Wall Shelley, Allorto Nikki, Weale Ross, Kong Victor, Clarke Damian
A surgeon and runs the burns unit at Grey's Hospital in Pietermaritzburg, South Africa.
The president of the South African Burns Society and founder of the Burn Care Trust.
AMA J Ethics. 2018 Jun 1;20(1):575-580. doi: 10.1001/journalofethics.2018.20.6.msoc1-1806.
This review focuses on burn care in low- and middle-income countries (LMICs). It attempts to put the burden of disease in perspective by showing that burn care is under-resourced across the spectrum of LMICs and by interrogating the ethical dilemmas and challenges that staff face in caring for burn patients in this environment, with a focus on South Africa. More specifically, it will attempt to address the following issues: the threshold for utilizing the intensive care unit (ICU), how to balance treatment against cost, the percentage burn considered survivable and how it should be determined, the use of skin from both cadavers and living related donors, and the appropriate ethical guidelines for LMICs.
本综述聚焦于低收入和中等收入国家（LMICs）的烧伤护理。它试图通过表明在整个LMICs范围内烧伤护理资源不足，以及审视工作人员在这种环境下护理烧伤患者时面临的伦理困境和挑战（重点关注南非），来正确看待疾病负担。更具体地说，它将试图解决以下问题：重症监护病房（ICU）的使用门槛、如何在治疗与成本之间取得平衡、可存活烧伤面积的百分比及其应如何确定、尸体和活体亲属供体皮肤的使用，以及LMICs的适当伦理准则。
