Questions/Answers

In order to treat burn victims, the first 48 hours is crucial and the starting part is extremely so. Wound size must be accurately assessed and fluid resuscitation proper and precise. All is to render treatments successful, save lives, ease pain and prevent limb losses. In Thailand, handling of those with burn injuries is still a big issue. Each year, there are up to 10,000 cases which is too many for the existing infrastructure. Thai hospitals do not have enough clean rooms, beds or burn specialists. So, Chonburi Hospital reached out to universities, businesses and non-profits in an initiative to research and develop the “3D Burn Resuscitation Smartphone Application”. With its patient-like graphic in 3D the App is designed to screen and determine the total body surface area affected. Fluid needs can also be calculated, based on a patient’s weight as well as duration and degree of a burn. This way, healthcare workers in general will be able to provide first aid at their local hospitals or at scene accurately and safely before referral to places with better equipment and more qualified staff. The “3D Burn Resuscitation Smartphone Application” is available in both Apple’s iOS and Google’s Android. It is free, downloadable worldwide and easy to use. This is a Thai-born innovation that aims to benefit patients and medical professionals alike. Treatment needs to be the most effective and patient aid and care fast, safe and universal. After the application was launched in 2016, many burn patients from all over Thailand, especially those in rural and remote area as well as patients from many other countries had been beneficial from this application.

What contributes to the chance of mortality or disability from burn injuries is the lack of specialists and effective first-aid. The traditional measurement using a 2D male figure on a paper chart is at times unreliable. The “3D Burn Resuscitation Smartphone Application” assesses severity of burnt wounds using a 3D graphic figure and automatically and precisely determine anti-shock fluid requirements. This way, all types of burn will be properly dealt with, and risk of deaths reduced. Easy to use, the free App will enable medical personnel to deliver services that are inclusive and equitable for all.

Our initiative supports 2 Sustainable Development Goals as follows; - (SGD 3) The Application is made for each and all of us. Now, regular people can evaluate cases as well as the burn specialists - which will come in handy in the absence of the latter. Medical teams in far-flung places can then perform as effectively as those in leading establishments. Now, burn victims worldwide can expect better treatment and care. (SGD 9) The “3D Burn Resuscitation Smartphone Application” is a brand-new innovation and the only one of its kind that features 3D graphic figures. It accurately calculates the total body surface area burnt, more so than a paper chart that has been part of the norm for over 70 years.

Inspired by the His Majesty King Bhumibol Adulyadej The Great’s philosophy of “Self-Sufficient Economy”, the idea is to make use of a locally-available modern technology in an economical manner. The initiative is also one that integrates knowledge, skills and specific expertise from partners representing various sectors. The research support from universities, government agencies and businesses and funding from a foundation culminate in a proud innovation. This locally-made work has gone on to deliver benefits around the world. This is a joint effort on a national level that went international, giving burn victims access to fast and safe treatments.

When the “3D Burn Resuscitation Smartphone Application” was finalised, Chonburi Hospital began to use it to determine seriousness of burn wounds to decide which case went to its Burn Unit and which to the General Unit. The App has also proven to benefit an early management of burn incidents in places with no specialists. Through its usage, the problem of bed shortages has been mitigated while complications from treatment and risk of limb or life losses reduced. Undoubtedly, the impressive success can be repeated anywhere else in the world.

The conventional way of evaluating the total body surface area burnt by using a Lund and Browder chart is male-centric and often leads to discrepancies with female patients. Besides, people of different ages differ in their body types. The “3D Burn Resuscitation Smartphone Application” can generate a 3D figure based on each patient’s gender, age, height and weight to closely resemble individuals. As a result, the chance of a precise and proper treatment as well as care for all patients equally is no longer out of reach.

Our goal is to screen and assess acuteness of burn cases to support and provide first-aid that is accurate and safe whether at a hospital or at scene. There are 3 target groups as follows: - 1. State-funded care providers who will be able to save their resources such as burn units and burn specialists for those who really need them; 2. Medical staffs, nurses, paramedics, rescuers, physicians and specialists who will benefit from simplicity and straightforwardness of the App while accuracy and precision are not compromised. This way, any member from the medical team will be able to provide first-aid (which happens to fall on the extremely important moment) correctly and safely; 3. The patients themselves who will be properly assessed from the onset. This way, complications from excess fluid resuscitation such as respiratory or blood circulation failure can be prevented and risk of fatalities averted.

