A WHO PLAN

FOR

BURN
PREVENTION
AND
CARE
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 classication: WO 704)
World Health Organization 2008
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Printed by the WHO Document Production Services, Geneva, Switzerland.
This document was prepared following a Consultation Meeting on the Prevention and Care of Burns, which was
held on 34 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 Childrens 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 Ofcer (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 nalized by:
Charles Mock Department of Violence and Injury Prevention and Disability, WHO, Geneva, Switzerland
Michael Peck Director of International Outreach, Arizona Burn Center, Maricopa Medical Center, Phoenix, AZ, USA
Margie 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, Switzerland
Rajeev Ahuja Head, Department of Burns & Plastic Surgery, Lok Nayak Hospital, New Delhi, India
Hendrina Albertyn Red Cross Childrens Hospital, Cape Town, South Africa
Welsly Bodha Director, Euro Skin Bank, Beverwijk, the Netherlands
Pascal Cassan National Medical Advisor, French Red Cross, Paris, France
Wijaya Godakumbura President, Safe Bottle Lamp Foundation, Rajagiriya, Sri Lanka
Grace Lo Senior Health Ofcer, International Federation of Red Cross and Red Crescent Societies,
Geneva, Switzerland
James Partridge Chief Executive, Changing Faces, London, England
Tom 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 Fireghters, the International Society for Burn Injuries, the Japa-
nese Society for Burn Injuries, and the Turkish Burn and Fire Disaster Society for their nancial 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 Krug
Director
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 disgurements. For some this means living with the stigma and rejection
that all too often comes with disability and disgurement.
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 ame retardant childrens sleepwear,
has meant that mortality rates from burns have steadily declined over the past 3040
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 benets 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.
Acknowledgements
Foreword
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 WHOs 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 ame-retardant childrens sleepwear, as well as the development of safer
buildings and household fuels and appliances, the number of deaths due to burns, both
re-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 beneted
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 rst 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 WHOs 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 WHOs 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 WHOs other injury prevention activities, for example, in the eld of road trafc 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 WHOs
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
BACKGROUND
PART I
BURN
PLAN
2
World Health Organization
It is estimated that each year over 300 000 people die from re-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 disgurements, 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 worlds poor. The
vast majority (over 95%) of re-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, re-related burns are the sixth leading cause of death among
514 year olds and the eighth leading cause death among 1529 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 res
is the sixth leading cause of death among females aged 1529 years. The highest
rates of re-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 disgure-
ment. It is estimated that re-related burns account for 10 million Disability Adjusted
Life Years (DALYs) lost globally each year (5). This gure 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 disgurements, which often result in social stigma
and restriction in participation in society but which are more difcult to quantify.
Risk factors for burn injury differ according to region, but typically include alcohol
and smoking, use of open res for space heating, use of ground level stoves for
cooking, the wearing of long, loose-tting 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
BURN
PLAN
3
World 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, ame
resistant childrens 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 res 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 RATES
DUE TO FIRE-RELATED BURNS
BY WHO REGION* AND INCOME GROUP, 2002
REGION Africa The Americas
South-East
Asia
Europe
Eastern
Mediterranean
Western
Pacic
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 res (%)
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
BURN
PLAN
4
World Health Organization
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 re 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 disgurement 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 identied 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 disgurement 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 scientically-
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 specically 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 specically 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
BURN
PLAN
5
World Health Organization
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
(911):
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 res;
the use of kerosene (parafn) stoves and lamps (these can be easily knocked over
and then ignite);
the wearing of loose tting cotton clothing which can ignite while cooking on an
open re (a risk factor for women in Asia).
It is clear given that approximately two billion people worldwide cook on open res
or very basic traditional stoves that in order to reduce the number of re-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 parafn stoves in South Africa and
safer, more stable parafn 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 worlds 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-
nicant 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
BURN
PLAN
6
World Health Organization
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 prole 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-specic publications (e.g.
the Burn Fact Sheet). Several of WHOs 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 WHOs 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 WHOs normative, facilitative and coordinating
role in public health (see below). The plan also addresses WHOs own organizational
priorities. WHO Director-General, Dr Margaret Chan, has stated that she wants to
use WHOs impact on improving health among two of the worlds most vulnerable
5. CONFRONTING
THE CHALLENGES
BURN
PLAN
7
World Health Organization
groups, women and people living in Africa, as an indicator of the organizations 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 WHOs 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.
WHOs 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 identied. 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.
WHOs 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 nancial 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 WHOS ROLE
BURN
PLAN
8
World Health Organization
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 trafc injuries, child injury prevention, and emergency
and trauma care provision (14, 17). It will also form the basis of WHOs 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 trafc injury prevention and on violence.
Consultative
process
Plan
1
Model
region/
country
programmes
Regional/
country
programmes
Funding
Advocacy
Technical support
(guidelines, best practices)
Political support
(World Health Assembly,
United Nations
General Assembly
and others)
BURN
PLAN
9
World Health Organization
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 prole 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, rst-aid
training and injury prevention;
reghters: reghters 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 disgured 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
BURN
PLAN
11
World Health Organization
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 disgurement 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 34 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 (20082017) was developed
in order to direct WHOs 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 ofces 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 identied.
The BURN PLAN
1. ADVOCACY
Raising awareness
Promoting and supporting action
International, multisectoral cooperation
2. POLICY
Effective and sustainable burn prevention and care policies
Action plans, legislation, regulations, enforcement
3. DATA AND MEASUREMENT
Magnitude and burden
Risk factors
4. RESEARCH
Set agenda of priorities
Promote and foster trials of promising interventions
5. PREVENTION
Stronger, more effective burn prevention programmes
More countries with national burn strategies
6. SERVICES
Strengthen treatment services available
Acute care
Rehabilitation
Recovery
7. CAPACITY BUILDING
Suffcient knowledge and skill to effectively carry out all of
the above components of the Burn Plan
AT A GLANCE
THE WHO PLAN
PART II
BURN
PLAN
12
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World Health Organization
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c
o
m
e

