For burn survivors, aftermath will go on long after Oz fires end

by Marisa Olivia | February 9, 2009 at 08:06 am

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The bush fires throughout Victoria, Australia have so far claimed the lives of 173 people. Identification experts have relieved volunteer fire fighters in recovering those who have perished in the blazes, some of which are thought to have been started and re-lit by arsonists. Prime Minister Kevin Rudd has stated that the perpetrators can be described as nothing short of "mass-murderers."

Many fires have been brought under control, but up to 25 fires are still burning. The Country Fire Authority posts updated incident summaries here. Forecasters warn that temperatures, which have cooled slightly, could increase again this week. See the BBC's aerial images of Victoria here.

This tragedy will not end with the fires, however. Entire towns have burned down, and many people have lost their families, their homes, and their possessions.

For some, there is an even higher cost, and doctors are fearing for their lives.

Nearly 600 patients have presented to emergency departments in Victoria, said a spokesman for the state's Health Minister, Daniel Andrews. Of these 120 were admitted, 55 of them children.

Twenty-one patients were in intensive care last night, including two children.

Attending to burn injuries is an incredibly complex task, involving very sensitive and time-consuming care.

Burns used to be evaluated on a first- to third-degree basis. The terminology has since changed:

Superficial (1st degree) burns only affect the thin, top layer of the skin, causing pain, redness and swelling at the site of the burn but no blistering. Commonly caused by sunburn.

Partial thickness (2nd degree) burns affect both the outer and underlying layer of skin, causing pain, redness, swelling and blistering at the burn site. Deemed either superficial or deep second degree burns depending on the extent.

Full thickness (3rd degree) burns extend through and destroy both skin layers. As nerve endings have usually been destroyed in the skin layer, the site of full thickness burns is usually not painful, however burns of lesser depth surrounding this will remain painful. Skin cannot regenerate at the site of a full thickness burn, so depending on the site and extent of injury, skin graft alternatives may be required. Severe scarring can result with this level of burn and potential skin contractures may restrict movement especially if the burn site is over a joint

Fourth degree burns involve burns which penetrate through the skin to the muscles, tendons, bones and sometimes internal organs. Surgical intervention is critical for survival at this level.

External burns are not the only worry. High temperatures and smoke inhalation can lead to burning and damage to the lungs, a life-threatening condition.

Burns victims are highly susceptible to infection and many have added complications from inhalation injuries, in which lungs are burned and the bloodstream is poisoned by chemicals released by burning plastics and treated timber.

Mr Haertsch, of Concord Hospital, said those exposed to bushfire smoke could become ill with chemical pneumonia in the days after the event, even if they felt well. "They may feel OK now and not suspect they have inhalation injury, but three to four days down the line the inflammatory process kicks in and they need respiratory support."

This makes it crucial for people who have the slightest feeling that they may have been affected to immediately seek medical treatment.

Once admitted to a hospital, according to the Washington Hospital Center, initial treatment has five steps:

Fluid replacement is the most important part of initial burn treatment. The skin cannot survive without fluid replacement, and burns, at the most simplest explanation, remove the fluid from tissues.

Fluid replacement may result in a huge amount of swelling, as the burned tissue restricts other healthy tissue. Sometimes, an escharotomy is performed. A cut is made into the burned flesh to allow the skin to spread apart and reduce the pressure on the damaged and burned tissue. [This is especially important where a swollen face or chest may restrict breathing.]

Sometimes the burn patient's airway is damaged from inhalation or from actual burning. The patient may need to have a breathing tube down his or her throat to help him or her breathe. This is called intubation.

As soon as the patient is stabilized, and the physicians think he or she is strong enough for surgery, they may perform surgery to remove the damaged tissue.

In the meantime, applying skin grafts or skin substitutes (i.e., spray-on skin) within four days, as damaged tissue is removed, is necessary in order to protect exposed areas. The wounds may need to be dressed for weeks or months.

