Changes Produce Changes: The Current Situation of Major Burns Treatment in Chile

Abstract

ABSTRACT

OBJECTIVES: Population, gross domestic product, life expectancy, and public spending on health in Chile have significantly changed over the past few decades. However, as of 2004, the fatality rate among major burn patients had remained constant at 76%. In this study, events that have affected the reduced fatality rates of patients with large burns in Chile over the recent decades were reviewed.

MATERIALS AND METHODS: Publications on fatality rates, the new law that guarantees care for pathologies with the highest burden of disease (GES Law), and official documents on interventions for large burns from the National Reference Center were reviewed. In addition, immediate results, incorporation of large burns to the GES Law and its consequences, emergence of new needs, and creation of new burn units and outcomes were reviewed. Lethality rate was the primary endpoint.

RESULTS: Reasons for persistent high fatality rates have included (1) conservative surgical index protocols designed to classify severity groups as a predictor of survival and (2) the late incorporation (in 2003) of intensive therapy to severe burn treatment. The promulgation of the 2004 Explicit Health Guarantee law, establishment of burn services at the Public Hospital of Urgent Care and National Reference Center in 2005, incorporation of major burns into the GES Law in 2007, and development of new burn units in 2012 have together generated a process that has allowed the fatality rate to be reduced to 6%.

CONCLUSIONS: Changes from conservative treatment to proactive treatment have been of great value. Significant structural and financial support provided by the GES Law has made it possible to offer coverage to patients at major burn units in Chile and to continue to improve the quality of the care. Development of new units has been stimulated through practical learning and through the use of infrastructure and human resources already available.