c
o
u
n
t
r
i
e
s
.

R
e
g
i
o
n
a
l

m
e
e
t
i
n
g
s

o
f

t
h
o
s
e

i
n
v
o
l
v
e
d

i
n

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
.



2
0
0
8

2
0
0
9
2
0
0
9

o
n
w
a
r
d
s
2
0
0
9

o
n
w
a
r
d
s
2
0
0
9

o
n
w
a
r
d
s
W
o
r
k

w
i
t
h

j
o
u
r
n
a
l
i
s
t
s

a
n
d

t
h
e

m
e
d
i
a

t
o

i
n
c
r
e
a
s
e

t
h
e
i
r

i
n
t
e
r
e
s
t

i
n

a
n
d

i
n
v
o
l
v
e
m
e
n
t

w
i
t
h

b
u
r
n

c
o
n
t
r
o
l
.


I
n
c
r
e
a
s
e
d

n
u
m
b
e
r

o
f

a
r
t
i
c
l
e
s

a
p
p
e
a
r
i
n
g

i
n

t
h
e

m
e
d
i
a

o
n

t
h
e

b
u
r
d
e
n

o
f

b
u
r
n
s

a
n
d

a
d
v
o
c
a
t
i
n
g

f
o
r

p
o
t
e
n
t
i
a
l

s
o
l
u
t
i
o
n
s
.


2
0
0
8

o
n
w
a
r
d
s
N
G
O
,

N
o
n
g
o
v
e
r
n
m
e
n
t
a
l

o
r
g
a
n
i
z
a
t
i
o
n
.
1
.


C
o
l
l
a
b
o
r
a
t
i
n
g

c
e
n
t
r
e
s

c
u
r
r
e
n
t
l
y

i
n
c
l
u
d
e

C
e
n
t
r
e

d
e
s

B
r
u
l

s
,

H
o
s
p
i
t
a
l

S
a
i
n
t
-
L
u
c
,

L
y
o
n
,

F
r
a
n
c
e

a
n
d

t
h
e

M
e
d
i
t
e
r
r
a
n
e
a
n

C
o
u
n
c
i
l

f
o
r

B
u
r
n
s

a
n
d

F
i
r
e

D
i
s
a
s
-
t
e
r
s

(
M
B
C
)
.

