Centre for Global Burn Injury Policy and Research goes from strength to strength in past 12 months

Swansea University’s Centre for Global Burn Injury Policy and Research is reflecting on 12 months worth of pioneering research and practice into helping tackle the global burns crisis.

This unique Centre – based at the University’s College of Human and Health Sciences – was set up in 2016 with the principal aim of providing evidence, developing policies and leading the way in burn care and prevention across the world, led by Professor Tom Potokar OBE.

This was aided by a £2m research grant that was secured last August through the National Institute for Health Research (NIHR). As a result, the Centre has been able to set up a Global Health Research Group on Burn Trauma in partnership with Interburns, the world’s leading global organisation for burn care and prevention. It is the only such Centre in the world that focuses on global burn injury.

The NIHR funded research has three main themes - capacity building and quality improvement, burn prevention and burns in conflict and mass casualty burns. There are key projects ongoing in different countries, with the focus from the research grant in Nepal – where burns account for around 5% of disabilities - Palestine and Ethiopia. Other funding supports work in Sierra Leone and Afghanistan.

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“The Centre is about how we can translate knowledge into action and how we can deliver quality improvement in the real-world environment,” said Potokar.

“We also look at impact, as well as education and training and whether that is helpful or not. It is very much a knowledge to action process and that has been supported by the University.”

According to the World Health Organisation (WHO), in India alone over one million people are moderately or severely burnt every year, with nearly 173,000 Bangladeshi children suffering the same consequences. Meanwhile, 95% of burns occur in low and middle-income countries and 70% of these injuries affect children. Furthermore, if burns aren’t treated properly it can lead to significant disability and deformity.

Capacity building and quality improvement

This focusses on existing burns services and builds on work done to develop international consensus standards for burns services. Assessment of services against these standards is done through a participatory process, which results in the production of a quality improvement scorecard and a tailored development programme for each service. This has led to improvements in 14 burn facilities in Nepal and Bangladesh, with the same process now being used elsewhere. The Centre has been working alongside local partners, one of which is Medical Aid for Palestinians, with the team helping to deliver training and education in both burns services in West Bank, in Nablus and Hebron.

“One of the training courses is now compulsory for all medical staff, and is delivered by local teams on a regular basis,” said Potokar.

“We have also been supporting them through specific workshops, based on their needs. We would carry out an assessment and then in discussion and participation with local teams, decide what their needs are and tailor training around that.”

With that being on an ongoing programme, the two hospitals in Nablus and Hebron are getting a level of support that might not have been possible previously, with the next step being to undertake community surveys to establish what the main causes of burns are so that a prevention strategy can be introduced.

Following success in West Bank, Potokar’s team were asked to replicate the process in nearby Gaza – something that wasn’t easily possible.

“Gaza is a difficult place to get in and out of, while its densely populated region has just two burns services to cover the entire population,” he said.

“A recent visit was used to establish relations, both with the clinicians and potential academic partners from within different institutes. This was extremely positive and a subsequent programme is about to start in the area.”

After an initial effort to improve the quality of the treatment of burns in low and middle income countries, Potokar’s team moved up to government level in a bid to influence strategy and policy, while at community level try to get to grips with the main factors that are contributing to the numbers of burn injuries.

This can be due to factors such as a lack of regular power supplies, which means people often use kerosene and open flame cooking facilities, coupled with overcrowding in dense areas and poor building regulations.

This leads to a high level of burns and the capacity to deal with such injuries are limited because there are very few staff who have received training in burn care, while there is also a shortage of burn centres around these communities.

In short, it equates to a hidden public health crisis.

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Burn prevention

Burn prevention is vitally important and before embarking on prevention programmes it is vital to understand the causes of burns injuries, as well as who they are affecting most. To this end, the Centre has engaged with research colleagues in Nepal, Ethiopia and Palestine as well as Sierra Leone to undertake community surveys to find out this information. An international workshop took place in Swansea earlier this year with experts from around the globe to look at the best ways to develop and deliver community prevention programmes, taking into account the knowledge gained from some of these community surveys. This work will continue over the next two years.

Burns in conflict and mass casualty burns

As is the case with high conflict environments, mass casualty burns are common while the burn care services within these regions simply do not have the capacity to deal with large numbers of injuries.

CGBIPR have been working closely with the World Health Organisation and last December hosted a meeting - Emergency Medical Teams Technical Working Group of Burns. As well as this, staff from the International Committee of the Red Cross will be attending the Advanced Burn Care Nursing Programme in Ethiopia in 2019, developed by Interburns, while Potokar’s team have also delivered training for Afghanistan and Syria and reviewed burn referral pathways in Iraq.

“We also have links with the George Institute whom we have been working with on community burn rehabilitation in India and John Hopkins University in Baltimore with the American University in Beirut who we are partnering with to look further at burn injury in conflict and fragile states,” said Potokar.

“We are also in the process of developing partnerships with Njala University in Sierra Leone after starting some work there recently, particularly looking at both community burn care and prevention.

“We have also been supporting a paediatric burns service in Kabul, while in Bangladesh we have been working with Interburns to support the National Burns Service.

“In short, we are looking at a long-term process in order to create sustainable change.”

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International attendees of the WHO-EMT meeting on mass burn casualties held in Swansea on 30th November and 1st December 2017.