0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Increased Incidence of Heater-Related Burn Injury During a Power Crisis FREE

Tina L. Palmieri, MD; David G. Greenhalgh, MD
[+] Author Affiliations

From the Shriners Hospitals for Children Northern California Burn Center and Department of Surgery, University of California at Davis Regional Burn Center, Sacramento.


Arch Surg. 2002;137(10):1106-1108. doi:10.1001/archsurg.137.10.1106.
Text Size: A A A
Published online

Hypothesis  Recent power shortages in California resulted in rolling blackouts and increased utility prices. Residents turned to alternative heating devices, such as space heaters, to decrease utility bills. Our hypothesis is that the incidence of heater-related injuries increased owing to the use of alternative heating methods during the power crisis.

Design  Retrospective case-series database and medical record review of all burn admissions for the 4 months of November through February for the period 1998-2002.

Setting  Regional pediatric and adult burn unit in northern California.

Patients  Patients admitted during the study interval with burn injury.

Main Outcome Measures  Parameters recorded included patient demographics, cause of burn, total body surface area burn, number of operative procedures, and hospital length of stay during each of the 4 months in the interval.

Results  A total of 512 patients were admitted during all 4-month intervals. During the power crisis there were significant increases in the number of hospital admissions (151 in 2000-2001 vs 117 in 1998-1999, 124 in 1999-2000, and 152 in 2001-2002) and heater-related burn admissions (36 in 2000-2001 vs 25 in 1998-1999, 26 in 1999-2000, and 29 in 2001-2002). The percentage total body surface area burn (mean ± SEM, 24.0% ± 4.6% in 2000-2001 vs 16.5% in 1998-1999, 12.3% in 1999-2000, and 12.0% in 2001-2002), hospital length of stay (15.0 days in 2000-2001 vs 9.9 days in 1998-1999, 12.3 days in 1999-2000, and 7.0 days 2001-2002), and the number of operations (55 in 2000-2001 vs 7 in 1998-1999, 18 in 1999-2000, and 19 in 2001-2002) also increased during the crisis.

Conclusions  The number of heater-related burn admissions, as well as their magnitude, increased during the energy crisis, resulting in increased resource use and health care costs. The economic stresses of the power shortage had societal costs that extended far beyond the price of electricity.

Figures in this Article

THE POWER shortage in northern California from November 2000 through February 2001 resulted in a substantial increase in the price of natural gas and electricity throughout the state. As a result many residents, in an attempt to lower their utility bills, took a variety of measures to decrease these costs, ranging from lowering the temperature on the thermostat to the use of alternative heating sources such as space heaters, woodburning stoves, and fireplaces. Improper or inadequate use, installation, or supervision of these devices can result in house fires or direct burn injury from the heating source.

Each year more than 100 000 persons are admitted to burn units with severe burns.1 The incidence of burn injury, owing to a variety of reasons, has been decreasing over the last 20 years.2 However, the number of admissions to the University of California Davis Regional Burn Center and Shriners Hospitals for Children Northern California Burn Center increased markedly during the winter months of 2000-2001, coinciding with the peak of the energy crisis.

Although the financial and economic consequences of the energy shortage have been widely publicized, the potential increase in burn injury and its socioeconomic effect have not been explored. The purpose of this study is to determine if the incidence in heater-related injuries in northern California increased during the power crisis.

The study was approved by the University of California at Davis institutional review board. The University of California at Davis Regional Burn Center and Shriners Hospitals for Children Northern California Burn Center admit patients from northern California, the central valley, and the adjacent states. Analysis of the Trauma Registry of the American College of Surgeons burn database and retrospective patient medical record review was completed for all burn admissions in the 4 months from November through February in years 1998 through 2002. Medical records were reviewed for patient demographics, cause of burn, percentage total body surface area (TBSA) burn, survival, number of operative procedures required, and hospital length of stay (LOS). The mean monthly temperature for each of the study months was obtained from the Western Regional Climate Center.3 Differences between the total number of burns, heater-related burns, and the number of heater-related burns by month during the power shortage months (November 2000-February 2001) were compared with each of the 2 periods immediately prior (November 1999-February 2000 and November 1998-February 1999) as well as to the ensuing year (November 2001-February 2002) using the χ2 test. Mean hosptial LOS and TBSA burn percentage differences between the power shortage months and each of the other 3 intervals were compared using the t test. Results are given as the mean (SEM).