The conception began at Chonburi Hospital. The project received support from partners representing several sectors. It is a cross-disciplinary collaboration between the public and private sectors from start to finish. Without it, the work would not have come to fruition. Here are our key developments and steps; - 1. Analyzing causes of congestion at the Burn Unit of Chonburi Hospital; 2. Conducting 3D scans of volunteers’ physique at the National Electronics and Computer Technology Center (NECTEC) to draw human-shaped graphics; 3. Developing a computer software to assess data from the 3D human-shaped graphics and a system to calculate fluid requirements by the Faculty of Engineering, Kasetsart University, Sri Racha Campus; 4. Converting the software into an application for smartphones with funding from Operation Smile Thailand (foundation); 5. Testing the “3D Burn Resuscitation Smartphone Application’ by Chulalongkorn Hospital, Maharaj Nakorn Chiang Mai Hospital, Thailand and Singapore General Hospital, Singapore; 6. Demonstrating and training on the “3D Burn Resuscitation Smartphone Application” for doctors and nurses of Chonburi Hospital, those from nearby institutions, as well as medical staffs in hospitals in Singapore (Singapore General Hospital), Malaysia and Indonesia.

The main hurdle we faced was the fact that there was so much then-available digital technology was able to do. For instance, when the project began in 2011, the hardware could not handle what we had developed. That kept our assessment software from being widely used, with regular office computers being a prime example. Luckily, from 2015, computers and smartphones began to advance plus prices starting to fall. Around the same time, the computer software was being progressed into a smartphone application, and started to be widely adopted and see its benefits reaped.

Traditionally, the calculation replied on a male-centric 2D chart which is prone to giving skewed suggestions. Chonburi Hospital saw the problem and kickstarted the development of an assessment software by painting on 3D graphic figures since 2011. In 2016, as smartphones started to become savvy, we built a mobile application which led to it being widely adopted both locally and overseas. International users are in countries like Malaysia, Indonesia, Singapore, Japan,China, Australia, Europe and America. Evidently, people like the fact that it is free and easy to use at anytime and anywhere without needing anything extra.

With the App being used for free both inside and outside Thailand, we continue to improve it. We take suggestions from real users from around the world such as measurements in imperial and metric systems and estimation reports in ratio and percentage. As of the 15th of November 2019, the App has been downloaded more than 9,000 times globally. At present, a 3D Ped Burn Resuscitation Smartphone Application is being developed for children. It is based on the same principle but with more details. It is also more complex because the head-to-body ratio shifts as children grow.

First introduced at Chonburi Hospital, the “3D Burn Resuscitation Smartphone Application” has been disseminated continuously in medical forums and seminars such as; - - “Go Together for Best Practice in Wound and Burn Care” (Annual Meeting); Wound and Burn Healing Association (Thailand), at The 50th Anniversary Chalermprabaramee Building, Bangkok, Thailand (1-3 May 2017); - “ASEAN Congress of Plastic Surgery Combine with ISAPS Symposium Update in Wound and Burn Management”; The 18th ASEAN Congress of Plastic Surgery, at AVANI Riverside Bangkok Hotel, Bangkok, Thailand (8-10 March 2017); - “42nd Annual Scientific Congress of The Royal College of Surgeons of Thailand”, at Ambassador City Jomtien Hotel, Pattaya, Thailand (7-10 July 2017); - “Burn Management Update 2017”, at Singapore General Hospital Academia, Singapore; - “ASEAN Wound Summit 2018”, at Imperial Hotel Kuching, Sarawak, Malaysia (20-21 July 2018); and - “Burn Care in Asia Pacific Region”; The 12th Asia Pacific Burn Congress Academia, Singapore (14-17 August 2019).

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When the computer software was being developed, we received support on knowhow from government agencies as well as universities in Thailand such as the Faculty of Engineering, Kasetsart University, Sri Racha Campus, and the National Electronics and Computer Technology Center (NECTEC). Later, for the computer software to be reworked into a smartphone application, we received funding from Operation Smile Thailand (foundation).

Our main goal is to assist burn victims most of whom live in low-income countries. These parts of the world lack both equipment and specialists. Our App points to a quick treatment that is precise and safe which will help prevent complications from assessment mistakes. It is available worldwide for free at both GooglePlay and AppStore. It lessens risks of mortality, saves costs,enhances treatment and mitigates income losses from disability all of which contributes to economic stability. Most importantly, it introduces an effective treatment that is inclusive and equitable for all.