The healing process can take weeks to months to years, depending on the severity and location of the burns. Especially true with full-thickness burns, skin regeneration may be impossible, and even with skin grafts, the patients may not regain full function and mobility, especially if the burn is in a joint area. Burns can also kill or severely damage nerve endings. Extensive surgery, medication, and physical therapy can follow. Reconstructive surgery and psychological counseling are other parts of rehabilitation.

The experience of simply being in the hospital can be very traumatic. Severe patients need to be sedated in order to survive the pain, and many go in and out of surgery multiple times. There is a high psychological cost from being isolated in a hospital room and on a constant course of medication.

According to Heath Cleland, the director of the Victorian Adult Burns Service at The Alfred Hospital in Melbourne,

"The classic burns patterns that we are seeing is mostly due to people who have been forced to run through flames or have been exposed to extremely high radiant heat temperatures," she said.

'Most patients have significant feet and hand burns as well as involving their arms and lower legs especially."

Many also had facial burns but most were superficial.

Ms Cleland said skin substitutes and other treatments were being used on the patients, many of whom would undergo major operations in the next two days. Some may have limbs amputated. A team of social workers would also be at work.

One doctor said that the injuries were "far worse than the Bali bombings."

A major burn is one which covers more than 20 percent of the body. Of the twenty people admitted to Cleland's unit in the past 24 hours, all of them were over 30 percent, and nine had to be put on life support.

This is, by far, the most severe fire to hit Australia in all its history. Area hospitals have said that they are coping with the influx of patients, but according to news.com.au, the Alfred Hospital has since run out of morphine to treat burn patients. Those who face less than 20 percent burns are being sent to other hospitals.

The Australian government and other organizations have many resources for people who have survived burns from the fires:

Burn Foundation Australia offers job support and counseling.

Job Access is an Australian government site which offers information on disability assistance in the workplace.

The Alfred Hospital Burns Unit is currently treating many patients. They have information here.

For a complete article, from the University of Maryland Medical Center, on how to treat and recover from burns, including dietary recommendations, click here.

See also this article in The Australian on how hospitals and survivors will cope, and this by news.com.au, on the recovery process.

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Maireid Sullivan

at 13:29 on February 9th, 2009

Thank you for this excellent detailed report - and for the good advice. The fires are now about 7 miles from our place. We have tall eucalyptus trees in the garden, and we are two houses from a reserve full of them! Everything is so dry here now, especially after last week. We can see the smoke and some of the fire in the distance from our shops, which are higher up than us.

I have posted information here, from the ABC tv/radio website, which has the quickest updates.

UPDATE: State of shock, as fires burn whole towns

mattlokot

at 13:21 on February 9th, 2009

These photos are taken from Melbourne. In my area (Eastern Suburbs) we experienced quite a lot of smoke from the Bunyip fires, and were quite close to the Churchill Park fires when they happened last week. One of my workmates lives right next to where the Narre Warren fires were, where 6 homes were destroyed right in the middle of the suburbs.

I feel so strongly for those who have lost families and homes. The stories continue to affect me. I pray for their wellbeing and safety, especially in the months to come once this settles down.

mattlokot has contributed a photo to this story.

jeanamarie

at 13:51 on February 9th, 2009

The photos were taken between Colac and Camperdown south west of Melbourne. My husband and our girls were driving by on our way to the coast as the grass fire started. I cannot imagine how it must have felt to have one's entire town engulfed in flames as was happening to the north of Melbourne. My family continues to pray for survivors and those who have lost so, so much.

jeanamarie has contributed a photo to this story.

Amy Judd

at 15:02 on February 11th, 2009

I agree with Kevin Rudd here - if people are found to have started these fires, they should get exactly what is coming to them and I don't think it's violent of me to say that.

Maenad_au

at 22:11 on February 13th, 2009

At the time of taking this photo in Reservoir I thought I was just photographing a spectacular cloud blown in with the southerly cool change at the end of the hottest day in Victoria's history. Little did I realise, it was actually the smoke from fires that had wiped out the towns of Kinglake, Marysville, and others. Only the following Friday when we went Whittlesea to help out, did we realise how close to Melbourne's northern suburbs the fires had come.

Maenad_au has contributed a photo to this story.