .0001). In the postcourse assessment, 139 of 140 respondents agreed that the 'It Happened in Seconds' course should be mandatory for all firefighters. This study showed that experienced firefighters and healthcare professionals thought that the course significantly improved their awareness level of issues specific to firefighter burn injury as well as their confidence in teaching these concepts to firefighters. Based on this positive evaluation, additional instructors will be trained to provide the course to all firefighters nationwide. Additional research must be conducted to evaluate whether the 'It Happened in Seconds' course results in a decreased rate of firefighter burn injuries.

Contemplating the Pentagon attack after five years of space and time: unheard voices from the ramparts of our burn center.

Marking the fifth year after the attack on the Pentagon, staff at the burn center in Washington, DC, memorialize in a contemplative frame of mind. These reflections are drawn from members of the extended burn team and render an interwoven sketch in prose that previously has not been heard.

The Pentagon attack of September 11, 2001: a burn center's experience.

On September 11, 2001, an airplane flown by terrorists crashed into the Pentagon, causing a mass casualty incident with 189 deaths and 106 persons treated for injuries in local hospitals. Nine burn victims and one victim with an inhalation injury only were transported to the burn center hospital. The Burn Center at Washington Hospital Center admitted and treated the acute burn patients while continuing its mission as the regional burn center for the Washington DC region. Eight of the nine burn patients survived. Lessons learned include 1) A large-volume burn center hospital can absorb nine acute burns and maintain burn center and hospital operations, but the decision to keep or transfer burn patients must be tempered with the reality that several large burns can double or triple the work load for 2 to 3 months. 2) Transfer decisions should have high priority and be timely to ensure optimum care for the patients without need for movement of medical personnel from one burn center to another. 3) The reserve capacity of burn beds in the United States is limited, and the burn centers and the American Burn Association must continue to seek recognition and support from Congress and the federal agencies for optimal preparedness.