WHO Fact Sheet

[Michael Peck]

Dear Friends on the ABA and ISBI Prevention Committees,
 
The WHO in Geneva has given me two weeks to revise the WHO Burn Fact Sheet (see attached).  Is anyone interested in sending me comments or suggestions?  I would appreciate your help.
 
For any "fact" or "factoid" you submit, I will need a reference.
 
Thanks,
 
Michael Peck

[Deb Jones]

Apply cool water, not cold water... and only 5-10 minutes. We're already fighting an uphill battle convincing "developed" countries to limit cool water applications in large burns and discouraging cold water or ice in any burn circumstance.

~Deb Jones



 

---

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CC: mo...@who.int
Subject: WHO Fact Sheet
Date: Mon, 15 Mar 2010 17:21:15 -0400

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[Michael Peck]

The ISBI Prevention Committee participated on the last revisions to the WHO Burn Fact Sheet prior to 2002 under the direction of Jacques Laterjet and David Mackie.  It was agreed that the definition should be improved for the next Burn Fact Sheet revision.

Over the next two years, a Delphi process was conducted with the members of the ISBI Prevention and Executive Committees to create a definition that would become the official ISBI definition of burns.

On Sept 24, 2006, the Executive Committee of the ISBI voted to approve the following definition:

A burn is an injury to the skin or other organic tissue primarily caused by thermal or other acute trauma. It occurs 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). Injuries to the skin or other organic tissues due to radiation, radioactivity, electricity, friction or contact with chemicals are also identified as burns.

In order to change the ISBI definition of burns, it would require passage of such a motion by the Executive Committee.  The ISBI definition will be provided to the staff of the WHO in consideration of its utilization in the revision of the Burn Fact Sheet.

However, any individual among you who wants to suggest an alternative definition to the WHO is free to do so. 

Thank you for your participation in this important process.

Mike

---

From: wibe...@hotmail.com
To: mpe...@hotmail.com
CC: aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; wibe...@hotmail.com; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; tom.p...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; jmo...@wfubmc.edu; mo...@who.int; andre...@surgery.cuhk.edu.hk; rba...@gmail.com; cinnam...@gmail.com
Subject: FW: WHO Fact Sheet
Date: Thu, 1 Apr 2010 13:41:03 +0000


Dear Michael:
 
The definition of burns that appears on the first page of the fact sheet,  is not quite clear, seems to me.
 
I know there has been wide discussion on the subject some time ago, and I dont have the definition that was finally adopted. But in order to further the interest  on the matter,  I think that the definition could be like this:
 
"a burn injury is the destruction of living tissue by action of a physical, chemical or biological agent"  
Physical agents are flames, hot or cold  solids,  hot liquids, electricity, radiation,   Chemical agents are acid or caustic.  Biological such as, some plants and animals.
The mechanism can be contact, scalds, explosion, electrocution
 
Greetings
 
Wilma
 

---

Subject: RE: WHO Fact Sheet
Date: Sat, 27 Mar 2010 23:29:24 +0800
From: andre...@surgery.cuhk.edu.hk
To: rba...@gmail.com; mpe...@hotmail.com; cinnam...@gmail.com
CC: aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; wibe...@hotmail.com; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; jmo...@wfubmc.edu; mo...@who.int

Rajeev, good work.

Michael are you redrafting the fact sheet? I think you should...it is fundamentally wrong and there is great scope for being far more positive about burns..

I  think you should emphasise

what significant improvements have been made,
what a major difference appropriate acute care would make if it were globally available
talk about cost-benefit and that investment in burns care is an  investment in life, long life; full, integrated and productive life: if treated acutely, appropriately. This is very different from investment in cancer services, transplant services etc. Make sure you get the colon and semi-colon right!

The anatomy is wrong...."different layers of cells in the skin".....I talk about irreversible denaturation of collagen and introduce the example of frying and egg.

Mention iatrogenic radiation burns...they are the most common I see...

310,000 in the introduction and 310,000 in the paragraph "Scope of the Problem" do not add up! Electrical and chemical burns can be, are, fatal.

Back of on gender issues....they are NOT globally relevant in this issue....it is a sad indictment of the democratization of India that has rendered it such a 'gender' divided country.....but not all are.

I think in fact if we really had the evidence to hand we could look at ethnic profiling and say that the incidence of burn injury rises with racially defined pigmentation and elevated levels of (racially independent) economic stress (aka poverty).

Forget gender inequality,  it is about power NOT gender And that in itself is an interesting observation...as the racial characteristics merge from brown to yellow the victim profile changes. The classically 'brown' women are more likely to be the victims but the 'yellow' women tend to more likely be the perpetrator. So again it is race NOT gender and you will have to see whether the WHO can face that reality. Same applies in the US.....never, ever, cross an hispanic lady! Particularly if you are....white? black? yellow, all of the above?

A 'considerable' number of burns in children are NOT due to abuse......most are tragic moments of inattention in loving and caring parents. Do not repeat the unproven in terms of a) abuse and b) malicious neglect and c) human error.


Moving on...other risk factors.

"Chemical used for assaults or defensive weapons"..that sounds like a load of nonsense.

Where do burns occur? Do NOT use the word 'victims' something far 'softer' but equally powerful should be used such as

"Where do burns occur?

Burns can occur anywhere; in the home, at work, in accidents whilst pursuing leisure activities, in the restaurant, barbacue, road traffic accidents. Most accidents however, and particularly those involving children and the elderly occur in the home. Architectural and cultural factors influence which areas of the home are most dangerous; in some it is the kitchen, in others the major living room and in others the bathroom. Generally the greatest incidence of burns in the home occur during either the preparation or consumption of food and drink.

In the workplace both men and women are exposed to potential dangers. Globally there has been a significant rise in health and safety at work , not just for humanitarian reasons but also for good business reasons. Accidents are costly in terms of interrupted production and potentially costly in terms of litigation. Nevertheless accidents do occur, in construction, heavy industry as well as very different occupations such as working in the kitchen of a restaurant.

Now this "The Burn Plan" reads like crap and needs to be translated into English..."multisectorial cooperation"  what nonsense....

The first mention in section 6...Services.."Acute Care"

We really need to think of the benefits globally of the improvement in acute care for burns...

The 'package' has to be.

Prevention through the education system...repeated to all children..the only way within a generation to get the message across; the same with first aid. So prevention and first aid must focus on the 79 year olds.

Enforcable legislation MUST be enforced eg flammable clothing kills. Make it a serious crime to sell it.

Some of the recommendations are a bit 'elitist' and just do not apply to the populations in whom the incidence is highest.

But better acute care.

Better physical and psychosocial reahabilitation and  these all lead to

better outcomes! (for relatively little investment of the health resource - for example twenty or more complex major burns for each liver transplant.)

With regard to first aid...the last bit.

Protect yourself and the environment and then:
1)remove the source of heat and
2)promote cooling.

It is that simple.  Use the word 'cool' rather than 'cold'  and leave it at that.

I agree with Shoba that ice can be effective in very small burns but it would be lethal in a larger burn.

Michael, perhaps you should have a look at this and think of the changes already suggested and send us your revised draft before you send it back to WHO...unless you would like me to do submit a revised version for the committee to review? My apologies by the way. Cannot attend but would have loved too.....family illness.

Istanbul does however now rate as the most expensive burns conference in the history of the ISBI but also has some cache by being associated with a right wing terrorist organization!