A total of 512 patients were admitted in the 4 months from November through February in 1998-2002. There was a significant increase (P<.006) in the incidence of heater-related burn injuries between the 2000-2001 period and each of the 2 previous years as well as in the subsequent year (Table 1, Figure 1, and Figure 2). There was a significant increase in the TBSA burn, with mean burn size greater than 20% in the 2000-2001 period vs the previous and subsequent years (Figure 3). The number of operations also increased markedly, with 7 operations performed in 1998-1999, 18 in 1999-2000, 55 in 2000-2001, and 19 in 2001-2002. The male-female ratio of patients with burn injury was 2.2 in 2001-2002, 2.4 in 2000-2001, 3.3 in 1999-2000, and 1.9 in 1998-1999. The most common causes of the burn are house fires, lighting a heater, and direct contact with a heater (Figure 4). To control for the potential effect of temperature on the incidence of heater burns, the mean California temperature for each of the study months was obtained from the Western Regional Climate Center.3 The mean temperature in each of the study months did not differ significantly between any of the study intervals (Figure 5).

Table Graphic Jump LocationDemographic Data of Burn Admissions During Study Period*
Place holder to copy figure label and caption
Figure 1.

Total number of burn admissions and heater-related burn admissions during the winter months (November-February) for 1998-2002. The percentages of heater-related burns increased significantly during November 2000 through February 2001 compared with November 1998 through February 1999, and November 2001 through February 2002 (P<.05, χ2 test). Asterisk indicates significant differences.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Distribution of heater-related burn injuries by month. A significant increase (P<.05, χ2 test) in burn injuries occurred in the period 2000-2001 compared with the 1998-1999, 1999-2000, and 2001-2002 periods. Asterisks indicate significant differences.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Mean percentage of total body surface area (TBSA) involvement and hospital length of stay increased significantly in the interval from November 2001 through February 2002 compared with November 1999 through February 1999, November 1999 through February 2000, and November 2001 through February 2002 (P<.05, t test). Asterisks indicate significant differences.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Causes of heater-related burns included contact burns with stoves, house fires, fireplaces, and campfires.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Average ambient temperature in northern California during the interval from November through February 1998-2001.

Graphic Jump Location

The greatest increase in heater-related burn injuries occurred in January 2001. Coincidentally, on January 1, 2001, Pacific Gas and Electric increased rates by 16.5%, and Southern California Edison raised rates by 9.9%. As the shortage became more severe, stage 3 alerts (declared when an operating reserve shortfall of 1.5% is unavoidable or when the operating reserve is forecast to be <1.5% after using all available resources) were instituted. On January 17 and 18, 2001, rolling blackouts were ordered statewide. A statewide stage 3 alert continued for 24 consecutive days. The rate of rotating blackouts increased from 1 in 2000 to 38 in the period from January to May 22, 2001. During this same interval, stages 1 and 2 notifications increased from 91 to 127.48

The fiscal impact of the California energy crisis has been the focal point of published reports. The financial effects of the shortage on California power companies, the state, and consumers have been well documented. California residents were encouraged to conserve electricity and gas during times of severe shortages, and the high cost of electricity further reinforced this request. Measures taken to conserve energy ranged from decreasing the set point on the thermostat to using alternative devices such as space heaters, wood-burning stoves, and fireplaces. Cost restraints frequently lead people to use unsafe heating sources. These alternative heating sources have the potential to cause serious injury if not used properly. To our knowledge, to date the potential effect of the shortage on consumer health has not been addressed.

This article is the first to document an increase in consumer-related burns after the implementation of rolling blackouts and increased energy costs. The greatest increase in the incidence of heater-related burns occurred in January 2001, coinciding with the electricity rate increase and the institution of blackouts. The increased number and severity of burn injuries, as indicated by a significantly greater number of operative procedures performed during this period, had a detrimental effect on consumer physical and financial health. This will likely result in long-term morbidity for the affected consumers. Prevention of these injuries could result in lower financial and consumer health costs. Implementation of preventive strategies, such as installation of smoke detectors in homes, have been successful in decreasing the incidence of burn injury.911 A similar strategy may well be of benefit in preventing heater-related burn injuries in the future. Although economic or societal events may increase the risk of this type of burn injury, education regarding appropriate behaviors in response to the power shortage may help to ameliorate these effects.

The full impact of the California energy crisis remains unclear. Although current studies have centered on the financial impact of the crisis, further investigation into the effects on consumer health needs to be undertaken.

This study was presented as a poster at the Pacific Coast Surgical Association Meeting, Las Vegas, Nev, February 16, 2002.

