Article

Analysis of burns caused by pre-filled gas canisters used for lamps or portable camping stoves

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Abstract

The use of pre-filled valveless gas canisters for lamps or camping stoves has caused a number of serious burn incidents. We performed a retrospective analysis of all of the patients who were victims of such incidents admitted to the Marseille Burn Centre between January 1990 and March 2004. There were a total of 21 patients burned in such conditions. Adult males made up the majority of the victims of this sort. Lesions were often extensive (60% of the patients were burned over more than 10% of their body surface) and systematically deep. In order of frequency, burn locations were: the lower limbs, the upper limbs, the hands and the face. The incidents principally occurred during replacement of the canister near an open flame. The marketing of a canister with a valve in order to avoid gas leaks did not cause the old canisters to be taken off the market. On the contrary, European Safety Standard EN417, updated in October 2003, validated the use of these valveless canisters. The severity of the lesions caused and the existence of safe equivalent products requires the passage of a law that forbids valveless canisters.

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... The intention is to obtain modifications in the relevant laws by promoting prevention at national and local levels, together with the promulgation of safety standards to be observed not only in the planning and realization of particular structures and buildings, but also in the legal regulation of industrial production to protect the public through product modification especially in the field of baby and children clothing, electric household appliances and toys, etc. . . [1,69]. This implies active implication of local administrative authorities and social orientation and commitment of politicians for the welfare and well-being of citizens. ...
... During the 1960s, a milestone in fire safety was achieved through research on various types of natural and synthetic fiber clothing ignition characteristics and regulatory activities for flammable fabrics [14,89]. The Flammable Fabric Act was instituted in the U.S. in 1967 to permit the regulation of a broad range of consumer products, including carpets, mattresses, upholstered furniture, tents, curtains, sleeping bags, and children's clothing [69]. Safety standards for children's sleepwear in sizes 0 through 6X were also imposed [14]. ...
Article
Burns are responsible for significant mortality and morbidity worldwide and are among the most devastating of all injuries, with outcomes spanning the spectrum from physical impairments and disabilities to emotional and mental consequences. Management of burns and their sequelae even in well-equipped, modern burn units of advanced affluent societies remains demanding and extremely costly. Undoubtedly, in most low and middle income countries (LMICs) with limited resources and inaccessibility to sophisticated skills and technologies, the same standard of care is obviously not possible. Unfortunately, over 90% of fatal fire-related burns occur in developing or LMICs with South-East Asia alone accounting for over half of these fire-related deaths. If burn prevention is an essential part of any integrated burn management protocol anywhere, focusing on burn prevention in LMICs rather than treatment cannot be over-emphasized where it remains the major and probably the only available way of reducing the current state of morbidity and mortality.
... Moreover, Tarim [1] found that the increasing use of LPG as a cooking or heating fuel has resulted in many burns in Turkey, which is also a developing country. In developed countries, LPG mishaps have resulted in several accidents, including sustaining cold burn while refueling a car [6][7][8], burns while prefilling gas canisters for lamps or stoves [9] and burns while using LPG for domestic barbeques [10]. However, few studies have been conducted on this topic in China. ...