Let me know whether you want me to help you with the redrafting?,

Best wishes,

Andrew





-----Original Message-----
From: Rajeev Ahuja [mailto:rba...@gmail.com]
Sent: Sat 3/27/2010 2:28 PM
To: Michael Peck; cinnam...@gmail.com
Cc: aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; wilma beatriz lopez; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rahib ahuja; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; irma oen; deh...@pasasa.org; BURD, Andrew; ken dunn; doctor eloteify; joseph molnar; saf...@sltnet.lk; joseph molnar; charlie mock oms
Subject: Re: WHO Fact Sheet

Dear Mike & Cinnamon,



Thanks for the opportunity to comment on the fact sheet. My response is a
bit delayed as I have been researching on epidemiology, but I have been
following the thread of discussions very closely.

My comments:



There are an estimated 310,000 burn deaths worldwide





It will not be far fetched to state that the incidence of burns is
decreasing globally-at least with development of a nation, and as preventive
measures and safety devices are employed more appropriately and
expeditiously. According to Dr David Herndon's book the incidence of burn
injury in USA has decreased from 600/100000 population in 1985 to about
200/100000 population in 2001. This translates in to 1.5 million burn cases
in 1985 (for a population of 250 million in USA) decreasing to 0.6 million
cases in 2001 for a population of 300 million. Deaths from burns decreased
to a crude death rate of 1.33/100000.



Were we to apply this standard to 1 billion populations that lives in the
developed world there would be 13300 burn deaths, annually, in the developed
world.



For the rest of 6 billion people living in the developing countries we may
hypothetically split the figure in to 2 billion living in the second world
and 4 billion in the third world conditions.



In the 2 billion population living in the second world burns are of much
higher TBSA, adequate safety standards are not in place, there is not much
by way of preventive programs and there may be paucity of burn specialists
and dedicated burn beds, leaving a higher mortality. It may be safe to
estimate that currently the crude death figures in these countries may be
2.2/100000 deaths, something the USA had 15 years back. If this be true,
then these countries will have annual burn deaths around 2.2 x 20000= 44000



For the remaining 4 billion people living in the third world poverty and
illiteracy are over riding factors in living conditions. The fuel used for
cooking and lighting is mainly kerosene, getting gradually replaced by
liquefied petroleum (which is some what safer but still quite unsafe).
Kerosene stoves are of extremely poor design and don't comply with any
safety standard or regulation ( I wonder if Elbie managed to get them
standardized in South Africa). They are prone to malfunction or explode.
Lighting lamps are unstable by design (Dr Godakumbura). (As Wilma has
mentioned children are permitted in to kitchens to cook and use these
appliances). Burn patients report with an average of 40% TBSA burns, they
come late to hospitals as transportation is still a problem, there is
extreme shortage of burn beds (India will have about 450 dedicated burn beds
for 1.2 billion population), there are not many surgeons caring for burn
patients, and the countries have no safety standards (and even if some laws
exist they are not implemented vigorously) or preventive programs applicable
countrywide. Most of the burn centers in India report 40-50% mortality
amongst burn patients because of above factors. It may be safe to assume a
crude mortality rate of 6/100000 in this region (it could be higher). With
this estimate there would be about 6 x 40000= 240000 burn deaths in this
region.





It's very fortuitous that WHO estimated for its earlier fact sheet (printed
some 10 years back) annualized global burn related deaths as 310,000,
something which may be coming true by current calculations.





Just getting carried over by figures! I referred to the burn fact sheet of
ABA (2007) which shows there were 40000 burn admissions and 4000 burn
related deaths for a population of 300 million I USA. If we directly
extrapolate this for India's 1.2 billion populations we will have 160000
burn admissions in India by USA standards of safety. It could be 200,000
admissions if we were to slightly adjust for social index. And, if 40-50% of
these admissions are dying (as reported by many publications from India)
then we have 80,000 to 100,000 burn deaths, annually, in India alone.





Either of these calculations may be useful in drafting an epidemiology
statement on annual, global burn deaths which is more reflecting of the
current situation.





   - More than one million people suffer moderate to severe burns in India
   each year.



*Burn Injuries Receiving Medical Treatment Per Year in USA: 500,000 (ABA
Fact sheet 2007). *

* *

*The figures for India are easy to calculate by above parameters. They
obviously exceed 1 million.*

* *

* *

   - In the USA, there are nearly 61,000 annual hospitalizations due to
   burns.

* *

*Comments as in ABA fact sheet 2007*- 40000 burn admissions**





The average duration of days missed from school or work due to burns in
Bangladesh is 22 and 23 days, respectively.





I doubt if they have a burn Registry in Bangladesh. How was this figure
reached?



 For kitchen accidents and cooking mishaps-fuel safety etc I will request
you to refer to our publications below. They will also provide an insight in
to epidemiology trends.



*Ahuja RB, *Bhattacharya S, Rai A.          Changing trends of an endemic
trauma.<http://www.ncbi.nlm.nih.gov/pubmed/19427125?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum>
Burns. 2009 Aug;35(5):650-6.



*Ahuja, R.B.*; Bhattacharya, S.        Burns in the developing world & burn
disasters. In ABC of Burns, Brit. Med. J. 329/7463: p447-449, 2004.



*Ahuja,R.B*.; Bhattacharya, S.        An analysis of 11196 burn admissions
and evaluation of conservative management techniques. *Burns* 28: 555-561,
2002





Apply cold water or allow the burnt area to remain in contact with cold
water.



We normally advise *tap water* for cooling, like many others in India. I
know it can get very cold in winter in Scandinavia and North America etc but
then these countries have water mixers at home, and the population is
educated, so *tap water* can be advised at 20-22 oC. It is difficult to
expect first aid with ideal water temperatures in emergency situations.





Rajeev

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[Michael Peck]

Andrew,
 
You are welcome to submit a motion to the ISBI Executive Committee to begin a process to revise the definition.
 
However, you may want to tone down your language a bit, because many of them were part of the process that created the definition.
 
As were your fellow members of the Prevention Committee...
 
Mike

 

---

Subject: RE: WHO Fact Sheet

Date: Fri, 2 Apr 2010 09:20:18 +0800
From: andre...@surgery.cuhk.edu.hk
To: mpe...@hotmail.com; wibe...@hotmail.com
CC: aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; jmo...@wfubmc.edu; mo...@who.int; rba...@gmail.com; cinnam...@gmail.com

Michael, who ever voted for such a definition as was agreed is clearly not in the field of clinical burns care!

"Skin or other organic tissue"..what is an "organic tissue"?!    just say tissue...the rest is nonsense

"caused by thermal or other acute trauma" .....absolute nonsense....."acute trauma" includes far more mechanisms of injury than burns:  cuts, bruises, crush etc

"cells in the skin or other tissues" yes but protein denaturation is the major problem

"radiation, radioactivity" what is the difference? wavelength or section of the em spectrum.

Michael the definition is nonsense and the ISBI Prevention Committee with you as Chairman should speak out and say so otherwise the ISBI will appear as a bunch of wallies if it tries to put this into the WHO fact sheet.

personal opinion only but reasoned and based on science and empiriscism and a reasonable command of the English language.

Happy Easter everyone!