Corresponding author: Tina L. Palmieri, MD, Department of Surgery, University of California, Davis, 2425 Stockton Blvd, Suite 718, Sacramento, CA 95817 (e-mail: tina.palmieri@ucdmc.ucdavis.edu).

American Burn Association, Initial assessment and management. Sheridan  RLed.Advanced Burn Life Support Course Instructor's Manual. Chicago, Ill American Burn Association2001;9- 11
Brigham  PAMcLoughlin  E Burn incidence and medical care use in the United States: estimates, trends, and data sources. J Burn Care Rehabil. 1996;1795- 107
Link to Article
Western Regional Climate Center, Available at: http://www.wrcc.dri.edu/. Accessed February 10, 2002.
National Energy Information Center, Available at: http://www.eia.doe.gov/cneaf/electricity/chg_str/california.html. Accessed February 10, 2002.
California Power Exchange, Available at: http://www.calpx.com. Accessed February 10, 2002.
Federal Energy Regulatory Commission, Order Directing Remedies for California Wholesale Electric Markets.  December15 2000;
California Public Utilities Commission and Electricity Oversite Board, California's Electricity Options and Challenges. Report to Governor Gray Davis. August2 2000;
Sheffrin  Anjali California Independent System Operatory: What Went Wrong with California Electric Utility Deregulation?  April19 2001;
Hall  JR  Jr The US experience with smoke detectors: who has them? how well do they work? when don't they work? NFPA J. 1994;8836- 3941- 46
McKnight  RHStruttmann  TWMays  JR Finding homes without smoke detectors: one step in planning burn prevention programs. J Burn Care Rehabil. 1995;16548- 556
Link to Article
Gorman  RLCharney  EHoltzman  NARoberts  KB A successful city-wide smoke detector giveaway program. Pediatrics. 1985;7514- 18

Figures

Place holder to copy figure label and caption
Figure 1.

Total number of burn admissions and heater-related burn admissions during the winter months (November-February) for 1998-2002. The percentages of heater-related burns increased significantly during November 2000 through February 2001 compared with November 1998 through February 1999, and November 2001 through February 2002 (P<.05, χ2 test). Asterisk indicates significant differences.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Distribution of heater-related burn injuries by month. A significant increase (P<.05, χ2 test) in burn injuries occurred in the period 2000-2001 compared with the 1998-1999, 1999-2000, and 2001-2002 periods. Asterisks indicate significant differences.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Mean percentage of total body surface area (TBSA) involvement and hospital length of stay increased significantly in the interval from November 2001 through February 2002 compared with November 1999 through February 1999, November 1999 through February 2000, and November 2001 through February 2002 (P<.05, t test). Asterisks indicate significant differences.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Causes of heater-related burns included contact burns with stoves, house fires, fireplaces, and campfires.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Average ambient temperature in northern California during the interval from November through February 1998-2001.

Graphic Jump Location

Tables

Table Graphic Jump LocationDemographic Data of Burn Admissions During Study Period*

References

American Burn Association, Initial assessment and management. Sheridan  RLed.Advanced Burn Life Support Course Instructor's Manual. Chicago, Ill American Burn Association2001;9- 11
Brigham  PAMcLoughlin  E Burn incidence and medical care use in the United States: estimates, trends, and data sources. J Burn Care Rehabil. 1996;1795- 107
Link to Article
Western Regional Climate Center, Available at: http://www.wrcc.dri.edu/. Accessed February 10, 2002.
National Energy Information Center, Available at: http://www.eia.doe.gov/cneaf/electricity/chg_str/california.html. Accessed February 10, 2002.
California Power Exchange, Available at: http://www.calpx.com. Accessed February 10, 2002.
Federal Energy Regulatory Commission, Order Directing Remedies for California Wholesale Electric Markets.  December15 2000;
California Public Utilities Commission and Electricity Oversite Board, California's Electricity Options and Challenges. Report to Governor Gray Davis. August2 2000;
Sheffrin  Anjali California Independent System Operatory: What Went Wrong with California Electric Utility Deregulation?  April19 2001;
Hall  JR  Jr The US experience with smoke detectors: who has them? how well do they work? when don't they work? NFPA J. 1994;8836- 3941- 46
McKnight  RHStruttmann  TWMays  JR Finding homes without smoke detectors: one step in planning burn prevention programs. J Burn Care Rehabil. 1995;16548- 556
Link to Article
Gorman  RLCharney  EHoltzman  NARoberts  KB A successful city-wide smoke detector giveaway program. Pediatrics. 1985;7514- 18

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles