(Date: 9th July, 2018)
The simple logic behind STOP DROP ROLL is when we blow on fire; the flame would rise more and more. In traditional Nepali society, which is still in practice in rural areas, people use open fire to cook. If we have seen this cooking style, we would understand this more. The wood they use to cook is rolled on the floor to extinguish the fire. So this is simple to understand that, when we get fire on our own body, we shouldn’t run but we should stop so that there won’t be chance to get more oxygen for burning. We should then drop to reduce the area which is on fire. Similar to the burning wood, we should roll so that the burning part of our body would get extinguished. What if it is not you who was on fire but someone in front of you? If he knows what to do, let him do the STOP DROP ROLL, but if the person is confused and is panicking, tell him not to run but use a blanket, rug or any cotton/wool cloth to wrap him. If possible use water to dampen the cloth and wrap him with it so that the fire is extinguished.
After STOP DROP ROLL, the most important part is to RINSE. When the fire is extinguished, the first aid for the burn patient is WATER. This is what people miss and make mistakes and ruin the life of the victim. First aid by water is very essential, which can reduce maximum number of injuries after the burn. We should cool the burn with cool running water for 20 to 30 minutes; –we should not use ice, iced water, or any creams or greasy substances. If there is no water around, take the patient to the place where there is water as soon as possible and do the same. If the cooling can be done within 1 hour, we have the chances to save his life. People have mistakenly used things like toothpaste, Aloe Vera, tomato and so on to cool the burned area. Well, these things are ordinarily good for the skin but not for the burned skin. It can make us feel cool for a while, but it traps the heat inside and the burn gets deep-rooted. It would harm the skin in such a way that, the skin starts to rot inside. Once the wound is rotting, it smells very bad and it takes a long time to recover.
For treatment of a burn wound, it requires more dressing than other wounds and the only best dressing for it would be skin itself. So if we can do cooling, the percentage of getting more injuries would be lower. After the 20-30 minutes of cooling with water, we can use clean cloth or plastic to wrap the wound. It would be better to use plastic because it doesn’t get stuck on the wound and would be easier to take off. Plastic is found everywhere, even in the rural areas and is also easy to clean. We can wrap the burned area with plastic and take the patient to the hospital. Neither cooling nor the plastic is the treatment, but only the first aid techniques so that the victim’s situation doesn’t get worse. We have to take the patient to the hospital but once we have done the cooling, the victim is safer and has more time so that we do not need to rush to the hospital.
The treatment for Burn is difficult and costly especially in a developing country like Nepal. In context of Nepal, it is difficult for the patient with more than 40% burn on his body to be saved. According to Dr. Kiran Kishor Nakarmi, Senior Consultant Plastic, Reconstructive, Hand and Micro surgeon, hardly any people with up to 55% burn are saved in Nepal. It is recorded that Burn Mortality Rate is 20% in the present context. That is because there are not enough resources for hospitals in Nepal. Other causes are the people with low income, who are more prone to these kinds of accidents, cannot afford for the expensive treatment. There are hospitals which care for burn patients but Kirtipur Hospital (Pushpalal Medical College and Teaching Hospital) is the hospital which cares especially for burn patients in Nepal and which also has a skin bank. Dr. Kiran and his team have started the Skin Bank, to which we can donate skin after death and the donated skin can be stored safely for 5 years. Till date, donation for the skin bank is not so good in Nepal; there is lack of donors. The record shows that only 15 people have donated their skin after death. But live donors, more than 20 in number, have donated their skin to their own family members. Live donation is difficult since a healthy person also gets wounded and sometimes the donated skin doesn’t help. In Nepal, there are Hindu religious beliefs that people shouldn’t donate their body parts, thus people who still have the superstitious thinking do not like to donate. Yet the awareness about this issue is rising and people have started signing agreements to donate their body parts after death. Still, the skin donation is not liked by many and some people are still not aware that they can donate body parts. If only the importance of skin donations was understood and acted on, lots of burn patients would be saved. The team has also been doing reconstructive surgery in different parts of Nepal.
Rescue Network Nepal, during the first aid training sessions, is also providing awareness about Burns and the techniques to care for burn patients. We have had the opportunity to get advanced burn training with Dr. Kiran and his team. We need to think more about burn patients and burn injuries in Nepal. Each and every person must have awareness about how to reduce the risks caused by fire, how to provide the first aid to the burn victims, how to care for burn patients and even how to donate their skin and why this is so important.