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1. Tests by Chulalongkorn Hospital, Maharaj Nakorn Chiang Mai Hospital, Thailand; “A Comparison Study for Burn Surface Area Calculation between Thai 3D Burn Program and Conventional Methods” in Thai Journal of Burn and Wound Healing 2. Test by Singapore General Hospital, Singapore; “The validation study on a three-dimensional burn estimation smartphone application: accurate, free and fast?” 3. Winner of “Economical & Integrated 3D Medical Innovation Award” by Office of the Public Sector Development Commission. 4. 1st Runner-Up in National Innovation Awards 2017 by National Innovation Board Thailand.

1st-Phase Evaluation: Experienced physicians found that the “3D Burn Resuscitation Smartphone Application” and a Lund and Browder chart are both correct in estimating the total affected area but the former is more concise. 2nd-Phase Evaluation: General physicians who use the “3D Burn Resuscitation Smartphone Application” are as correct and concise in estimating the total affected area as specialists. 3rd-Phase Evaluation: Non-doctor staffs such rescuers and first-aid providers who use the “3D Burn Resuscitation Smartphone Application” are as correct and concise in estimating the total affected area as general physicians and specialists.

The 3-phased evaluation demonstrates that the “3D Burn Resuscitation Smartphone Application” can replace the old modality of a Lund and Browder chart and the non-doctor staffs can use the App to estimate the total affected area and produce the same results as the specialists. Therefore, rescuers should also be able to use the App to determine gravity of the situation and safely give fluid replacement to prevent a shock first. Besides, from the evaluation, complications from excess fluid replacement are cut down by up to 20 percent.

At its early stage, the Surgical Team of Chonburi Hospital led the initiative and liaised with partners and external organizations such as the National Electronics and Computer Technology Center (NECTEC), the Faculty of Engineering, Kasetsart University, Sri Racha Campus, Faculty of Medicine, Chulalongkorn University, Faculty of Medicine, Chulalongkorn University, and Operation Smile Thailand foundation. This way, knowledge, skills, expertise and potential were combined and integrated to create an innovation out of 3D Medical Technology which ultimately became the “3D Burn Resuscitation Smartphone Application”, which so far has been recognized (locally and internationally) by the likes of Burn and Wound Healing Association (Thailand), The Society of Plastic and Reconstructive Surgeons of Thailand, and The Asia Pacific Burn Association (APBA).

Since the very beginning of our effort, we have continuously received support from various sectors as follows; - 1. Volunteers from the general public who agreed to have their physique 3D-scanned and used as prototypes; 2. Universities who took part in designing and developing the software that eventually became the “3D Burn Resuscitation Smartphone Application” and their own students who were given the opportunity to cultivate skills; 3. Businesses and factories (whose employees are at risk of thermal injuries) who contributed to the funding from Operation Smile Thailand. 4. Hospitals, both local and overseas, who tested the ‘3D Burn Resuscitation Smartphone Application” in their treatment of burn patients and provided feedback from real users for improvement. Notably, what brought several sectors together in this cross-disciplinary endeavor to eventually realize the ‘3D Burn Resuscitation Smartphone Application” was the awareness of the challenges in handling those suffering from burns and the wishes for the entire world to have the same equal access to treatment that is safe and enhanced by modern technology.

This 3D burn resuscitation mobile application was developed through collaboration from several institutions including Faculty of Medicine, Chulalongkorn University, Chonburi Hospital, Ministry of Public Health of Thailand, Faculty of Computer Engineering, Kasetsart University, NECTEC Thailand and granted by Operation Smile Thailand foundation. After the application was launched in 2016, many burn patients from all over Thailand, especially those in rural and remote area as well as patients from many other countries had been beneficial from this application. After having experience of using this application and acknowledged its impact on sever burn patients. The experience led us to reach out to stakeholders across sectors to combine knowledge, skills and expertise and come up with the “3D Burn Resuscitation Smartphone Application”. This is essentially promoting Integrated Mechanisms for Sustainable Development across aspects such as ensuring healthy lives and promoting wellbeing for all at all ages, reducing inequality within and among countries and promoting sustainable communities where everyone can equally access advanced medical care through international partnership with no one left behind.