Article
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Background: The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies. Methods: A 5-year retrospective study was conducted in patients with LPG-related burns admitted to the Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, College of Medicine, between 1st January 2011 and 31st December 2015. Information obtained for each patient included age, gender, education status, occupation, medical insurance, average hospital cost, length of hospital stay, monthly distribution of incidence, place of burns, mechanism of burns, extent of burns, site of burns, accompanying injuries, and treatment outcomes. Results: For the first 4 years (2011-2014), the yearly incidence of LPG-related burns was at approximately 10% of all burns; however, in the fifth year (2015) alone, there was a surge to 26.94%. A total of 1337 burn patients were admitted during this period. Of these, 195 patients were admitted because of 169 LPG-related accidents; there were 11 accidents involving more than one victim. LPG-related burns occurred most frequently in patients aged 21-60 years (73.85%). The majority of injuries occurred from May to August (56.41%), and the most common place was home (83.08%, 162 patients). Gas leak (81.03%) was the main cause of LPG-related burns, followed by inappropriate operation (7.69%) and cooking negligence (2.05%). The mean burn area was 31.32±25.40% of TBSA. The most common sites of burns were the upper extremities (37.47%), followed by the head/face and neck (24.80%) and lower extremities (19.95%). The most common accompanying injuries included inhalation injury (23.59%), shock (8.71%), and external injury (7.18%). The average hospital stay was 22.90±19.47days (range 2-84 days). Only 48 patients (24.62%) had medical insurance, while 124 patients (63.59%) had no medical insurance. The average hospital cost of the no medical insurance group was significantly higher (p<0.0001) than that of the medical insurance group. In addition, 72.73% of patients who left against medical advice (LAMA) were uninsured. The number of patients who recovered at our hospital was 165 (84.62%), while 22 patients (11.28%) LAMA. The overall mortality rate was 4.10% (8 patients). Conclusion: Our study shows that the exponential increase in LPG-related burns is alarming. This calls for rigorous precautions. Because gas leak was the main cause of LPG-related burns, any part of LPG stove system that shows signs of weathering should be replaced regularly. In addition, we also found that most of the LAMA patients were uninsured. Thus, comprehensive medical insurance should be involved early in the recovery process to assure a safe and adequate discharge.
... As found in this study, portable or picnic gas stoves turn out to be a popular cooking or even heating appliance for everyday home usage in some households. Studies stress the relevant risks either in product safety and design or with mishandling or improper use of them [2]; [7]; [12]; [27]–[29]. ...
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The aim of this study was to assess the feasibility of injury specific home safety investigation and to examine the home safety status focused on burn related safety in a rural population in the North-West of Iran. A cross-sectional study was conducted on 265 rural households of rural Meshkinshahr, Iran. Cluster sampling method was used in 38 clusters with 7 households in each cluster. Clusters were selected on a probability proportional to size (PPS) basis using the available health census database called D-Tarh. Data were analyzed using the statistical software package STATA 8. Possible risks were explored in fields of house structure; cooking and eating attitudes and behaviors; cooking appliances, specific appliances such as picnic gas burners, valors (traditional heaters), samovars (traditional water boilers), and air-heating appliances. Many safety concerns were explored needing to draw the attention of researchers and public health policy makers. Injury specific home safety surveys are useful and may provide useful information for safety promotion interventions.
... Even if kerosene is still the most commonly used household fuel in our country the aim is to provide an improved understanding of this potential threat from increasing use of LPG. As following reports indicate several accidents have also resulted in the developed world from LPG mishaps; LPG powered cars [16][17][18][19], LPG tube explosions [20], pre-filled gas canisters for lamps and stoves [21], liquefied gas fired barbeques [22], and LPG disasters [23,24]. But, in spite of our vigorous search in 'pubmed' we did not get any information on pattern of domestic LPG injuries which are now showing an increasing trend. ...
Article
Previous studies from our department reflected a trend of decreasing incidence of burns culminating from rising income levels, which were bringing about a change in the cooking fuel in many urban households [1,2]. These studies also indicated a changing scenario of increased incidence of burns from LPG mishaps [2]. In the absence of much information on the subject we felt it rather imperative to comparatively study the pattern of burn injuries resulting from LPG and kerosene. This prospective study was conducted on the clinical database of consecutive patients admitted with burns sustained due to LPG and kerosene from 1st January 2009 to 31st May 2010 (17 months). Data recorded for each patient included; age, gender, religion, socioeconomic status, literacy level, type of family unit, marital status, type of dwelling unit, mode of injury and its exact mechanism, place of incident, level of cooking stove, extent of burns (%TBSA), presence of features of inhalation injury, number of patients affected in a single mishap, size of LPG cylinder used, length of hospital stay and mortality. Of 731 flame burn patients in this study, 395 (54%) were due to kerosene burns and 200 (27.4%) from LPG mishaps. Significantly, the majority of injuries, in both the groups, occurred in lower middle class families living as nuclear units, in a single room dwelling, without a separate kitchen. Majority of LPG burns (70.5%, 141 patients) resulted from a gas leak and 25.5% were from cooking negligence (51 patients). 