urns are a global public health problem, accounting for an estimated 180,000 deaths annually (WHO 2018). Thermal (heat) burns occur when some or all of the cells in the skin or other tissues are destroyed by hot liquids (scalds), hot solids (contact burns), or flames (flame burns). The fire accidents among females are higher than among males. The higher risk for females is associated with open-fire cooking and unsafe cook-stoves. Loose clothing poses a risk of catching fire too. Along with adult women, children are particularly vulnerable to burns. Risk factors for domestic fires are poverty, overcrowding and young girls handling utensils in the kitchen. Underlying medical conditions like epilepsy and peripheral neuropathy also increase the risk of burn accidents. Alcohol abuse and cigarette smoking are also risk factors for fire accidents.

Common accidents reported at homes are kitchen fires, gas leakage igniting fire, hot bath injuries and electric appliances catching fire.

We have witnessed serious injuries, disfigurement, and prolonged hospitalisation due to such happenings. Many times, such accidents have led to deaths.

Education and community awareness are very important to prevent these accidents. If we ensure taking precautionary measures, such incidents can be avoided.

There is a need to educate family and friends. Initiatives in this regard should be taken through print media, TV and social media. Training and awareness sessions should be arranged at schools, offices and commercial organisations. It is important to encourage the use of smoke detectors, fire sprinklers and fire-escape systems in homes and working places. Promoting safer cook-stoves and less hazardous fuels and educating women regarding loose clothing in the kitchen can also help. Long scarves, shawls, and hanging sleeves have been reported to catch fire. Basic precautions such as cooking on the back burners of the stove when children are around and never holding a child while cooking can prevent the worst from occurring. The entrance to the kitchen can be protected by barriers for toddlers and young children. Family members should know the gas pipe and knob’s location; they must always be accessible. Gas knobs should be turned off before bed and leaving the house as a precautionary measure. All family members should know where the main supply shut-off valve is located outside the home so that it can be timely accessed in case of emergency. Keeping an emergency ladder on the upper floors of your home in case there is a fire is essential. The ladder must be kept in or near the room of an adult person or an older child who knows how to use it. Having a fire extinguisher in the kitchen and learning to use it can prevent fire-related accidents. One must avoid smoking in the house, especially if they are drowsy, on medication or in bed. Matches, lighters, chemicals and lit candles must at all costs be kept out of children’s reach. Replacing smoke alarms over ten years old is integral to home safety.

In case of emergency, do not panic. Be vigilant and act smartly. Be aware of warning signs and take appropriate measures. Immediately evacuate the house once a gas is suspected. A gas leak can be identified through its rotten odour and hissing sound. While exiting, open doors and windows. Turn off the gas supply. Do not strike a match stick or a lighter. Do not switch on a light or any electrical appliance if there is darkness. It can ignite a huge fire.

Education and community awareness are very important to prevent such accidents. If we ensure taking precautionary measures, such incidents can be avoided. There is a need to educate family and friends. Initiatives in this regard should be taken through print media, TV and social media. 

Hazardous chemicals like acids should not be placed in kitchen cabinets as many times mishandling has been a reason of severe acid burn injuries. Moreover, combustible liquids like insecticides, aerosol cans, paint thinners, nail polish removers, rubbing alcohol, gasoline and linseed oil should not be kept near stoves or fireplaces. Many uncontrollable fire accidents have been reported due to negligence in storing these products.

Hot water bath injuries are common in children and the elderly. Check the temperature of tap water using an elbow before putting in a child for bath or toilet wash. Set geysers/ water heaters at temperatures less than 120F. Check the temperature of food, soups and other hot beverages before serving them to children.

Whenever an electric appliance catches fire, first of all, cut off the electric supply. Spread a blanket to suppress flames. Baking soda (sodium bicarbonate) can be used too. Do not bring water close by.

To prevent electric fires, make sure all cords are free of fraying or cracking, and replace them if found damaged. Always pull out from the plug, not the cord, when unplugging electronics. Avoid using extension cords for too long. Unplug all appliances when not in use. Keep all electric appliances away from water sources. Never store combustible materials (clothes, papers, cleaning materials etc) close to your main power board. Always buy home appliances from reputable brands and follow the instructions supplied for installing and using them.

One should know the initial management steps. In case of emergency, call on 16 for fire brigade service. You may dial the 911 emergency number too. These contacts have been issued by the government of Pakistan. Flames can be extinguished by cutting the oxygen supply to the burning object by spreading a blanket or mud or by using water or fire extinguisher liquid. If a utensil containing oil/ ghee catches fire on the stove, do not shower water. The best way would be to turn off the stove knob and to cover that utensil with a lid. If your clothes catch fire, practice the stop, drop and roll routine. Stop where you are; drop to the ground and lie flat with your legs out straight, and cover your eyes and mouth with your hands; roll over and over and back and forth until the flames are out. Remove or dilute the chemical agent in chemical burns by irrigating with large volumes of water. Stay away from water in case of an electric fire.

In case of a burn injury, keep the wound under running tap water/ cool water for 20 minutes. Do not apply toothpaste, oil, haldi (turmeric) or raw cotton to the burn (recommended by WHO). Do not apply ice because it deepens the injury. Do not apply any material directly to the wound as it might become infected. Scrubbing the wound with povidone/iodine solution, chlorhexidine or other cleaning agents is not recommended. Cleaning the wound with sterile water/ normal saline is generally adequate to remove debris. Burn wounds heal best in moist—not wet—environments. Topical agents provide pain control, promote healing and prevent wound infection. Cover the wound with topical antibiotics like bacitracin and mupirocin. Silver sulfadiazine also promotes healing. Do not try to rupture blisters yourself as it can complicate the wound. The patient should be taken to a burn care facility at the earliest for evaluation and timely management. The risk of complications depends on how much surface area of the body is affected, the depth of the burn and the site of the burn on the body. Also, if a person is diabetic or is immunocompromised, an expert opinion is a must. If burns are in concerning areas of the body, such as the face, major joints, or genitalia, you must see your doctor immediately. If the burn seems deep, you have burn blisters, the burn site is very painful or the burn does not heal within two weeks, one should see their doctor for appropriate management.

The writer is a senior registrar in family medicine at Baqai Medical University