A
d
d
i
t
i
o
n
a
l

i
n
s
t
i
t
u
t
i
o
n
s
,

p
a
r
t
i
c
u
l
a
r
l
y

t
h
o
s
e

f
r
o
m

l
o
w
-

a
n
d

m
i
d
d
l
e
-
i
n
c
o
m
e

c
o
u
n
t
r
i
e
s
,

w
i
l
l

b
e

e
n
c
o
u
r
a
g
e
d

t
o

b
e
c
o
m
e

W
H
O

c
o
l
l
a
b
o
r
a
t
i
n
g

c
e
n
t
r
e
s

o
n

b
u
r
n
s

i
n

t
h
e

f
u
t
u
r
e
.


BURN
PLAN
14
World Health Organization
2
.


P
O
L
I
C
Y
G
O
A
L
I
n
c
r
e
a
s
e

t
h
e

e
n
a
c
t
m
e
n
t

a
n
d

i
m
p
l
e
m
e
n
t
a
t
i
o
n

o
f

e
f
f
e
c
t
i
v
e
,

s
u
s
t
a
i
n
a
b
l
e

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e

p
o
l
i
c
i
e
s

w
o
r
l
d
w
i
d
e
,

i
n
c
l
u
d
i
n
g

a
c
t
i
o
n

p
l
a
n
s
,

l
e
g
i
s
l
a
-

t
i
o
n
,

r
e
g
u
l
a
t
i
o
n
s

a
n
d

e
n
f
o
r
c
e
m
e
n
t
.


A
R
E
A

O
F

W
O
R
K
P
R
O
D
U
C
T
S

A
N
D

O
U
T
P
U
T
S
T
I
M
E
L
I
N
E
I
n
c
o
r
p
o
r
a
t
e

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e

i
n
t
o

n
a
t
i
o
n
a
l

a
n
d

l
o
c
a
l

h
e
a
l
t
h

p
l
a
n
s

a
n
d

i
n
j
u
r
y

c
o
n
t
r
o
l

p
l
a
n
s
.


S
u
p
p
o
r
t

t
h
e

d
e
v
e
l
o
p
m
e
n
t

o
f

a
p
p
r
o
p
r
i
a
t
e

p
o
l
i
c
y

a
n
d

l
e
g
i
s
l
a
t
i
o
n

f
o
r

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e

b
y

c
o
u
n
t
r
i
e
s
.


P
o
l
i
c
y

s
t
a
t
e
m
e
n
t
s

a
n
d

g
u
i
d
e
l
i
n
e
s

o
n

b
u
r
n

p
r
e
v
e
n
t
i
o
n

l
e
g
i
s
l
a
t
i
o
n
,

r
e
g
u
l
a
t
i
o
n
s

a
n
d

e
n
f
o
r
c
e
m
e
n
t
.


A
p
p
r
o
p
r
i
a
t
e

i
n
f
o
r
m
a
t
i
o
n

t
o

s
u
p
p
o
r
t

p
o
l
i
c
y

r
e
c
o
m
m
e
n
d
a
t
i
o
n
s
,

s
u
c
h

a
s

e
s
t
i
m
a
t
e
s

o
f

c
o
s
t
-
e
f
f
e
c
t
i
v
e
n
e
s
s

o
f

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

t
r
e
a
t
m
e
n
t

s
t
r
a
t
e
g
i
e
s
.