Andrew
HK

NB Delphi process should not be used for definitions of fact but just in the  prediction of possibility

-----Original Message-----
From: Michael Peck [mailto:mpe...@hotmail.com]
Sent: Fri 4/2/2010 2:19 AM
To: Wilma de Benavides
Cc: ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Joseph Molnar; Charles Mock; BURD, Andrew; Rajeev Ahuja; cinnam...@gmail.com
Subject: RE: WHO Fact Sheet

The ISBI Prevention Committee participated on the last revisions to the WHO Burn Fact Sheet prior to 2002 under the direction of Jacques Laterjet and David Mackie.  It was agreed that the definition should be improved for the next Burn Fact Sheet revision.

Over the next two years, a Delphi process was conducted with the members of the ISBI Prevention and Executive Committees to create a definition that would become the official ISBI definition of burns.

On Sept 24, 2006, the Executive Committee of the ISBI voted to approve the following definition:

A burn is an injury to the skin or other organic tissue primarily
caused by thermal or other acute trauma. It occurs 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). Injuries
to the skin or other organic tissues due to radiation, radioactivity,
electricity, friction or contact with chemicals are also identified as
burns.

In order to change the ISBI definition of burns, it would require passage of such a motion by the Executive Committee.  The ISBI definition will be provided to the staff of the WHO in consideration of its utilization in the revision of the Burn Fact Sheet.

However, any individual among you who wants to suggest an alternative definition to the WHO is free to do so. 

Thank you for your participation in this important process.

Mike

From: wibe...@hotmail.com
To: mpe...@hotmail.com
CC: aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; wibe...@hotmail.com; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; tom.p...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; jmo...@wfubmc.edu; mo...@who.int; andre...@surgery.cuhk.edu.hk; rba...@gmail.com; cinnam...@gmail.com
Subject: FW: WHO Fact Sheet
Date: Thu, 1 Apr 2010 13:41:03 +0000









Dear Michael:



The definition of burns that appears on the first page of the fact sheet,  is not quite clear, seems to me.



I know there has been wide discussion on the subject some time ago, and I dont have the definition that was finally adopted. But in order to further the interest  on the matter,  I think that the definition could be like this:



"a burn injury is the destruction of living tissue by action of a physical, chemical or biological agent" 

Physical agents are flames, hot or cold  solids,  hot liquids, electricity, radiation,   Chemical agents are acid or caustic.  Biological such as, some plants and animals.

The mechanism can be contact, scalds, explosion, electrocution



Greetings



Wilma

[Michael Peck]

 

---

Subject: Urgent...on elbows!
Date: Thu, 29 Apr 2010 18:43:03 +0800

From: andre...@surgery.cuhk.edu.hk
To: mpe...@hotmail.com; wibe...@hotmail.com

CC: aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; jmo...@wfubmc.edu; mo...@who.int; rba...@gmail.com; cinnam...@gmail.com

Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in  a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked.  The nurse is understandably going through hell.

 

I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature.  This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!

 

It strikes me that this is a load of nonsense but what are the facts!

 

Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.

 

best wishes,

 

Andrew

 

For what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.

 

 

 

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,
Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

!

[Jimenez, Desiree]

This is the information that we give to families concerning scald prevention.

·         Never leave hot beverages, soups or food unattended or within reach of a curious toddler.

·         Set your hot water heater to 120°.

·         Test your water temperature with a candy or water thermometer.

·         Always test the water temperature with your hand for at least 30 seconds before placing your child in the tub.

·         While cooling hot liquids or soups from the microwave keep them out of reach of children and away from counters or tables.

 

 

Desiree Jimenez, EMT-B

Multi Skilled Burn Technician

The Children's Hospital Burn Program

13123 East 16th Ave., B467

Aurora, CO  80045

720-777-6603

jimenez...@tchden.org

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[burnprev]

The real issue is not so much with which body part did the nurse test
the water, but did she test it at all before putting the infant into
the water. If she did not, then there may well be grounds for
negligence. Most prevention interventions I have seen recommend
passing ones hand with open fingers back and forth through the water
to test the temperature. As you well know, the skin on the elbows is
much thicker than the skin on the back of the hand and thus is a less
senitive to detecting dangerously hot temperatures.

Dan


On Apr 29, 2:09 pm, "Jimenez, Desiree" <Jimenez.Desi...@tchden.org>
wrote:

> This is the information that we give to families concerning scald prevention.
>
> ·         Never leave hot beverages, soups or food unattended or within reach of a curious toddler.
>
> ·         Set your hot water heater to 120°.
>
> ·         Test your water temperature with a candy or water thermometer.
>
> ·         Always test the water temperature with your hand for at least 30 seconds before placing your child in the tub.
>
> ·         While cooling hot liquids or soups from the microwave keep them out of reach of children and away from counters or tables.
>
> Desiree Jimenez, EMT-B
> Multi Skilled Burn Technician
> The Children's Hospital Burn Program
> 13123 East 16th Ave., B467
> Aurora, CO  80045
> 720-777-6603

> jimenez.desi...@tchden.org
> [cid:image001....@01CAE794.CF1311F0]

>
> From: aba-pre...@googlegroups.com [mailto:aba-pre...@googlegroups.com] On Behalf Of Michael Peck
> Sent: Thursday, April 29, 2010 11:47 AM
> To: ABA Prevention Committee
> Subject: FW: Urgent...on elbows!
>
> ________________________________
> Subject: Urgent...on elbows!
> Date: Thu, 29 Apr 2010 18:43:03 +0800

> From: andrewb...@surgery.cuhk.edu.hk
> To: mpec...@hotmail.com; wibena...@hotmail.com
> CC: aba-pre...@googlegroups.com; fiona.w...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhachama...@gmail.com; rbah...@vsnl.com; Tom.Poto...@swansea-tr.wales.nhs.uk; tom.poto...@abm-tr.wales.nhs.uk; tom.poto...@wales.nhs.uk; barbara-laten...@uiowa.edu; amrmabr...@hotmail.com; kcjudk...@aol.com; sd.mac...@wxs.nl; o...@mcrz.nl; deh...@pasasa.org; ken.d...@uhsm.nhs.uk; dr_elote...@hotmail.com; jmol...@triad.rr.com; safe...@sltnet.lk; jmol...@wfubmc.edu; mo...@who.int; rbah...@gmail.com; cinnamondi...@gmail.com

> Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in  a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked.  The nurse is understandably going through hell.
>
> I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature.  This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!
>
> It strikes me that this is a load of nonsense but what are the facts!
>
> Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.
>
> best wishes,
>
> Andrew
>
> For what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.
>
> Professor Andrew Burd. MB ChB MD FRCSEd FHKAM
> Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
> Department of Surgery,
> Chinese University of Hong Kong
> Prince of Wales Hospital,
> Shatin, NT
> Hong Kong.
>

> email: andrewb...@surgery.cuhk.edu.hk<mailto:andrewb...@surgery.cuhk.edu.hk>

> tel:        (852).2632.2639
> fax:       (852).2632.4675
>
> ________________________________

> !<http://search.msn.com/results.aspx?q=windows+vista&mkt=en-US&form=QBRE>

> --
> You received this message because you are subscribed to the Google Groups "ABA Prevention" group.
> To post to this group, send email to aba-pre...@googlegroups.com.
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> 12KViewDownload

[Brunner, Margaret L]

I agree with Dan! I have never heard of using the elbow to check the water temp. (Having been a new Mom and A burn nurse for more decades than I care to count) And in some cases you would have to be a contortionist to get your elbow into position to check the water temp. Hand or wrist would make sense.

