Buring issue of bonfires

GAVIN Ball couldn't take his eyes off the bonfire as flames shot up into the November night sky. The ten-year-old was one of a group of youngsters standing around as the flickering fire spread higher. Pushing and shoving each other to get a better look, nobody realised the danger they were in as they inched closer to the fierce heat.

Gavin loved seeing the blazing bonfire and feeling the heat on his face, but as he moved closer to the flames, disaster happened. Nobody knows exactly how, but as the children jostled with each other, he somehow ended up in the bonfire. Screaming with pain, he was rushed to hospital after suffering severe burns to his back, hand and leg.

That was seven years ago and now Gavin, after no fewer than 19 skin grafting operations at the Royal Victoria Infirmary's paediatric burns unit, in Newcastle, is backing an urgent new safety call by doctors.

Apart from covering Tyneside and Wearside, the regional unit takes serious burns cases from as far away as South Durham and Teesside.

"When people told me playing near bonfires was dangerous I never listened, but now I tell everybody not to do it," says Gavin, who still has disfiguring scars on his hand and back that will always be with him.

"Bonfires might seem like a game but they are not. People can get really hurt," the 17-year-old from Sunderland adds.

Plastic surgeon Tania Cubison is desperate to prevent youngsters like Gavin going through the agony of serious burns. And for this Guy Fawkes night, she believes it might be worthwhile to focus on the very real threat presented to younger children by bonfires as well as the more familiar problem of teenagers misusing fireworks.

Along with her colleague, Alex Edwin, she has discovered that children in the North-East appear to be more at risk from bonfires than fireworks.

North-East youngsters are also far more likely to suffer bonfire or firework-related burns around November compared to children from the South-East of England, who tend to suffer burns throughout the year.

That's why she is urging parents to keep younger children adequately supervised at all times during the Guy Fawkes season, particularly when it gets dark.

In a separate development, a team at the RVI burns unit is working on a revolutionary new way of treating burns, by spraying a "soup" of cultured skin cells onto damaged skin.

Miss Cubison and Miss Edwin hope that their studies in this previously neglected field could lead to a more accurately targeted bonfire safety campaign, directed at areas of the North-East where unsupervised bonfire building - and injuries - are most common.

Their ultimate hope is that this could become a national bonfire safety campaign, reducing the number of younger children, particularly those aged between seven and ten, who seem to be more at risk from bonfires than fireworks.

By collecting information between 1997 and 2000 and comparing the Newcastle figures with those of a similar unit at the Queen Victoria Hospital, in East Grinstead, Sussex, where Miss Cubison used to work, the two Tyneside-based plastic surgeons were able to clearly demonstrate the stark differences between the two geographically distant areas.

"We started looking at the number of fireworks injuries at the two centres when we noticed an unusual and unexpected pattern of referrals to the local paediatric burns unit," says Miss Cubison.

"There was a definite difference in the statistics from East Grinstead, which is near Gatwick airport, and the North-East."

The two plastic surgeons found that the East Grinstead hospital received small numbers of bonfire and firework injuries distributed throughout the area, generally at the weekend.

The Newcastle results were very different. There were more bonfire injuries than firework injuries and the majority of Newcastle children sustained bonfire injuries in November around bonfire night, whatever the weather.

In 1997, when the weather in November was dry, the Newcastle unit had only three firework injuries but 13 bonfire burns. In the next two years, there were five bonfire burns to two firework injuries - but this was still twice as many bonfire incidents compared to firework incidents.

Jumping forward another year to November 2000, the statistics from the RVI paediatric burns unit again showed that the number of bonfire incidents significantly outnumbered fireworks incidents, with nine bonfire injuries compared to only two fireworks injuries.

Overall, in the month of November between 1997 and 2001, there were a total of 32 bonfire injuries. Significantly, only an extra ten children were injured by bonfires in the other 11 months of the year.

The research also threw up an interesting age profile of the children injured by bonfires. The average age of a child referred to the RVI unit for bonfire-related burns was ten, about three to five years lower than expected. "These children may not be the fire setters themselves but have been burnt by a bonfire," says Miss Cubison.

Boys outnumbered girls by over six times - 38 compared to six.

While the figures are alarming, the two surgeons say that they are the tip of the iceberg, as many minor burns are treated in accident and emergency departments, by GPs or in the home.

The surgeons plan to carry out more research into the circumstances surrounding bonfire injuries. "We have records of these injuries over the last ten years and we are now tracking them down and trying to find out exactly what happened," says Miss Cubison.

So far, the evidence gathered suggests that the fires are lit by 14 and 15-year-olds but attract younger children, who are less aware of the dangers from burns. "We are talking about seven and eight-year-olds who are unsupervised. They start messing about and shoving each other and some children end up being burnt," says Miss Cubison, who recently treated a child with head injuries after another child whirled a burning plastic tube around their head, dripping molten plastic onto the watching youngster.

As part of Miss Edwin's research for a master's degree, she plans to visit and interview former bonfire victims to piece together as much information as possible. "We will be comparing truancy rates with bonfire injuries and trying to be a bit more specific about which areas and which schools are involved," she says.

The suspicion is that the problem is probably more acute in inner-city, deprived areas, but Miss Cubison believes that the fringes of smaller market towns could also provide the space and opportunity for bonfire setting.

While firemen routinely visit schools and warn younger pupils about playing with matches and what to do if there is a fire, Miss Cubison wonders if there is scope for more precise warnings about bonfires aimed at particular communities.

While two thirds of children referred to the RVI unit have been scalded, there is particular concern about bonfire-related burns. "Fire burns hotter than the temperature of very hot water. If you add in materials like plastic and rubber, you are talking about much higher temperatures, which can cause much more serious injuries, scarring and even permanent disability," says Miss Cubison.

Apart from parents knowing where their children are during the run-up to and aftermath of Guy Fawkes night, Miss Cubison says it is vital that burns are immediately immersed in cold water.

"That is a really vital message. Even if the child cries and struggles, you should keep them in the cold water for at least ten to 15 minutes. That limits the damage," she says.

Even with organised bonfires and firework displays, she advises that parents should keep a bucket of cold water to hand in case of an accident.

She also advises everyone attending such events to wear natural fibre clothing rather than man-made fibres.

"Hats are a good idea because of what can fall out of the sky. If you have a hood, put it up. Avoid scarves and tie your hair back if you wear it long," she adds.

While plastic surgeons can perform minor miracles by taking skin from another part of the body and replacing burned tissue, they would prefer not to see any injured children this Guy Fawkes.