2
0
0
8

o
n
w
a
r
d
s
2
0
0
8

o
n
w
a
r
d
s
I
n
c
r
e
a
s
e

t
h
e

n
u
m
b
e
r

o
f

c
o
u
n
t
r
i
e
s

t
h
a
t

h
a
v
e

a
n
d

a
r
e

i
m
p
l
e
m
e
n
t
i
n
g

l
e
g
i
s
l
a
t
i
o
n

a
n
d

p
o
l
i
c
i
e
s

o
n

b
u
r
n

p
r
e
v
e
n
t
i
o
n
,

s
u
c
h

a
s

p
o
l
i
c
i
e
s

o
n

s
m
o
k
e

d
e
t
e
c
t
o
r
s
,

s
e
t

t
e
m
p
e
r
a
t
u
r
e
s

o
f

h
o
t

w
a
t
e
r

h
e
a
t
e
r
s
,

a
m
e

r
e
s
i
s
t
a
n
t

c
h
i
l
d
r
e
n
s

s
l
e
e
p
w
e
a
r
,

r
e

a
n
d

e
l
e
c
t
r
i
c
a
l

c
o
d
e
s
,

s
a
f
e

s
t
o
v
e
s

a
n
d

R
e
d
u
c
e
d

I
g
n
i
t
i
o
n

P
r
o
p
e
n
s
i
t
y

(
R
I
P
)

c
i
g
a
r
e
t
t
e
s
,

i
n

l
o
c
a
t
i
o
n
s

w
h
e
r
e

t
h
e
s
e

w
o
u
l
d

b
e

a
p
p
r
o
p
r
i
a
t
e
.


I
n
c
r
e
a
s
e
d

n
u
m
b
e
r

o
f

c
o
u
n
t
r
i
e
s

t
h
a
t

r
e
c
e
i
v
e

a
n
d

u
t
i
l
i
z
e

g
u
i
d
a
n
c
e

f
r
o
m

W
H
O

o
n

p
o
l
i
c
i
e
s
,

s
t
r
a
t
e
g
i
e
s

a
n
d

r
e
g
u
l
a
t
i
o
n
s

o
n

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
.


I
n
c
r
e
a
s
e
d

n
u
m
b
e
r

o
f

c
o
u
n
t
r
i
e
s

w
i
t
h

n
a
t
i
o
n
a
l

h
e
a
l
t
h

i
n
s
u
r
a
n
c
e

p
l
a
n
s

t
h
a
t

i
n
c
l
u
d
e

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
.


2
0
0
8

o
n
w
a
r
d
s
2
0
0
9

o
n
w
a
r
d
s
BURN
PLAN
15
World Health Organization
3
.


D
A
T
A

A
N
D

M
E
A
S
U
R
E
M
E
N
T
G
O
A
L
F
a
c
i
l
i
t
a
t
e

a
n
d

e
n
h
a
n
c
e

t
h
e

c
o
l
l
e
c
t
i
o
n
,

a
n
a
l
y
s
i
s

a
n
d

d
i
s
s
e
m
i
n
a
t
i
o
n

o
f

d
a
t
a

o
n

b
u
r
n
s

(
i
n
c
l
u
d
i
n
g

d
a
t
a

o
n

m
o
r
t
a
l
i
t
y
,

m
o
r
b
i
d
i
t
y
,

h
e
a
l
t
h

i
m
p
a
c
t
s
,

d
i
s
a
b
i
l
i
t
y

a
n
d

a
s
s
o
c
i
a
t
e
d

c
o
s
t
s
)

a
t

t
h
e

c
o
u
n
t
r
y
,

r
e
g
i
o
n
a
l

a
n
d

g
l
o
b
a
l

l
e
v
e
l
s
.


A
R
E
A

O
F

W
O
R
K
P
R
O
D
U
C
T
S

A
N
D

O
U
T
P
U
T
S
T
I
M
E
L
I
N
E
I
m
p
r
o
v
e

G
l
o
b
a
l

B
u
r
d
e
n

o
f

D
i
s
e
a
s
e

(
G
B
D
)

e
s
t
i
m
a
t
e
s

a
n
d

n
a
t
i
o
n
a
l

d
a
t
a

o
n

b
u
r
n

d
e
a
t
h
s

a
n
d

d
i
s
a
b
i
l
i
t
i
e
s
.

I
d
e
n
t
i

c
a
t
i
o
n

o
f

e
x
i
s
t
i
n
g

c
o
u
n
t
r
y
-
l
e
v
e
l

b
u
r
n

s
u
r
v
e
y

a
n
d

s
u
r
v
e
i
l
l
a
n
c
e

d
a
t
a

f
o
r

u
s
e

i
n

G
B
D

e
s
t
i
m
a
t
e
s
.