Margaret Brunner, RN, BAN, CCRN
Clinical Care Supervisor
Burn Center
Henepin County Medical Center
701 Park Ave.
Minneapolis, MN 55415
612-873-2915
pager: 612-336-0498
fax: 612-904-4221
Margaret...@hcmed.org

www.hcmc.org

[Wilma Yu]

Its an old time method from the days when women poured boiling water from
the kettle into big wash tubs to bathe the kids.

Wil


Wilma Yu, RN, MS, CEN
Yu Consultants, Inc
30 Boulder Brook Dr
Wilmington, DE 19803
302-750-7491
FAX: 302-764-2013
yu...@verizon.net


On 4/29/10 5:40 PM, "Brunner, Margaret L" <Margaret...@hcmed.org>
wrote:

[jcusic...@cox.net]

Mike, Dan and All -

I'm older than many of you and do remember hearing about testing bath water with an elbow but don't know where I heard it and it was long, long ago. For the past 2 decades I've taught to use the hand with fingers open and spread and moving your hand through the water to test and mix. I was curious about what other organizations are recommeinding so went to some of the following websites.

A question to consider asking is whether the hospital/city/country/governing body have any regulations about the maximum water temperature that is coming out of the tap/faucet/outlet. At the hospital I used to work for the temperature was set to be no higher than 110 degrees F at the tap and when i did some random checks in the burn center, it usually came out even lower than that. That may increase liability for the hospital but decrease it for the nurse.

Red Cross: I searched scalds, got directed to the babysitter course and could find no reference to how to test bath water.

NFPA from the Educational Messages Advisory Committee: "Fill the tub or sink, running cool water first and then add hot water. Turn hot water off first. Mix the water thoroughly and check the temperature by moving your hand, wrist, and forearm through the water. The water should feel warm to the touch."

Safe Kids Worldwide: "Bath time: Check the water with your wrist or elbow before placing your baby in the shower or bath."

CPSC, USFA and FEMA: a quick search did not produce any results on prevention tap water scald burns. It may be there but I sure couldn't find it easily.

ABA website and Burn Prevention Scald Prevention Campaign: "Fill tub to desired level and turn water off before getting in. Run cool water first, then add hot. Turn hot water off first. This can prevent scalding in the event someone should fall in while the tub is filling. Mix the water thoroughly and check the temperature by moving your elbow, wrist or fingers with spread fingers through the water before allowing someone to get in. The water should feel warm, hot to touch."
The last sentence of the above bullet point doesn't make sense though and might need to be edited ( does the word "NOT" need to be inserted before the word "HOT"?. I was involved in the first version of this campaign and had the opportunity to review it when it was revised and was surprised to see that we included the elbow as an option for testing. Go figure!!!!!

Dan - An interesting research project for the ABA Burn Prevention Committee might be to test the accuracy of testing water temperature with different body parts so we can make recommendations to educators and parents/caregivers based on science not urban myths and "that's the way we've always done it." Surely there is some organization that would fund this and it would fit in well with your long-range scald prevention campaign.

Hope you are all having a great spring! I hope we hear the results from Hong Kong and that the nurse turns out okay.

Janet Cusick Jost

> > </pre>---------------------------------------------------------------------­------------------------------------------------<br>

[Burn Prevention Foundation]

Thanks Janet. Your suggestion for a BPC research project on how to
accurately gauge the safety of hot/warm water is an interesting one that I
will present to the group. Also, as you have uncovered, we must scrutinize
our own messaging to eliminate contradictions and misleading statements.

Dan

B. Daniel Dillard
Executive Director
Burn Prevention Foundation

-----Original Message-----
From: aba-pre...@googlegroups.com
[mailto:aba-pre...@googlegroups.com] On Behalf Of jcusic...@cox.net
Sent: Friday, April 30, 2010 10:27 AM
To: burn...@fast.net; ABA Prevention
Subject: Re: Urgent...on elbows!

[Michael Peck]

 

---

Subject: RE: Urgent...on elbows!
Date: Fri, 30 Apr 2010 09:38:26 +0800
From: andre...@surgery.cuhk.edu.hk
To: rba...@gmail.com; jmo...@wfubmc.edu
CC: mpe...@hotmail.com; wibe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com

Many thanks for all the comments so far.

 

It has been ascertained that the temperature of the water was most probably in the region of 45 degrees Celsius (113 degrees Fahrenheit for our American friends). The baby is three months old and did not cry during bathing.

 

Was in the water for two to three minutes.

 

When the nurse was drying the baby she noticed some blistering of the skin of the lower limbs. Subsequently extended to 14% BSA and the baby was transferred to a PICU in the south of HK. I have not been able to see either the baby or the photographs but apparently baby is fine and not needing surgery.

 

Headlines in today's paper: "Scalded baby's nurse admits making an error"  and the error? She did not use her elbow to test the water temperature! Apparently all the nursing schools in HK tell the nurses to test the water with the elbow. Parents want compensation and the nurse to be sacked.

 

Something so simple and it is to do with Burns Prevention.  The mixer tap would deliver water at 48 degrees centigrade so that is too high a temperature. Thermometers are not perfect. I have asked my Face book friends this question and yes there seem to be two diverging schools of thought....the thinkers and the doers! The former use hands, thermometers, wrists and anything but the scragg end of the chickens neck (the human elbow) and those that follow grandmothers advice..well they do dip the scragg end of the chickens neck in the water!

 

Does anyone remember the Eusol debate?

 

So how can one sensitively educate the nurse educators?!

 

For all doctors replying to this can you take a straw poll of your nursing colleagues to see how they respond to the question "How do you test the temperature of the water before bathing a three month old baby in a bath?".

 

Best wishes to all.

 

Andrew

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

From: Rajeev Ahuja [mailto:rba...@gmail.com]

Sent: Friday, April 30, 2010 8:59 AM
To: Joseph Molnar
Cc: BURD, Andrew; Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: Re: Urgent...on elbows!

This seems like the most sensible and scientific reasoning to me by far.

Rajeev Ahuja

On Fri, Apr 30, 2010 at 6:24 AM, Joseph Molnar <jmo...@wfubmc.edu> wrote:

Joe,

We did a mathematical model of a contact burn a few years ago based on the work of Moritz and Henriques (American Journal of Pathology, 1940's, 3 articles).
Raphael, Florin Despa and I looked at specific macromolecules and how they denature as a function of temperature. The bottom line is that in the US, there are plumbing standards to keep water from exiting the tap of less than 120 deg F. This is nicely summarized in the following website (its an expert witness website but seems accurate):


http://www.hgexperts.com/article.asp?id=5135
Seems like this is a lack of plumbing standards and not which part of the body can sense temperature the best, (an unreliable metric - that's why we have thermometers).

Best,

do

Dennis P. Orgill, M.D., Ph.D.
Professor of Surgery
Assistant Program Director
Combined Plastic Surgery Residency
Harvard Medical School
Associate Chief, Plastic Surgery
Brigham and Women's Hospital
75 Francis St.
Boston, MA 02115
 ▼ 617-732-5456
 ▼ 617-732-6397
dor...@partners.org

---

From: BURD, Andrew [mailto:andre...@surgery.cuhk.edu.hk]
Sent: Thursday, April 29, 2010 6:43 AM

To: Michael Peck; Wilma de Benavides

Cc: ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Joseph Molnar; Charles Mock; Rajeev Ahuja; cinnam...@gmail.com
Subject: Urgent...on elbows!

Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in  a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked.  The nurse is understandably going through hell.

 

I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature.  This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!

 

It strikes me that this is a load of nonsense but what are the facts!