50.5% of kerosene accidents were from 'stove mishaps' and 49% due to cooking negligence. In all kerosene accidents the stove was kept at floor level but in LPG group 20.6% had the stove placed on a platform. There was a slight difference in mean TBSA burns; 51% in kerosene group compared to 41.5% TBSA in LPG group. There were nine episodes in LPG group in which there were more than three burn victims admitted for treatment. Very importantly, 77% patients in LPG group were from a large cylinder (14.2 kg), which uses a rubber connecting tube. Mortality in kerosene group (50.6%) was far higher than in LPG group (33.5%). This study, from 200 LPG burn admissions, for the first time details the profile from LPG mishaps. It is very interesting to note that of all burns in the world the inequitable distribution bias towards LMICs (low and middle income countries) extends further towards low middle class families within the LMIC. A major risk factor is constrained living condition of a single room dwelling unit. Almost all burns from LPG mishaps were potentially preventable if more care had been practiced to ensure safety. Since majority of LPG mishaps were from gas leaks, either from the rubber tube (Fig. 1) or the stove valve, the observation of floor level cooking in 79.4% of LPG cases may be an economic compulsion of a single room dwelling unit without much impact on the injury pattern. The small LPG cylinder (5 kg) in which the burner is placed directly over the cylinder, as one unit without a connecting tube, is safer because it reduces the chances of a gas leak from an ill-fitting or a cracked rubber connecting tube (Fig. 2).
Article
Burns, an endemic public health problem has had a dynamic epidemiology in India, in sync with economic and social changes. In the last decade a major shift of kitchen fuel usage from kerosene to the Liquefied Petroleum Gas has resulted in an increase in the incidence of burns from LPG mishaps. This prospective descriptive study conducted in a tertiary care burn centre in an urban area aims to determine the causes of LPG related burns, its injury profile, identify the population at risk and also to determine the level of knowledge of users regarding the safety issue with LPG usage. In the study LPG burns accounted for 52.3% of the admitted flame burns. On the whole there were 33 incidents of LPG mishaps involving multiple victims. Most common age group affected was 26–50 years. Leakage from larger cylinders was more common and malfunction of valve/regulator was the most common cause. Level of knowledge was dismally low across all socioeconomic strata. Our study highlights impact of changing socioeconomic pattern of the country on burns epidemiology and the glaring lack of public awareness regarding safe management principles.
Article
The aim of this study is to understand the aetiological factors and pattern of burns caused by the use of liquefied petroleum gas (LPG). This hospital based study was conducted on consecutive patients admitted with major burns from September 2011 to August 2012. The data was recorded on predesigned data sheet. Age, gender, mode of injury, its exact mechanism, place of incidence, extent of burn and inhalation injury were recorded for every patient. 182 patients with LPG related burn injury were admitted in one year. This is 11% of total burn patients received during the same period (182/1656). 147 incidents caused these burns due to gas leak from various parts of the LPG cooking system. Leakage was either from the cylinder, pipe or stove in 52%, 36% and 2% incidents respectively. Human error accounted for 3% incidents while in 7% the mechanism could not be ascertained. Leakage from 5kg cylinder with pipe was the commonest aetiological factor. There were 14 group casualties with more than one victim involved. LPG related burns are preventable to a large extent. There is a need to improve the safety standards in the LPG stove system. Public awareness needs to be improved.
Article
Liquefied petroleum gas (LPG) is a fuel that is widely used for domestic, agricultural, and industrial purposes. LPG is also commonly used in restaurants, industries, and cars; however, the home continues to be the main site for accidents. In Turkey, the increased usage of LPG as a cooking or heating fuel has resulted in many burn injuries from LPG mishaps. Between January 2000 and June 2011, 56 LPG-burned patients were compared with 112 flame-burned patients. There were no significant differences with respect to the mean age, sex, hospitalization time, and mortality in both groups. In the LPG-caused burn cases, 41 burns (73.2%) occurred at home, seven (12.5) were work-related mishaps, and eight (14.3) were associated with car accidents. The majority of the LPG burns (82%, 46 patients) resulted from a gas leak, and 18% of them were related to the failure to close LPG tubes in the patients' kitchens (10 patients). Burns to the face and neck (82 vs 67%, P = .039) and upper (62 vs 23%, P = .000) and lower (70 vs 45%, P = .002) extremities were significantly higher in LPG-caused burn cases than flame-burned cases. General awareness regarding the risk of LPG and first aid for burns appears to be lacking. The LPG delivery system should be standardized throughout countries that widely use LPG.
Article
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Burns continue to be a major environmental factor responsible for significant morbidity and mortality in developing countries and, in particular, burns due to stove bursts are a major problem. Two types of stoves are available in Pakistan: gas stoves and kerosene stoves. The state is considered of patients burned by stove bursts in general, and also with specific reference to 34 adult patients admitted with stove burns to our hospital in Pakistan. Various treatment options were used, and the patients' treatment and outcome are reported. The continued commercialization of such stoves, and especially of the gas stove, is is a cause of serious and permanent consequences that represent a danger for the population. Proper care should be observed when handling them because, as always, prevention is better than cure.
Article
Due to its unique location, the South West England Paediatric Burns Service based in Bristol admits an interesting cohort of holiday-makers, who have sustained their burns whilst on camping and caravanning holidays. We aimed to establish whether burns sustained during camping and caravanning holidays are more severe and require more extensive intervention compared to burns sustained in other situations. We undertook a retrospective, observational study of admissions to the South West Paediatric Burns Service between June, and August from 2003 to 2005. Our primary outcome was to assess the severity of the burns as defined by percentage total body surface area of partial and full thickness burns. We used secondary outcomes of indirect indicators of burn severity: length of hospital stay, number of general anaesthetics, and need for surgical debridement, artificial skin dressing and/or skin grafting. Analysis of the data was undertaken using Mann-Whitney test, Fisher's exact test, and Chi-squared test. 151 patients were included in the study, 30 (20%) of which were campers. Our results show that burns sustained during camping and caravanning holidays are significantly more likely to be of larger surface area than burns sustained in other environments. Campers' burns also required more frequent surgical intervention (in 87% versus 66%) and had longer inpatient admissions (5.3 days versus 3.8 days). Our results have implications for clinicians and campsite owners. Access to free flowing water is often not immediately available on campsites and time taken to reach the nearest Emergency Department is often prolonged with a further delay before reaching the tertiary centre. The general public needs to be aware of the risks of burn during camping and caravanning holidays. Campsite owners should consider improving first aid facilities and clinicians need to be aware of the need for early referral and timely transfer to tertiary facilities.
Article
Burn injuries associated with domestic barbeques were responsible for 80 admissions to Concord Hospital Burns Unit during the period from January 1998 until December 2007. In our series the number of burn injuries associated with domestic barbeques is increasing and we have reviewed the records of these patients to document their injuries and identify possible causes. The database of the unit was reviewed for all admissions resulting from domestic barbeques from January 1998 until December 2007. Patients whose injuries resulted from bonfires, camping or other domestic fires were excluded from the study. The number of barbeque related burn injuries has increased as has the incidence of burns associated with gas fired barbeques. Young adult males predominate. Injuries ranged from 2 to 65% TBSA and 34% required intubation. There were 10 major complications with one death and 20% of patients required grafting. Length of stay varied from 1 to 51 days. In this series the number of admissions resulting from both wood fired and gas barbeques has increased. The cause of injury in open fires is associated with misuse of accelerants, whilst the cause of injury in gas barbeques is mainly due to delayed ignition of gas or incorrect use of the appliance. Distribution and severity of injuries are similar.
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Baby walkers have been implicated in many forms of paediatric trauma, ranging from finger tip entrapment to severe head injury. Their relationship to childhood burns has been documented previously. The Department of Trade and Industry published further warnings in 1984 and the British Standards Institution in 1989. We wished to determine if the degree or frequency of thermal injury had been lessened by these recommendations.All parents of children under 15 months of age admitted to this unit in 1994 were asked if their child was in a baby walker at the time of injury. Eight of the 32 infants, aged between 6 and 12 months, were burned in their walking aid. Half of the burns were contact and half scalds, and the average in-patient stay was 8 days. One patient required formal resuscitation and three were grafted.The incidence and severity of thermal injury sustained in baby walkers remains at a high level despite increased safety measures. Perhaps it is time to concur with the American Academy of Paediatrics and recommend a ban on these dangerous aids.
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An epidemiological review of electrical burns of the mouth in children pinpoints the cause to the female end of extension cords. The use of a protective cuff, designed to prevent these disfiguring injuries, is suggested.
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Five years after a 1983 Washington State law required new water heaters to be preset at 49 degrees C (120 degrees F), 77% of homes (84% of homes with postlaw and 70% of homes with prelaw water heaters) had tap water temperatures of less than 54 degrees C. In 1977, 80% of homes had tap water temperatures greater than 54 degrees C. Mean temperature in 1988 was 50 degrees C compared with 61 degrees C in 1977. Both changes were significant compared with 1977 temperatures. Few people increased their heater temperature after installation. Eighteen burn victims were identified from July 1979 through May 1988, for an average admission rate of 2.4 per year, compared with 5.5 per year in the 1970s. Compared with the 1970s, total body surface area burned, mortality, grafting, scarring, and length of hospital stay were all reduced, while the likelihood that scald burns were the result of child abuse increased to 50%. Both education campaigns and legislation have resulted in significantly safer water temperatures. Further, this change seems to have resulted in a reduction in frequency, morbidity, and mortality of tap water burn injuries in children. Lower water heater settings proved acceptable to the consumer.
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Admissions to the Wessex Regional Burns Unit for injuries sustained whilst using portable butane camping stoves are reviewed. There have been 31 cases of such injuries in the past 10 years with one fatal outcome. Most accidents occurred while changing the canister. The number of accidents occurring suggests that these stoves must be regarded as intrinsically very hazardous and that a greater awareness of the dangers by users is necessary.
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Editor—During four months last summer we treated nine patients who had sustained burns from portable butane camping stoves. The injuries varied from relatively minor burns, usually occurring in the open, to a 60% burn sustained when a canister exploded in the cab of a lorry. The figure shows a typical injury: 10% mixed depth burns to both legs, which required excision and grafting. This 48 year old man was fitting a butane canister to a portable stove in his kitchen in preparation for his daughter’s camping trip. The canister, which had been bought in a high street camping shop, had no instructions in English on its exterior. He pierced the outer skin of the canister with the sharp point of the burner/valve assembly but was unable to secure it with the metal clips. The butane leaking from the pierced canister was ignited into a fireball by a spark from the electric refrigerator thermostat. All nine of the patients were injured while changing the canister. There is no failsafe mechanism to prevent uncontrolled leakage of explosive butane, and if the canister is not secured immediately after it is pierced it acts as a bomb waiting to ignite. Thirteen years ago we drew attention to the danger of these devices1; since then, the design has not been changed, nor has the frequency of injury.
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The objective of this paper is to highlight landmarks in burn prevention. Novel strategies in the areas of law and regulation, environmental and consumer product design, and educational programs are identified and discussed. Notwithstanding marked reductions in burn morbidity and mortality, especially in economically developed countries, burn injuries remain an important public health concern throughout the world. More, and more effective, burn prevention programs coupled with renewed efforts to reduce the social and environmental correlates of burn injuries (poverty, overcrowding, family stress, and educational deficits) are needed to further reduce burn incidence and its long-term sequelae.
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The electric water heater has recently become a popular household appliance replacing the hot water dispensing jug. This device provides hot water and potable cool water directly from the faucets thus removing the need to refill the container or boil water separately in a kettle. Along with the convenience of dispensing hot water immediately has come an increased incidence of pediatric burns. This paper presents a 6-year retrospective study of such pediatric scald burns from 1996 to 2001. Computer database records revealed that the incidence of pediatric scald burns caused by the electric water heater during the past 6 years was 6.4% (66/1028). The age of victims ranged 0-6 years (mean 1.5+/-1.1 years), most of the victims were in the 1-2-year-old group. In most common cases burn location was the trunk. The accidents often occurred during the cold months and in the living room of the house. From this retrospective study, it was seen that the etiology and incidence of scald burns among children have changed as people have modified their household practice for obtaining hot water in our country. This study aims to increase public awareness to the problem and suggest some prevention measures to reduce this type of scald injury.