2
0
0
8

o
n
w
a
r
d
s
P
r
o
m
o
t
e

t
h
e

i
n
c
l
u
s
i
o
n

o
f

b
u
r
n
-
r
e
l
a
t
e
d

q
u
e
s
t
i
o
n
s

i
n

n
a
t
i
o
n
a
l

D
e
m
o
g
r
a
p
h
i
c

a
n
d

H
e
a
l
t
h

S
u
r
v
e
y
s

(
D
H
S
)

a
n
d

o
t
h
e
r

s
u
r
v
e
y
s
.


A

s
e
t

o
f

k
e
y

q
u
e
s
t
i
o
n
s

w
h
i
c
h

c
o
u
l
d

b
e

i
n
c
l
u
d
e
d

i
n

f
o
r
m
s

f
o
r

s
u
r
v
e
i
l
l
a
n
c
e

a
n
d

i
n

q
u
e
s
t
i
o
n
n
a
i
r
e
s

f
o
r

s
u
r
v
e
y
s

s
u
c
h

a
s

t
h
e

D
H
S
.




2
0
0
8

2
0
0
9
P
r
o
m
o
t
e

t
h
e

i
n
c
l
u
s
i
o
n

o
f

m
o
r
e

d
e
t
a
i
l

o
n

m
e
c
h
a
n
i
s
m

o
f

i
n
j
u
r
y

a
n
d

d
e
t
a
i
l
s

o
f

t
r
e
a
t
m
e
n
t

f
o
r

f
a
t
a
l

b
u
r
n

c
a
s
e
s

r
e
c
o
r
d
e
d

i
n

m
o
r
t
u
a
r
y

d
a
t
a
b
a
s
e
s
.


A

s
e
t

o
f

k
e
y

q
u
e
s
t
i
o
n
s

w
h
i
c
h

c
o
u
l
d

b
e

i
n
c
l
u
d
e
d

w
i
t
h

d
a
t
a

e
l
e
m
e
n
t
s

g
a
t
h
e
r
e
d

f
o
r

m
o
r
t
u
a
r
y

d
a
t
a
b
a
s
e
s
.


2
0
0
8

2
0
0
9
H
a
r
m
o
n
i
z
e

d
a
t
a

g
a
t
h
e
r
i
n
g
,

f
o
r

e
x
a
m
p
l
e
,

b
y

W
H
O
,

n
a
t
i
o
n
a
l

h
e
a
l
t
h

d
a
t
a

s
y
s
t
e
m
s

a
n
d

o
t
h
e
r

g
r
o
u
p
s
,

o
n

t
h
e

b
u
r
d
e
n

o
f

b
u
r
n
s
.


S
t
r
e
n
g
t
h
e
n

h
e
a
l
t
h

i
n
f
o
r
m
a
t
i
o
n

s
y
s
t
e
m
s

f
o
r

b
u
r
n

d
a
t
a
,

i
n
c
l
u
d
i
n
g

s
t
a
n
d
a
r
d
i
z
i
n
g

d
a
t
a

g
a
t
h
e
r
e
d

i
n

a

v
a
r
i
e
t
y

o
f

s
p
e
c
i

c

c
i
r
c
u
m
s
t
a
n
c
e
s
,

i
n
c
l
u
d
i
n
g

b
u
r
n

a
d
m
i
s
s
i
o
n
s

(
e
.
g
.

t
r
a
u
m
a

r
e
g
i
s
t
r
i
e
s
)

a
n
d

b
u
r
n
s

t
r
e
a
t
e
d

i
n

e
m
e
r
g
e
n
c
y

d
e
p
a
r
t
m
e
n
t
s

(
e
.
g
.

m
i
n
i
m
u
m

d
a
t
a

e
l
e
m
e
n
t
s
)
.


I
n
c
r
e
a
s
e

q
u
a
l
i
t
y

o
f

b
u
r
n

d
a
t
a

f
o
r

u
s
e

i
n

r
i
s
k

f
a
c
t
o
r

a
n
a
l
y
s
i
s

t
o

p
r
o
v
i
d
e

r
m

s
c
i
e
n
t
i

c

b
a
s
i
s

f
o
r

p
r
e
v
e
n
t
i
o
n

e
f
f
o
r
t
s
.