 

Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.

 

best wishes,

 

Andrew

 

For what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.

 

 

 

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk

tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

!

--
Dr. Rajeev B. Ahuja
Secretary, ISBI
Secretary General, IPRAS-Asia Pacific Section
Chair, IPRAS 2009
Head, Department of Burns & Plastic Surgery,
Lok Nayak Hospital & assoc. Maulana Azad Medical College,
New Delhi -110002
Phone: 011-23231871
Fax: 011-23222756

[Combs, Elena]

WOW!  This really generated a lot of response from the Burn Prevention Committee.  My question is:  did the hospital have a policy on how to bathe the babies and does that policy state that they must test the bath water with their elbows?  I was born in the Philippines and my grandmother was Chinese.  I helped my mother with my younger siblings and tested the bath water (usually in a basin) with our open hands.  Is it a traditional way in Hongkong to use the elbows? 

 

Elena Combs

Burn Unit Coordinator

Shriners Hospital for Children

2425 Stockton Blvd.

Sacramento, California 95817

Tel.#:   (916)453-2111

Fax:    (916)453-2370

e-mail: eco...@shrinenet.org

---

From: Michael Peck [mailto:mpe...@hotmail.com]
Sent: Thursday, April 29, 2010 10:47 AM
To: ABA Prevention Committee
Subject: FW: Urgent...on elbows!

CONFIDENTIALITY NOTICE: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients. If you are not the intended recipient, (or authorized to receive for the recipient) you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please destroy all copies of this communication and any attachments and contact the sender by reply e-mail or telephone (813) 281-0300.

[burnprev]

Mike,

Thanks for the additional updates. Let us know what the ultimate
outcome is on this case. In addition to the light this discussion has
shed on our own need to clarify and standardize our prevention
messaging, I also learned that the elbow is also referred to as the
"scragg end of a chicken's neck." That being the case, I can't wait to
hear more colorful descriptions of other interesting body parts!

Regards,
Dan

On Apr 30, 11:37 am, Michael Peck <mpec...@hotmail.com> wrote:
> Subject: RE: Urgent...on elbows!
> Date: Fri, 30 Apr 2010 09:38:26 +0800

> From: andrewb...@surgery.cuhk.edu.hk
> To: rbah...@gmail.com; jmol...@wfubmc.edu
> CC: mpec...@hotmail.com; wibena...@hotmail.com; aba-pre...@googlegroups.com; fiona.w...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhachama...@gmail.com; rbah...@vsnl.com; Tom.Poto...@swansea-tr.wales.nhs.uk; tom.poto...@abm-tr.wales.nhs.uk; tom.poto...@wales.nhs.uk; barbara-laten...@uiowa.edu; amrmabr...@hotmail.com; kcjudk...@aol.com; sd.mac...@wxs.nl; o...@mcrz.nl; deh...@pasasa.org; ken.d...@uhsm.nhs.uk; dr_elote...@hotmail.com; jmol...@triad.rr.com; safe...@sltnet.lk; mo...@who.int; cinnamondi...@gmail.com

>
> Many thanks for all the comments so far.
>
> It has been ascertained that the temperature of the water was most probably in the region of 45 degrees Celsius (113 degrees Fahrenheit for our American friends). The baby is three months old and did not cry during bathing.
>
> Was in the water for two to three minutes.
>
> When the nurse was drying the baby she noticed some blistering of the skin of the lower limbs. Subsequently extended to 14% BSA and the baby was transferred to a PICU in the south of HK. I have not been able to see either the baby or the photographs but apparently baby is fine and not needing surgery.
>
> Headlines in today's paper: "Scalded baby's nurse admits making an error"  and the error? She did not use her elbow to test the water temperature! Apparently all the nursing schools in HK tell the nurses to test the water with the elbow. Parents want compensation and the nurse to be sacked.
>
> Something so simple and it is to do with Burns Prevention.  The mixer tap would deliver water at 48 degrees centigrade so that is too high a temperature. Thermometers are not perfect. I have asked my Face book friends this question and yes there seem to be two diverging schools of thought....the thinkers and the doers! The former use hands, thermometers, wrists and anything but the scragg end of the chickens neck (the human elbow) and those that follow grandmothers advice..well they do dip the scragg end of the chickens neck in the water!
>
> Does anyone remember the Eusol debate?
>
> So how can one sensitively educate the nurse educators?!
>
> For all doctors replying to this can you take a straw poll of your nursing colleagues to see how they respond to the question "How do you test the temperature of the water before bathing a three month old baby in a bath?".
>
> Best wishes to all.
>
> Andrew
>
> Professor Andrew Burd. MB ChB MD FRCSEd FHKAM
>
> Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
>
> Department of Surgery,
>
> Chinese University of Hong Kong
>
> Prince of Wales Hospital,
>
> Shatin, NT
>
> Hong Kong.
>

> email: andrewb...@surgery.cuhk.edu.hk
>
> tel:        (852).2632.2639
>
> fax:       (852).2632.4675

>
> From: Rajeev Ahuja [mailto:rbah...@gmail.com]
> Sent: Friday, April 30, 2010 8:59 AM
> To: Joseph Molnar
> Cc: BURD, Andrew; Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.Poto...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnamondi...@gmail.com
> Subject: Re: Urgent...on elbows!
>
> This seems like the most sensible and scientific reasoning to me by far.
> Rajeev Ahuja
>

> On Fri, Apr 30, 2010 at 6:24 AM, Joseph Molnar <jmol...@wfubmc.edu> wrote:
>
> Joe,
>
> We did a mathematical model of a contact burn a few years ago based on the work of Moritz and Henriques (American Journal of Pathology, 1940's, 3 articles).
>
> Raphael, Florin Despa and I looked at specific macromolecules and how they denature as a function of temperature. The bottom line is that in the US, there are plumbing standards to keep water from exiting the tap of less than 120 deg F. This is nicely summarized in the following website (its an expert witness website but seems accurate):
>
> http://www.hgexperts.com/article.asp?id=5135
>
> Seems like this is a lack of plumbing standards and not which part of the body can sense temperature the best, (an unreliable metric - that's why we have thermometers).
>
> Best,
>
> do
>
> Dennis P. Orgill, M.D., Ph.D.
>
> Professor of Surgery
>
> Assistant Program Director
>
> Combined Plastic Surgery Residency
>
> Harvard Medical School
>
> Associate Chief, Plastic Surgery
>
> Brigham and Women's Hospital
>
> 75 Francis St.
>
> Boston, MA 02115
>
>  ▼ 617-732-5456
>
>  ▼ 617-732-6397
>

> dorg...@partners.org

>
> From: BURD, Andrew [mailto:andrewb...@surgery.cuhk.edu.hk]
> Sent: Thursday, April 29, 2010 6:43 AM
>
> To: Michael Peck; Wilma de Benavides

> Cc: ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.Poto...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Joseph Molnar; Charles Mock; Rajeev Ahuja; cinnamondi...@gmail.com

> Subject: Urgent...on elbows!
>
> Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in  a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked.  The nurse is understandably going through hell.
>
> I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature.  This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!
>
> It strikes me that this is a load of nonsense but what are the facts!
>
> Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.
>
> best wishes,
>
> Andrew
>
> For what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.
>
> Professor Andrew Burd. MB ChB MD FRCSEd FHKAM
> Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
>
> Department of Surgery,
>
> Chinese University of Hong Kong
>
> Prince of Wales Hospital,
>
> Shatin, NT
>
> Hong Kong.
>

> email: andrewb...@surgery.cuhk.edu.hk
>
> tel:        (852).2632.2639
>
> fax:       (852).2632.4675
>

[Michael Peck]

 

---

Subject: RE: Urgent...on elbows!
Date: Sat, 1 May 2010 07:38:16 +0800
From: andre...@surgery.cuhk.edu.hk
To: Ken....@UHSM.NHS.UK; rba...@gmail.com; jmo...@wfubmc.edu
CC: mpe...@hotmail.com; wibe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com

Kenn, you are a star!

