Perspectives in Disease Prevention and Health Promotion Motor Vehicle-Related Burn Injuries -- Massachusetts

To assess the importance of motor vehicles in causing persons to be hospitalized with burns, data were analyzed for Massachusetts residents burned in Massachusetts between July 1, 1978, and June 30, 1979, and treated as hospital inpatients in any of the 240 acute-care hospitals participating in the New England Regional Burn Program (NERBP).*

Of the 1,237 persons hospitalized for burns, 127 (10%) were hospitalized for motor vehicle-related burns. The incidence rate for these persons was 2.3 burns per 100,000 person-years. The rate varied considerably by age and sex (Table 1). The burn rate for males was approximately nine times that for females, accounting for 13% of all males hospitalized with burns in Massachusetts during the study period. For each sex, individuals 15-24 years old experienced the highest burn rates and accounted for half of all persons with vehicle-related burns.

Flame burns, associated with gasoline from carburetors, and scald burns from radiators were the most common types of injury, accounting for 35% and 32%, respectively, of all reported burns (Table 2). Burns from contact with hot tail pipes or engine surfaces accounted for an additional 14%, and 15% of burns were caused by vehicle crashes.

The average length of hospital stay for the 127 hospitalized burn patients was 12.9 days (11.9 days for males; 21.2 days for females) (Table 2). Burns associated with vehicle crashes had the longest average stays, attributable in part to the need for medical treatment of other injuries sustained during the crash.

A strong seasonal variation in the incidence of vehicle-related burns was evident, with the estimated peak occurring in mid-July (Figure 1). Thirty-six percent of all vehicle-related burns occurred in June or July, and 61% occurred during the 4 months of May through August. Reported by AM Rossignol, ScD, JA Locke, MPH, CM Boyle, MPH, JF Burke, MD, Dept of Civil Engineering, Tufts University, Medford, Massachusetts; Div of Injury Epidemiology and Control, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: October 6-12 is Fire Prevention Week,** an appropriate time to consider the importance of fire- and burn-related injuries and the effectiveness of prevention efforts. Fires and burns, which cause about 6,000 deaths per year, are the fourth most common cause of death from unintentional injury, surpassed only by motor vehicle crashes, falls, and drownings. Over a million burn injuries each year require medical attention or restriction of activity. Each year, 90,000 patients are admitted to hospitals, and patients with burns require over a million days of hospital care--an average of 12 days of hospital care per admission. Severely burned patients may need skin grafting and frequently suffer disability, disfigurement, and emotional distress (1).

House fires account for approximately 75% of all deaths from fires and burns (2). Most deaths result from the toxic byproducts of combustion (1). Fatality rates are highest among young children and the elderly, who have difficulty escaping fires and reduced likelihood of survival after burn injuries. Cigarettes are the leading cause of fatal residential fires. High blood alcohol concentrations are found in about 50% of adults who die in house fires (2).

The U.S. Department of Health and Human Services has included reducing burn injuries in its 1990 objectives for the nation: (1) by 1990, residential fire deaths should be reduced to no more than 4,500 per year (between 1978 and 1982, annual residential fire deaths decreased by 900 per year); and (2) by 1990, at least 75% of residential units should have a properly placed and functioning smoke detector (smoke detector installation increased from 50% in 1980 to 67% in 1982) (2).

Many preventive measures have been recommended to save lives and to decrease injuries caused by fires and burns. Smoke detectors (alarms) provide an early warning of fire. Several studies have suggested that smoke detectors reduce the risk of death from fires (3,4); protection is increased if sprinkler systems are also used (4). More effort is needed to ensure that smoke detectors are not only installed but are also functioning properly, especially among groups at highest risk of death from fires. Enactment and enforcement of fire extinguisher codes and building construction codes have also prevented fire deaths (4).

Because up to two-thirds of persons dying in house fires are unable to escape, residents need to know exit routes and to have a well-prepared escape plan (4,5). Fire drills are an important component of preparation. Other prevention strategies may include increasing the self-extinguishing capacity of cigarettes (estimated to cause about half of fatal house fires); use of matches that burn at lower temperatures and self-extinguish when dropped; and use of flame-retardant fabrics and designs to prevent clothing and upholstery fires (4,6-8).

Instruction in fire-related emergencies and first aid should also help to prevent further injury once an incident has occurred. For example, use of the "drop and roll" technique for extinguishing burning clothing should be taught. The importance of cooling a burn with cold water--not butter--to stop skin damage and reduce pain should be emphasized (9).

The Massachusetts study of motor vehicle-related burns illustrates another aspect of preventing fire and burn-related injuries and mortality by demonstrating how local or regional inquiry can target problem areas for effective safety programs. Motor vehicle-related burns have rarely been studied in the past. The findings here show that male teenagers and young adults are at high risk for burns from carburetor gasoline fires and for scalds from radiator fluids, especially during the summer months. Such data will enable prevention efforts to be targeted more efficiently.

Some strategies to prevent motor vehicle-related burns, such as installing radiator safety caps, have been implemented. Teaching the hazards of "carburetor priming" and other potential areas of injury during drivers' education, automotive-repair classes, or testing for new drivers' licenses has been proposed.

References

1. Baker SP, O'Neill B, Karpf RS. The injury fact book. Lexington, Massachusetts: Lexington Books, 1984.

2. U.S. Department of Health and Human Services. Promoting health/preventing disease: objectives for the nation. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, 1980:45-9.

3. McLoughlin E, Marchone M, Hanger L, German PS, Baker SP. Smoke detector legislation: its effect on owner-occupied homes. Am J Public Health 1985;8:858-62.

4. Smith GS, Falk H, Coleman P. Unintentional injuries: intervention strategies and their potential for reducing human losses. A position paper for the Carter Center "closing the gap" project. Atlanta, Georgia: Emory University, 1984.

5. Baker SP, Dietz PE. Injury prevention. In: Healthy people, the Surgeon General's report on health promotion and disease prevention background papers. Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1979.

6. Feck G, Baptiste MS, Tate CL, Jr. An epidemiologic study of burn injuries and strategies for prevention. Atlanta, Georgia: U.S. Department of Health, Education, and Welfare, Public Health Service, Centers for Disease Control, January 1978.

7. Mierley MC, Baker SP. Fatal house fires in an urban population. JAMA 1983;249:1466-8.

8. Teret JD, Baker SP, Trinkoff AM, DeFrancesco S. Report of the national conference on injury control, May 18-19, 1981. Atlanta, Georgia: Centers for Disease Control, 1981.

9. U.S. Consumer Product Safety Commission. What you should know about home fire safety. Washington, D.C.: U.S. Consumer Product Safety Commission, 1979. *The NERBP was one of six projects within the National Burn Demonstration Project established under contractual agreements with the Division of Emergency Medical Services of the U.S. Department of Health and Human Services. **The theme of Fire Prevention Week is "Fire Drills Save Lives."

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