G
r
e
a
t
e
r

u
s
e

o
f

e
x
t
e
r
n
a
l
-
c
a
u
s
e

c
o
d
e
s

f
o
r

b
u
r
n
s

i
n

h
o
s
p
i
t
a
l

d
a
t
a
b
a
s
e
s
.


S
t
a
n
d
a
r
d

c
h
a
r
t

f
o
r

b
u
r
n

a
d
m
i
s
s
i
o
n
s
,

w
h
i
c
h

w
o
u
l
d

b
e

u
s
e
f
u
l

f
o
r

c
l
i
n
i
c
a
l

c
a
r
e
,

r
e
c
o
r
d
-
k
e
e
p
i
n
g

a
n
d

d
a
t
a

g
a
t
h
e
r
i
n
g

(
s
e
p
a
r
a
t
e

o
n
e
s

w
o
u
l
d

n
e
e
d

t
o

b
e

d
e
v
e
l
o
p
e
d

f
o
r

g
e
n
e
r
a
l

h
o
s
p
i
t
a
l
s

a
n
d

f
o
r

b
u
r
n

c
e
n
t
r
e
s
)
.


U
p
d
a
t
e
d

s
t
a
n
d
a
r
d
s

f
o
r

b
u
r
n
/
t
r
a
u
m
a

r
e
g
i
s
t
r
y
,

w
h
i
c
h

h
a
d

b
e
e
n

i
n
c
l
u
d
e
d

i
n

t
h
e

o
r
i
g
i
n
a
l

B
u
r
n

K
i
t
.

S
t
a
n
d
a
r
d
i
z
e
d

q
u
e
s
t
i
o
n
n
a
i
r
e

f
o
r

d
a
t
a

g
a
t
h
e
r
i
n
g

i
n

m
o
r
e

d
e
p
t
h

i
n

c
o
m
m
u
n
i
t
y

s
t
u
d
i
e
s

o
r

f
o
r

u
s
e

i
n

h
o
s
p
i
t
a
l
s

i
n

o
n
e
-
t
i
m
e

s
t
u
d
i
e
s
.


2
0
0
8

o
n
w
a
r
d
s
2
0
0
8

2
0
0
9
2
0
0
8

2
0
0
9
2
0
0
8

2
0
0
9
I
n
c
r
e
a
s
e

d
i
s
s
e
m
i
n
a
t
i
o
n

o
f

d
a
t
a

o
n

t
h
e

b
u
r
d
e
n

o
f

b
u
r
n
s

a
n
d

t
h
e

b
e
n
e

t
s

o
f

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

t
r
e
a
t
m
e
n
t

s
t
r
a
t
e
g
i
e
s
.


A
l
l

o
f

a
b
o
v
e

p
r
o
d
u
c
t
s

a
n
d

o
u
t
p
u
t
s

p
l
u
s

t
h
o
s
e

l
i
s
t
e
d

i
n

a
d
v
o
c
a
c
y

s
e
c
t
i
o
n
.


2
0
0
8

o
n
w
a
r
d
s
D
H
S
,

D
e
m
o
g
r
a
p
h
i
c

a
n
d

H
e
a
l
t
h

S
u
r
v
e
y
;

G
B
D
,

G
l
o
b
a
l

B
u
r
d
e
n

o
f

D
i
s
e
a
s
e
.

BURN
PLAN
16
World Health Organization
4
.


R
E
S
E
A
R
C
H
G
O
A
L
S
I
d
e
n
t
i
f
y

k
e
y

r
e
s
e
a
r
c
h

n
e
e
d
s

i
n

t
h
e

e
l
d

o
f

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
,

s
e
t

a
n

a
g
e
n
d
a

o
f

p
r
i
o
r
i
t
i
e
s
,

a
n
d

e
n
s
u
r
e

t
h
a
t

i
n
f
o
r
m
a
t
i
o
n

o
n

t
h
e
s
e

p
r
i
o
r
i
t
i
e
s

i
s

a
v
a
i
l
a
b
l
e

t
o

r
e
s
e
a
r
c
h
e
r
s
,

g
o
v
e
r
n
m
e
n
t
s
,

d
o
n
o
r
s

a
n
d

o
t
h
e
r

s
t
a
k
e
h
o
l
d
e
r
s
.


