No Ice, No Toothpaste: Govt Rolls Out Evidence-Based Treatment Protocols For Burn Injuries

(MENAFN- Live Mint) New Delhi: To reduce India's high burn-related mortality rates and standardise care across hospitals, the Centre has issued comprehensive treatment guidelines that formalise first-aid practices and discourage the use of common household remedies, according to two officials and a document seen by Mint.

The development assumes significance given the rising burn injuries-an estimated 6-7 million injuries annually and around 150,000 deaths each year-with women and children disproportionately affected due to cooking fires and flammable liquids.

The new framework, to be adopted by health centres with immediate effect, seeks to replace India's fragmented, hospital-specific burn care protocols with a uniform, evidence-based system ranging from first responders, primary health centres (PHCs) and tertiary hospitals.

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The guidelines organise burn care into four levels-pre-hospital, primary, secondary and tertiary-clearly outlining responsibilities at each stage to reduce delays, inappropriate treatment and avoidable complications.

They address a critical gap where healthcare professionals often relied on a mix of personal expertise and conflicting protocols due to resource constraints .

The effectiveness of burn care in India has been constrained by chronic shortages of trained personnel, essential supplies and specialised equipment, gaps that are most acute in resource-limited settings, impacting patient recovery and complication rates.

"Standard treatment guidelines are vital because medical science is evidence-based, yet currently, individual hospitals often follow disparate protocols. It is crucial to collate best practices to ensure uniformity," said Dr. Sameek Bhattacharya, head of the department of burns and plastic surgery at RML Hospital and a contributor to the report.

No more home cures

A major focus of the new protocol is proper first aid. The guidelines explicitly instruct community-level intervention, instructing responders to cool wounds with running tap water for ten minutes while prohibiting the application of household remedies such as ice, toothpaste, or grease, which can worsen tissue damage.

The guidelines warn that agents like grease, ghee, gentian violet, and butter make the formal assessment of the wound's depth and extent difficult.

"Household items like toothpaste or ice should not be used on burned skin, as they further damage the tissue. Running water at room temperature is a simple first aid measure to cool the surface before a patient sees a doctor," Bhattacharya said.

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At the clinical level, the protocol mandates a formula for fluid resuscitation to prevent shock and recommends silver-based dressings for wound care, citing their antimicrobial effectiveness and reduced need for frequent dressing changes. It specifies which categories of burns can be managed at PHCs and identifies red flags that require immediate referral.

“We have stratified these guidelines to align with our healthcare hierarchy,” Bhattacharya said.“It is essential that PHC staff can handle initial cases while instantly recognizing the red flags that necessitate a transfer."

It also integrates comprehensive supportive care, marking a shift from survival-focused treatment to holistic recovery.

The guidelines mandate immediate physical therapy and splinting to prevent deformities. A dedicated chapter on psychological care outlines protocols for screening delirium, acute stress, and depression, aiming to mitigate long-term mental health impacts like post-traumatic stress disorder and body image disturbances among survivors.

It standardizes nutritional support with specific calorie requirements to aid metabolic recovery, defining healthcare roles to ensure seamless referrals and reduce long-term disability.

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The guidelines also address the economic consequences of burn injuries, emphasizing the need to provide the "most cost-effective treatment". The economic toll of burns is immense, with the costs of medical care, rehabilitation, and loss of income often pushing families into poverty, it states.

Burn injuries require prolonged treatment, and the initial few hours are crucial for determining the specific care a patient needs, said Dr. Maneesh Singhal, head of the department of plastic, reconstructive and burns surgery at AIIMS, Delhi.

“These guidelines are vital as they educate medical professionals on correct treatment protocols-such as proper dressing techniques and the role of skin banks-while also outlining how schemes like Ayushman Bharat can benefit patients.”

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