Two things. The first relates to the matter you are describing of holding the infant. One of my Indian colleaugues described just what you are mentioning as a 'cultural imprint' with holding the baby with one hand supporting the head and the other cradling the buttock and back as the baby is lowered into the water and yes, dipping the elbow into the water as it is the only part free. But "the elbow test" as described in the nursing manuals and many internet sites and as illustrated in many  of the sites relates to the preparation of the bath BEFORE the baby is picked up and the isolated elbow being dipped into the bath.

The second point is the one that you have picked up on that the whole story is  a little bizzare and from all accounts the burns on the lower limbs were not confluent. Now we know about sparing of the flexure aspects of the scalded immersion burn because of the reflex contracture but in this case apparently there was a 'tide' mark between normal and erythematous skin about the buttocks but the lateral aspect of the left thigh and the entire right thigh were unburned and then the bilateral lower leg and feet were burned eitih exfoliation of skin and blistering.

I have been told that that baby has been investigated for dermatological disease and I did ask that very question about bleach for cleaning the bath but i was tole that the bath was not cleaned between baby baths!

Altogether fascinating but certainly the issue of "the elbow test" needs to be discussed with our nursing colleagues. the earliest reference I have found so far is a column in the Palm Springs Daily from 1931 in which a lady columnist is writing about children's issues and begins her piece by saying that every home containing children should possess a thermometer!

Perhaps you could pass this onto Keith as the AOL server blocks emails fro China and my posts do not get through to him.

Best wishes to all in Manchester,

Andrew


-----Original Message-----
From: Ken Dunn [mailto:Ken....@UHSM.NHS.UK]
Sent: Sat 5/1/2010 4:51 AM
To: BURD, Andrew; Rajeev Ahuja; Joseph Molnar
Cc: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!

Andrew,
I have read the emails with interest and agree this matter seems to be very odd and unfair.
I add these comments on testing of water with the elbow hestitantly because as a mere man they may seem a tad 'left field' these days. You and I have had cause as modern chaps to bathe our offspring and have no problems safely balancing a baby in one hand/arm and testing the water with another. I recall my days as an med student doing obstetrics when both we and the student midwives were told to ALWAYS hold the babay with both hands. I believe my mother and others were taught to do the same in case their grip and balance proved inadequate and they dropped the infant. Thus the only portion of exposed skin available to test the water with was the elbow. The reason for this is a simply strength issue. Holding babies with one hand takes a bit of arm strength. It is safer to use two if the biceps are a tad weaker.
I do not doubt that the thick and battered skin of the elbow is less sensative than the back of the hand but I suspect this type of historic teaching is the basis of this 'custom and practice'.
I must also observe that if the nurse was bathing the baby with her hands immersed in the water and neither she, nor the child, complained of the heat, then I wonder if some other mechanism is at play here that may have caused the subsequent skin changes. Residual bleach in the sink? Dermatological disease in the infant? Just wondered.
Regards,
Ken
________________________________
From: BURD, Andrew [andre...@surgery.cuhk.edu.hk]
Sent: 30 April 2010 02:38
To: Rajeev Ahuja; Joseph Molnar
Cc: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!

Many thanks for all the comments so far.

It has been ascertained that the temperature of the water was most probably in the region of 45 degrees Celsius (113 degrees Fahrenheit for our American friends). The baby is three months old and did not cry during bathing.

Was in the water for two to three minutes.

When the nurse was drying the baby she noticed some blistering of the skin of the lower limbs. Subsequently extended to 14% BSA and the baby was transferred to a PICU in the south of HK. I have not been able to see either the baby or the photographs but apparently baby is fine and not needing surgery.

Headlines in today's paper: "Scalded baby's nurse admits making an error"  and the error? She did not use her elbow to test the water temperature! Apparently all the nursing schools in HK tell the nurses to test the water with the elbow. Parents want compensation and the nurse to be sacked.

Something so simple and it is to do with Burns Prevention.  The mixer tap would deliver water at 48 degrees centigrade so that is too high a temperature. Thermometers are not perfect. I have asked my Face book friends this question and yes there seem to be two diverging schools of thought....the thinkers and the doers! The former use hands, thermometers, wrists and anything but the scragg end of the chickens neck (the human elbow) and those that follow grandmothers advice..well they do dip the scragg end of the chickens neck in the water!

Does anyone remember the Eusol debate?

So how can one sensitively educate the nurse educators?!

For all doctors replying to this can you take a straw poll of your nursing colleagues to see how they respond to the question "How do you test the temperature of the water before bathing a three month old baby in a bath?".

Best wishes to all.

Andrew


Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,

Department of Surgery,

Chinese University of Hong Kong

Prince of Wales Hospital,

Shatin, NT

Hong Kong.

email: andre...@surgery.cuhk.edu.hk<mailto:andre...@surgery.cuhk.edu.hk>

tel:        (852).2632.2639

fax:       (852).2632.4675



________________________________

From: Rajeev Ahuja [mailto:rba...@gmail.com]

Sent: Friday, April 30, 2010 8:59 AM
To: Joseph Molnar

Cc: BURD, Andrew; Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com

Subject: Re: Urgent...on elbows!

This seems like the most sensible and scientific reasoning to me by far.
Rajeev Ahuja

On Fri, Apr 30, 2010 at 6:24 AM, Joseph Molnar <jmo...@wfubmc.edu<mailto:jmo...@wfubmc.edu>> wrote:

Joe,

We did a mathematical model of a contact burn a few years ago based on the work of Moritz and Henriques (American Journal of Pathology, 1940's, 3 articles).

Raphael, Florin Despa and I looked at specific macromolecules and how they denature as a function of temperature. The bottom line is that in the US, there are plumbing standards to keep water from exiting the tap of less than 120 deg F. This is nicely summarized in the following website (its an expert witness website but seems accurate):

http://www.hgexperts.com/article.asp?id=5135

Seems like this is a lack of plumbing standards and not which part of the body can sense temperature the best, (an unreliable metric - that's why we have thermometers).

Best,

do

Dennis P. Orgill, M.D., Ph.D.

Professor of Surgery

Assistant Program Director

Combined Plastic Surgery Residency

Harvard Medical School

Associate Chief, Plastic Surgery

Brigham and Women's Hospital

75 Francis St.

Boston, MA 02115

 ? 617-732-5456

 ? 617-732-6397

dor...@partners.org<mailto:dor...@partners.org>

________________________________
From: BURD, Andrew [mailto:andre...@surgery.cuhk.edu.hk<mailto:andre...@surgery.cuhk.edu.hk>]

Sent: Thursday, April 29, 2010 6:43 AM

To: Michael Peck; Wilma de Benavides

Cc: ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk<mailto:Tom.P...@swansea-tr.wales.nhs.uk>; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Joseph Molnar; Charles Mock; Rajeev Ahuja; cinnam...@gmail.com<mailto:cinnam...@gmail.com>

Subject: Urgent...on elbows!

Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in  a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked.  The nurse is understandably going through hell.

I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature.  This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!

It strikes me that this is a load of nonsense but what are the facts!

Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.

best wishes,

Andrew

For what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.




Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,

Department of Surgery,

Chinese University of Hong Kong

Prince of Wales Hospital,

Shatin, NT

Hong Kong.

email: andre...@surgery.cuhk.edu.hk<mailto:andre...@surgery.cuhk.edu.hk>

tel:        (852).2632.2639

fax:       (852).2632.4675



________________________________

!<http://search.msn.com/results.aspx?q=windows+vista&mkt=en-US&form=QBRE>

--
Dr. Rajeev B. Ahuja
Secretary, ISBI
Secretary General, IPRAS-Asia Pacific Section
Chair, IPRAS 2009
Head, Department of Burns & Plastic Surgery,
Lok Nayak Hospital & assoc. Maulana Azad Medical College,
New Delhi -110002
Phone: 011-23231871
Fax: 011-23222756

________________________________
This e-mail and any files transmitted with it are confidential and solely for the use of the intended recipient. If you have received this e-mail in error you should not disseminate, distribute or copy it. Please notify the sender immediately and delete this e-mail from your system.

[Michael Peck]

 

---

From: Ken....@UHSM.NHS.UK
To: andre...@surgery.cuhk.edu.hk; rba...@gmail.com; jmo...@wfubmc.edu

CC: mpe...@hotmail.com; wibe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com

Date: Fri, 30 Apr 2010 21:51:01 +0100

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk

tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

From: Rajeev Ahuja [mailto:rba...@gmail.com]

Sent: Friday, April 30, 2010 8:59 AM
To: Joseph Molnar
Cc: BURD, Andrew; Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: Re: Urgent...on elbows!

This seems like the most sensible and scientific reasoning to me by far.

Rajeev Ahuja

On Fri, Apr 30, 2010 at 6:24 AM, Joseph Molnar <jmo...@wfubmc.edu> wrote:

Joe,

We did a mathematical model of a contact burn a few years ago based on the work of Moritz and Henriques (American Journal of Pathology, 1940's, 3 articles).
Raphael, Florin Despa and I looked at specific macromolecules and how they denature as a function of temperature. The bottom line is that in the US, there are plumbing standards to keep water from exiting the tap of less than 120 deg F. This is nicely summarized in the following website (its an expert witness website but seems accurate):


http://www.hgexperts.com/article.asp?id=5135

Seems like this is a lack of plumbing standards and not which part of the body can sense temperature the best, (an unreliable metric - that's why we have thermometers).

Best,

do

Dennis P. Orgill, M.D., Ph.D.
Professor of Surgery
Assistant Program Director
Combined Plastic Surgery Residency
Harvard Medical School
Associate Chief, Plastic Surgery
Brigham and Women's Hospital
75 Francis St.
Boston, MA 02115

 ▼ 617-732-5456
 ▼ 617-732-6397
dor...@partners.org

---

From: BURD, Andrew [mailto:andre...@surgery.cuhk.edu.hk]

Sent: Thursday, April 29, 2010 6:43 AM

To: Michael Peck; Wilma de Benavides

Cc: ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom.P...@swansea-tr.wales.nhs.uk; Tom Potokar; Tom Potokar; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Joseph Molnar; Charles Mock; Rajeev Ahuja; cinnam...@gmail.com
Subject: Urgent...on elbows!

Dear Michael and fellow member of the prevention committee...breaking news in Hong Kong. A baby has been accidentally scalded whilst in  a public hospital and the investigation panel deemed that because she had not tested the temperature of the water with her elbow she was negligent and will be disciplined. The parents are clambering for her to be sacked.  The nurse is understandably going through hell.

 

I am trying to find any evidence to support or refute the "elbow test" as a matter of urgency. There are those who are claiming it is a world wide practice to test the temperature of the water with the elbow. My preliminary research indicates that it has as much justification as many urban myths and the only justification I can find is the comment that the hands are used to water and therefore not so sensitive to the temperature whilst the elbow is not so used to water and so is more sensitive to the temperature.  This explains why grandma used to say test the temperature of milk on the wrist and the temperature of water by the elbow..but is grandma's explanation justification for sacking nurse?!

 

It strikes me that this is a load of nonsense but what are the facts!

 

Please let me know your thoughts on this asap as we have to nip this in the bud one way or the other.

 

best wishes,

 

Andrew

 

For what it is worth I have raised four children and given countless baths but never used my elbow!! Oh and it was not my hospital and have no personal involvement but I do care about the child and the parents but also about the nurse.

 

 

 

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk

tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

!

--
Dr. Rajeev B. Ahuja
Secretary, ISBI
Secretary General, IPRAS-Asia Pacific Section
Chair, IPRAS 2009
Head, Department of Burns & Plastic Surgery,
Lok Nayak Hospital & assoc. Maulana Azad Medical College,
New Delhi -110002
Phone: 011-23231871
Fax: 011-23222756

---

This e-mail and any files transmitted with it are confidential and solely for the use of the intended recipient. If you have received this e-mail in error you should not disseminate, distribute or copy it. Please notify the sender immediately and delete this e-mail from your system.

[Michael Peck]

 

---

From: wibe...@hotmail.com
To: andre...@surgery.cuhk.edu.hk; rba...@gmail.com; jmo...@wfubmc.edu
CC: mpe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; tom.p...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!
Date: Tue, 4 May 2010 16:45:08 +0000


Andrew:  I did my homework and asked several nurses how do they test the water temperature before bathing a baby, either newborn or three months old. Among those, a head of a nursing school.
 
The answer is unanimous:  first of all, a themomether is the tool  and the water should be at 35.5 degrees, but not more than 37. degrees celcius.   In case of lack of thermomether, the elbow should be  used, since the hand is thought to have lost sensitivity to warm objects because of constant contact.  Note that I am repeating nurses'information.
 
Bathing  a newborn is not done as routine as before, but only cleaning the skin.
 
You told us that the temperature of the water in your case was 45 degree celcius.  Let me quote Dr. Hugo Linares,  "Tratado de Quemaduras"  by Bendlin, Linares and Benaim, 1993,  pg.119,:
 
 "Temperature of agent as well as duration of contact and thickness of the skin  will determine the depth of burn:  Between 45 and 50 debrees celcius,  5 minutes of contact will produce a serious burn. (it does not say Full thickness)  2 minutes  contact will be enough at 52 de degrees, 30 seconds at 54, 10 s at 57  etc  and 1 second will cause a full thickness burn at 70 degrees."
 
If it is truth that the temperature was 45,  I would belive that a  short two minute exposure would cause a superficial second degree burn , which seems to be the case
 
What is extrange is that neither the baby cried, not the nurse had any discomfort during the bath.
 
My best regards
 
Wilma

 
 

---

Subject: RE: Urgent...on elbows!

Date: Fri, 30 Apr 2010 09:38:26 +0800
From: andre...@surgery.cuhk.edu.hk
To: rba...@gmail.com; jmo...@wfubmc.edu
CC: mpe...@hotmail.com; wibe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; Tom.P...@swansea-tr.wales.nhs.uk; tom.p...@abm-tr.wales.nhs.uk; tom.p...@wales.nhs.uk; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com

Many thanks for all the comments so far.

 

It has been ascertained that the temperature of the water was most probably in the region of 45 degrees Celsius (113 degrees Fahrenheit for our American friends). The baby is three months old and did not cry during bathing.