P
r
o
m
o
t
e

a
n
d

f
o
s
t
e
r

t
r
i
a
l
s

o
f

p
r
o
m
i
s
i
n
g

i
n
t
e
r
v
e
n
t
i
o
n
s

f
o
r

p
r
e
v
e
n
t
i
n
g

b
u
r
n
s
,

e
s
p
e
c
i
a
l
l
y

i
n

l
o
w
-

a
n
d

m
i
d
d
l
e
-
i
n
c
o
m
e

c
o
u
n
t
r
i
e
s
.

A
R
E
A

O
F

W
O
R
K
P
R
O
D
U
C
T
S

A
N
D

O
U
T
P
U
T
S
T
I
M
E
L
I
N
E
D
e
v
e
l
o
p

a

r
e
s
e
a
r
c
h

a
g
e
n
d
a

f
o
r

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
,

t
o

i
n
c
l
u
d
e

a

l
i
s
t

o
f

h
i
g
h

p
r
i
o
r
i
t
y

r
e
s
e
a
r
c
h

q
u
e
s
t
i
o
n
s

a
n
d

p
o
t
e
n
t
i
a
l

r
e
s
e
a
r
c
h

p
r
o
j
e
c
t
s
,

a
n
d

w
h
i
c
h

e
n
c
o
m
p
a
s
s
e
s

e
p
i
d
e
m
i
o
l
o
g
i
c
/
e
t
i
o
l
o
g
i
c

a
s
p
e
c
t
s

o
f

b
u
r
n

i
n
j
u
r
y
,

p
r
e
v
e
n
t
i
o
n

p
r
o
g
r
a
m
m
e
s

a
n
d

t
h
e
i
r

e
v
a
l
u
a
t
i
o
n
,

c
l
i
n
i
c
a
l

c
a
r
e
,

o
u
t
c
o
m
e
s
,

c
o
s
t
i
n
g

a
n
d

c
o
s
t
-
e
f
f
e
c
t
i
v
e
n
e
s
s
.




A

t
a
s
k

f
o
r
c
e
/
n
e
t
w
o
r
k

o
f

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e

r
e
s
e
a
r
c
h
e
r
s
,

e
m
p
h
a
s
i
z
i
n
g

p
a
r
t
i
c
i
p
a
t
i
o
n

o
f

t
h
o
s
e

f
r
o
m

l
o
w
-

a
n
d

m
i
d
d
l
e
-
i
n
c
o
m
e

c
o
u
n
t
r
i
e
s
.


P
u
b
l
i
c
a
t
i
o
n

o
f

k
e
y

r
e
s
e
a
r
c
h

n
e
e
d
s
,

a

r
e
s
e
a
r
c
h

a
g
e
n
d
a
,

a
n
d

l
i
s
t
s

o
f

h
i
g
h

p
r
i
o
r
i
t
y

r
e
s
e
a
r
c
h

q
u
e
s
t
i
o
n
s

a
n
d

p
o
t
e
n
t
i
a
l

r
e
s
e
a
r
c
h

p
r
o
j
e
c
t
s
.
A

w
e
b

s
i
t
e

o
f

r
e
s
e
a
r
c
h

p
r
i
o
r
i
t
i
e
s

a
n
d

n
e
e
d
s

i
n

t
h
e

b
u
r
n

e
l
d
.

2
0
0
8

2
0
0
9
2
0
0
9

o
n
w
a
r
d
s
2
0
0
9

o
n
w
a
r
d
s
P
r
o
m
o
t
e

a
n
d

s
u
p
p
o
r
t

n
e
t
w
o
r
k
(
s
)

f
o
r

i
n
f
o
r
m
a
t
i
o
n

e
x
c
h
a
n
g
e

a
n
d

d
e
b
a
t
e

o
n

m
a
t
t
e
r
s

r
e
l
a
t
i
n
g

t
o

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
.


