Kajal Mehta, MD, MPH
Nominated From: University of Washington
Research Site: Nepal Cleft and Burn Center
Research Area: Burn, Trauma, Critical and Injury Prevention
Primary Mentor: Barclay Stewart
Feasibility and Implementation of an Enteral Resuscitation Bundle for Moderate-sized Burn Injuries to Prevent Shock in Nepal
Burns disproportionately affect individuals in low- and middle-income countries, and the morbidity and mortality rate of burn injuries is vastly higher than in high-income countries. There are many barriers to accessing timely burn care in different parts of the world, which significantly impacts the mortality and outcomes of burn injuries. By examining the feasibility of alternate means of resuscitation (enteral or oral-based resuscitation) and conducting a pilot study, we may find a method to provide earlier, easier, widely accessible access to resuscitation in the event of moderate and major burn injuries. By studying the implementation of an enteral resuscitation bundle that acknowledges the unique pre-conditions of resource limited settings, we hope to provide a playbook for dissemination of this life-saving technique in a variety of contexts (e.g., LMICs, combat casualty care, mass casualty incidents, rural health centers in countries of all income levels).
Ninety percent of the 9 million people who sustain burn injuries each year live in LMICs and lack timely access to centers that routinely perform burn resuscitations. As a result, burn injured patients frequently suffer preventable death or disability that could be reduced through implementation of a simple enteral resuscitation bundle. Enteral (or oral-based) resuscitation entails the use of Oral Rehydration Solution (ORS) administered either by drinking or through a naso-gastric tube. ORS is widely available, and this treatment is routinely employed in conditions like childhood diarrhea with high success. This method has of resuscitation has not been compared directly with the standard of care intravenous resuscitation for moderate-sized and larger burn injuries. Therefore, this is a unique opportunity to inform resuscitation and enteral resuscitation protocols in resource-limited settings, with the potential to improve mortality from these common injuries around the world.