 

Was in the water for two to three minutes.

 

When the nurse was drying the baby she noticed some blistering of the skin of the lower limbs. Subsequently extended to 14% BSA and the baby was transferred to a PICU in the south of HK. I have not been able to see either the baby or the photographs but apparently baby is fine and not needing surgery.

 

Headlines in today's paper: "Scalded baby's nurse admits making an error"  and the error? She did not use her elbow to test the water temperature! Apparently all the nursing schools in HK tell the nurses to test the water with the elbow. Parents want compensation and the nurse to be sacked.

 

Something so simple and it is to do with Burns Prevention.  The mixer tap would deliver water at 48 degrees centigrade so that is too high a temperature. Thermometers are not perfect. I have asked my Face book friends this question and yes there seem to be two diverging schools of thought....the thinkers and the doers! The former use hands, thermometers, wrists and anything but the scragg end of the chickens neck (the human elbow) and those that follow grandmothers advice..well they do dip the scragg end of the chickens neck in the water!

 

Does anyone remember the Eusol debate?

 

So how can one sensitively educate the nurse educators?!

 

For all doctors replying to this can you take a straw poll of your nursing colleagues to see how they respond to the question "How do you test the temperature of the water before bathing a three month old baby in a bath?".

 

Best wishes to all.

 

Andrew

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

From: Rajeev Ahuja [mailto:rba...@gmail.com]

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

!

--
Dr. Rajeev B. Ahuja
Secretary, ISBI
Secretary General, IPRAS-Asia Pacific Section
Chair, IPRAS 2009
Head, Department of Burns & Plastic Surgery,
Lok Nayak Hospital & assoc. Maulana Azad Medical College,
New Delhi -110002
Phone: 011-23231871
Fax: 011-23222756

---

Connect to the next generation of MSN Messenger  Get it now!

[Michael Peck]

 

---

Subject: RE: Urgent...on elbows!

Date: Tue, 4 May 2010 17:01:19 +0800
From: andre...@surgery.cuhk.edu.hk
To: Tom.P...@wales.nhs.uk; rba...@gmail.com; jmo...@wfubmc.edu
CC: mpe...@hotmail.com; wibe...@hotmail.com; aba-pre...@googlegroups.com; fiona...@health.wa.gov.au; fio...@mccomb.org.au; ae...@worldonline.co.za; shobhac...@gmail.com; rba...@vsnl.com; barbara-...@uiowa.edu; amrma...@hotmail.com; kcju...@aol.com; sd.m...@wxs.nl; oe...@mcrz.nl; deh...@pasasa.org; ken....@uhsm.nhs.uk; dr_el...@hotmail.com; jmo...@triad.rr.com; saf...@sltnet.lk; mo...@who.int; cinnam...@gmail.com

Sorry...this is the correct one....!

 

http://blogs.bmj.com/bmj/2010/04/30/andrew-burd-on-elbows-and-burning-babies/

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

From: Tom Potokar (ABM ULHB - Burns & Plastics) [mailto:Tom.P...@wales.nhs.uk]
Sent: Tuesday, May 04, 2010 4:08 PM
To: BURD, Andrew; Rajeev Ahuja; Joseph Molnar
Cc: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!

Hi Andrew,

A couple of comments..you mention that the water was 45 degrees. If you put your hand into 45 degress you would immediately remove it as it is certainly extremely uncomfortable (different from if you are in bath at 40 degrees and slowly increase the temp.) I am therefore suprised that the nurse was able to bathe the baby in this temp and also very suprised that there was no (apparent) screaming from the child. The elbow dipping business seems like nonsense to me and reflects more the sort of practice that Hattie Jaques would have done in a carry on film than any baring on evidence or reality.

Reghards

Tom

 

Mr Tom Potokar FRCS(Ed); FRCS(Plast); DA(UK); DTM&H

Consultant Plastic Surgeon

Senior Clinical Tutor

Director Interburns

 

Welsh Centre for Burns & Plastic Surgery

Canolfan Llosgiadau a Llawfeddygaeth Blastig Cymru

 

Email: Tom.P...@wales.nhs.uk

Tel:0044 (0)1792 702222 ext 4574 (Secretary)

---

From: BURD, Andrew [andre...@surgery.cuhk.edu.hk]
Sent: 30 April 2010 02:38
To: Rajeev Ahuja; Joseph Molnar

Cc: Michael Peck; Wilma de Benavides; ABA Prevention Committee; Fiona Wood; Fiona Wood; Elbie van der Merwe; Shobha Chamania; Rajeev Ahuja; Tom Potokar (ABM ULHB - Burns & Plastics); Tom Potokar (ABM ULHB - Burns & Plastics); Tom Potokar (ABM ULHB - Burns & Plastics); Barbara Latenser; Amr Reda Mabrouk; Keith Judkins; David Mackie; Irma Oen; Dehran Swart; Ken Dunn; Mahmoud El-Oteify; Joseph Molnar; Wijaya Godakumbura; Charles Mock; cinnam...@gmail.com
Subject: RE: Urgent...on elbows!

Many thanks for all the comments so far.

 

It has been ascertained that the temperature of the water was most probably in the region of 45 degrees Celsius (113 degrees Fahrenheit for our American friends). The baby is three months old and did not cry during bathing.

 

Was in the water for two to three minutes.

 

When the nurse was drying the baby she noticed some blistering of the skin of the lower limbs. Subsequently extended to 14% BSA and the baby was transferred to a PICU in the south of HK. I have not been able to see either the baby or the photographs but apparently baby is fine and not needing surgery.

 

Headlines in today's paper: "Scalded baby's nurse admits making an error"  and the error? She did not use her elbow to test the water temperature! Apparently all the nursing schools in HK tell the nurses to test the water with the elbow. Parents want compensation and the nurse to be sacked.

 

Something so simple and it is to do with Burns Prevention.  The mixer tap would deliver water at 48 degrees centigrade so that is too high a temperature. Thermometers are not perfect. I have asked my Face book friends this question and yes there seem to be two diverging schools of thought....the thinkers and the doers! The former use hands, thermometers, wrists and anything but the scragg end of the chickens neck (the human elbow) and those that follow grandmothers advice..well they do dip the scragg end of the chickens neck in the water!

 

Does anyone remember the Eusol debate?

 

So how can one sensitively educate the nurse educators?!

 

For all doctors replying to this can you take a straw poll of your nursing colleagues to see how they respond to the question "How do you test the temperature of the water before bathing a three month old baby in a bath?".

 

Best wishes to all.

 

Andrew

 

Professor Andrew Burd. MB ChB MD FRCSEd FHKAM

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

From: Rajeev Ahuja [mailto:rba...@gmail.com]

Chief of Division of Plastic, Reconstructive and Aesthetic Surgery,
Department of Surgery,

Chinese University of Hong Kong
Prince of Wales Hospital,
Shatin, NT
Hong Kong.

email: andre...@surgery.cuhk.edu.hk
tel:        (852).2632.2639
fax:       (852).2632.4675

 

---

!

--
Dr. Rajeev B. Ahuja
Secretary, ISBI
Secretary General, IPRAS-Asia Pacific Section
Chair, IPRAS 2009
Head, Department of Burns & Plastic Surgery,
Lok Nayak Hospital & assoc. Maulana Azad Medical College,
New Delhi -110002
Phone: 011-23231871
Fax: 011-23222756

Cymraeg;-
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