P
r
o
m
o
t
e

a
n
d

p
r
o
v
i
d
e

t
e
c
h
n
i
c
a
l

s
u
p
p
o
r
t

f
o
r

r
e
s
e
a
r
c
h

i
n
t
o

p
r
o
m
i
s
i
n
g

b
u
r
n

p
r
e
v
e
n
t
i
o
n

s
t
r
a
t
e
g
i
e
s
.


A
n

e
x
p
a
n
d
e
d

n
e
t
w
o
r
k

o
f

c
o
l
l
a
b
o
r
a
t
i
n
g

c
e
n
t
r
e
s
,

e
m
p
h
a
s
i
z
i
n
g

l
o
w
-

a
n
d

m
i
d
d
l
e
-
i
n
c
o
m
e

c
o
u
n
t
r
i
e
s
,

s
o

t
h
a
t

t
h
e
i
r

i
n
v
o
l
v
e
m
e
n
t

i
n

f
o
r
m
u
l
a
t
i
n
g

r
e
s
e
a
r
c
h

q
u
e
s
t
i
o
n
s

a
n
d

i
n

c
o
n
d
u
c
i
n
g

r
e
s
e
a
r
c
h

t
o

a
n
s
w
e
r

t
h
e
s
e

q
u
e
s
t
i
o
n
s

i
s

i
n
c
r
e
a
s
e
d
.


A

s
e
t

o
f

m
o
d
e
l

c
o
u
n
t
r
i
e
s

f
o
r

p
i
l
o
t
i
n
g

a
n
d

e
v
a
l
u
a
t
i
n
g

g
o
o
d

p
r
a
c
t
i
c
e
s

i
n

b
u
r
n

p
r
e
v
e
n
t
i
o
n

a
n
d

c
a
r
e
.


2
0
0
9

o
n
w
a
r
d
s
2
0
0
9

o
n
w
a
r
d
s
BURN
PLAN
17
World Health Organization
5
.


P
R
E
V
E
N
T
I
O
N
G
O
A
L
S
S
u
p
p
o
r
t

t
h
e

d
e
v
e
l
o
p
m
e
n
t

o
f

s
t
r
o
n
g
e
r

a
n
d

m
o
r
e

e
f
f
e
c
t
i
v
e

b
u
r
n

p
r
e
v
e
n
t
i
o
n

p
r
o
g
r
a
m
m
e
s

i
n

a
l
l

c
o
u
n
t
r
i
e
s
.

I
n
c
r
e
a
s
e

t
h
e

n
u
m
b
e
r

o
f

c
o
u
n
t
r
i
e
s

w
i
t
h

n
a
t
i
o
n
a
l

s
t
r
a
t
e
g
i
e
s

a
n
d

p
r
o
g
r
a
m
m
e
s

f
o
r

p
r
e
v
e
n
t
i
n
g

b
u
r
n
s
.

A
R
E
A

O
F

W
O
R
K
P
R
O
D
U
C
T
S

A
N
D

O
U
T
P
U
T
S
T
I
M
E
L
I
N
E
P
r
o
m
o
t
e

k
n
o
w
n

i
n
t
e
r
v
e
n
t
i
o
n
s

i
n

c
i
r
c
u
m
s
t
a
n
c
e
s

w
h
e
r
e

t
h
e
y

a
r
e

l
i
k
e
l
y

t
o

w
o
r
k

(
e
.
g
.

u
r
b
a
n
/
m
i
d
d
l
e

i
n
c
o
m
e

e
n
v
i
r
o
n
m
e
n
t
s
)
,

t
o

i
n
c
l
u
d
e

s
m
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2
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BURN
PLAN
18
World Health Organization
6
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2
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2
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2
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2
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0
9

o
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s
BURN
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BURN
PLAN
21
World Health Organization
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 PLAN
TWO-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
Dene key questions for surveillance and surveys
(e.g. Demographic and Health Surveys).
Dene 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.
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8. CONCLUSION
The major gaps in burn prevention and care have been identied 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) Insufcient scientic 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 insufcient numbers of people trained in the skills needed to
undertake the above spectrum of burn control activities.
WHOs 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-
ed 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.
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