When a severely burnt patient is wheeled into the Singapore General Hospital (SGH) Burn Centre, one of the first things emergency staff do is to pump air into the patient’s lungs.
That is because if the airway is swollen shut, it can deprive the patient of oxygen, affecting chances of survival.
Associate Professor Ong Yee Siang, who heads the department of plastic, reconstructive and aesthetic surgery at SGH, explained this following several accidents in which people suffered burn injuries.
The department manages the burn centre.
On Feb 13, Ms Raybe Oh Siew Huey, 26, suffered severe burns on about 80 per cent of her body when she tried to save her boyfriend and their four friends from the fiery Tanjong Pagar car crash.
Then, last Wednesday, 10 migrant workers were hospitalised following an explosion in Tuas on the premises of Stars Engrg. Three workers died and five remain in critical condition, while two have been discharged.
Prof Ong said some burn victims can talk, albeit hoarsely, and move a little, but it gets riskier when the head and neck areas have burns. When hair and eyebrows are singed, and soot coats the mouth and airways, the patient must be immediately intubated to pump air into the lungs.
Within the first 24 hours, severely burnt patients will be taken to the operating theatre for a special wound dressing that will help absorb fluids and aid healing.
For those with deep burns, where all three layers of the skin, the blood vessels and nerve endings are destroyed, the skin would look white and leathery.
Dr Zulfikar Rasheed from Azataca Plastic Surgery used to work in the SGH department that manages the burn centre, but is now in private practice.
He said the extent of the burns can also cause systemic inflammatory response syndrome, where the immune system goes into overdrive and causes multi-organ failure.
Smoke inhalation injuries are also deadly.
Prof Ong said: “If the person was trapped in an enclosed room and inhaled a lot of smoke, it will cause severe damage to the lungs.
“Even if you have very low percentage burns, but have inhalation injury, you can still die from lung complications.”
He added that younger patients tend to have a better shot at survival as they are less likely to have co-morbidities such as heart disease and diabetes.
Dr Zulfikar said passers-by can try to douse the fire with water, as long as it does not put them in danger.
They can also guide the victim to stop, drop and roll on the ground if his clothes are aflame. They can also use a wet blanket or cloth to douse the flames before the ambulance arrives.
He does not recommend removing pieces of clothing from the victim as it could burn the other person.
Dr Zulfikar added that a severely burnt patient has to undergo a series of operations that include removing burnt tissue that would delay wound healing, and covering the gaping regions with a skin graft.
Prof Ong said if the patient does not have enough healthy skin for the graft, donated human skin from the SGH Skin Bank will be used temporarily until new skin can be cultured.
He said severely burnt patients can spend a few months in hospital. Once the skin grafts are healed, they have to undergo intensive rehabilitation to get back on their feet and get used to their new skin.
Burn rehabilitation can take about two years and patients may have to undergo psychological treatment to find acceptance, manage post-traumatic stress disorder, and body image issues.
SGH’s head of psychology Evelyn Boon said: “In the recuperation stage, they may experience increasing pain and anger. They may have rapid emotional shifts from feeling of hopelessness to depressive episodes.
“These are part of the grieving process.”