Philippa Willitts examines the challenges involved in supporting people with severe burn injuries…Every day in the UK, 21 people are admitted to hospital after suffering severe burn injuries. 300 people die from such injuries each year. For survivors of severe burns, treatment can be lengthy and painful, with wide-ranging physical and emotional effects lasting for many years.
More people now survive severe burns than ever before, though this will often require extensive surgeries, physiotherapy, reconstruction, pain relief and psychological support, provided by specialist teams in Burns Units, all doing their best to treat these highly complex injuries in the most appropriate way.
Eight days in intensive care
Lucy Hill, 31, set fire to her hair while trying to light a cigarette six years ago. For eight days she comatose, on a ventilator in intensive care, where medical staff began the long process of treating her most life-threatening injuries and the breathing difficulties she was experiencing due to smoke inhalation, as well as minimising the risk of infection.
If a burns patient is so badly hurt that their life is at risk, the immediate priority will be to provide resuscitation and emergency treatment. Then, as soon as possible, the burns will be treated – often surgically. Removing burned tissue is vital to reducing the likelihood of infection in wounds that cannot heal themselves. Such surgeries will usually take place in the first few days following the burn, or potentially after a few weeks if the team needs to gauge whether an injury is indeed healing without assistance.
Serious burn wounds will usually require either the application of synthetic skin or a graft of the patient’s own skin from elsewhere on their body in order to reduce the risk of infection and improve the long-term appearance of the scars that will be left.
The pain associated with these injuries and surgeries can be considerable. In Lucy’s case, the morphine and other painkillers she was prescribed were no match for the pain she experienced when nurses changed her dressings. She remembers this as one of the most painful aspects of her recovery, along with the pains on her skin graft sites, and the whiplash she sustained from her instinctive response to her hair catching fire.
No believer in sugarcoating the truth, Lucy valued the absolute honesty she received from the doctors and nurses treating her – even when they were warning her that something was going to be extremely painful. As she explains, “If you know what to expect, it’s not such a surprise. At least you can prepare yourself.” After multiple operations, including skin grafts and a reconstruction of her ear, she is now something an expert in painful recoveries.
The acute pain from burns and surgery can turn into long-term, chronic discomfort. Neuropathic pain is particularly difficult to treat, with alternative therapies such as relaxation and hypnosis sometimes offered in addition to more conventional medical approaches involving painkillers. Intensive itching on the burn site, especially during healing, can be treated with antihistamines and creams, alongside oral or intravenous antibiotics to keep infections at bay.
Burn scars can contract and harden, making movement difficult. Occupational therapists and physiotherapists therefore often work with patients to keep the injured areas active using variety of techniques, including the use of splints and exercises. Since scars take time – sometimes years – to fully mature, this is long-term work, designed to ensure that the patient is able to maintain maximum mobility.
Emotional and social support
The impact of severe burn injuries extends beyond the patients themselves. Friends and families can find it difficult to know how to support them, and may feel useless in the face of the pain and distress that their friend or relative is going through. For this reason, support from peers can be incredibly important in helping the patient re-integrate into their community and develop a sense of self-acceptance.
It is important to tackle a patient’s grief over the things they have lost, their trauma about what happened and their struggle to adapt to a body that may feel unfamiliar and unsightly. Support and encouragement for individuals to re-enter their former lives and begin coping with potentially negative reactions from the public is often also necessary. Friends and family can be just as important as professionals in these roles, and peer support groups with other burns victims can be invaluable in the time following a severe injury.
When Lucy, who now lives in Eastbourne, was moved to the High Dependency ward at Wythenshawe Hospital, she found a caring team of staff who treated not just her physical injuries, but also supported her through the trauma she had been through, and helped her to cope with the psychological impact of her severe burns.
The unit’s psychologist and medical staff took into account the fact that Lucy was already dealing with prior mental health problems and issues with body image from before the accident. They were happy to help manage the extra difficulties she was having by allowing small concessions, such as early visitors or a few minutes outside in the sun, in a way which made her feel that her individual needs were being taken into account.
“The psychologists were brilliant,” she recalls. “They understood that I had issues around eating, and they wanted to prepare me before I looked in a mirror”. The fact that her injuries were on her face and neck was particularly difficult for her, because they felt more visible. The loss of her hair in the fire, and the need to shave the remaining areas was especially distressing. “My hair is the one bit of me that I like, so I was devastated that they shaved it all off”.
The ways that scars can change a person’s body and their image of themselves is something frequently tackled by specialist mental health professionals in burns units across the country. Burn patients’ self-esteem can take a severe blow, and feelings of depression and anxiety are common.
A 2011 guidance document (PDF) produced by Burn Model Systems in collaboration with staff at the University of Washington cites a process called ‘body image distress’, which can occur after experiencing burn injuries and involve the following:
– Grief or sadness about changes in appearance and physical abilities.
– Anxiety about social or intimate settings where the scars may be noticed
– Worrying about how people will react when they see the scars
As well as exploring these issues with a psychologist and seeking support from peers, many burns survivors can receive assistance from Changing Faces – a UK charity set up to help people with facial and bodily disfigurements. The organisation offers a free Skin Camouflage Service to anybody living with scars upon referral by a health professional.
Dealing with trauma
During the time it takes for a scar to mature, it can change in colour, texture and shape, often causing the individual to become highly self-conscious. Lucy found that having strangers stare at her became a commonplace occurrence – especially upon leaving hospital for the first time when still covered in dressings. The support she received from her friends was invaluable in giving her the confidence to keep going, and she now credits them with helping her to regain her self-esteem.
Issues with self-esteem and body image are not the only problems that burns survivors can face. Experiencing post-traumatic stress disorder (PTSD) in relation to the incident that caused the burns is not uncommon, with some individuals experiencing flashbacks and nightmares about what happened to them.The subsequent regrowth of Lucy’s hair has also given her a boost. “My hair is now halfway down my back,” she says. “My hairline’s a lot further back, I lost a lot at the front and I’ve lost half of one side of my eyelashes that will never return, but I’m so glad it’s grown back.”
Severe burn injuries can cost people their lives, so it can be understandably difficult to cope with the magnitude of what has happened. Psychologists and other mental health workers will offer support in coming to terms with the event, and can teach patients new coping mechanisms in the light of the accident alongside courses of therapy or medication.
After burns – The Dos and Don’ts
– Offer reassurance – burns patients can feel frightened, overwhelmed and self-conscious
– Offer moral support in public if strangers stare or ask questions
– Ask questions, but don’t insist on answers
– Stay in touch – never avoid your friend or relative because you don’t know what to say
– Forget that the person is an individual with their own preferences and needs
– Lose patience – it takes time for somebody to adapt to such severe injuries
– Focus entirely on the burns – the person concerned is more than their injury
– Make decisions on the person’s behalf – they still have opinions of their own!
0207 391 9270 www.changingfaces.org.uk
British Burn Association
0207 869 6923 www.britishburnassociation.org
Children’s Burns Trust
0207 233 8333 www.cbtrust.org.uk
Dan’s Fund for Burns
020 7262 4039 www.dansfundforburns.org