Translation, Implementation, and Evaluation of best-pRacticE burn First aid in prolonged FiEld Care and pre-hospiTal environments (TIER EFFECT)

Dr Bronwyn Griffin1, Prof  Roy Kimble, Prof Fiona Wood, A/Prof  Leila  Cuttle, Mr Cody Frear

1Griffith University, Brisbane, Australia


Evidence-based, first aid for burns is defined as 20 minutes of cool running water (CRW) within the first three hours of injury, decreasing burn depth, time to re-epithelialization, need for skin grafting, intensive care admission, and long-term scarring sequelae, in addition to serving an analgesic function. The three hour treatment window post burn provides an limited opportunity where first responders can deliver effective treatment in the pre-hospital. Despite the significant benefits of the intervention, its adoption in the pre-hospital setting remains challenging.

Aims: 1) Identify the perceived enablers and barriers of burns first aid in pre-hospital and EMS settings which will inform the co-design of a TIER EFFECT intervention in California. 2) Evaluate the TIER EFFECT intervention strategies and determine the impact on patient outcomes and cost effectiveness. 3) Incorporate the post implementation evaluation into the development of a national support strategy to improve the adoption and sustainability of the intervention.

This research design will focus the primary outcome on implementation and the secondary outcome focused on effectiveness of the intervention (patient outcomes and cost). Procter et al’s (21) taxonomy will be used to measure the effectiveness of the TIER EFFECT post implementation. An interrupted time series analysis will be performed to determine the effect on patient outcomes. The cost of associated care, will determine the economic impact of the implementation.

Engaging with a broad context of stakeholders, including first responders, in situations where access to medical help may be delayed, we anticipate the TIER EFFECT to be easily adaptable. This project was successful in attracting an international US Department of Defense Military Burns Award in 2021.


Dr Griffin is a Senior Research Fellow with Griffith University NHMRC CRE in Wiser Wound Care, based at the Queensland Children’s Hospital. She has over 20 years experience in paediatric, emergency, burns and trauma nursing across the Royal Children’s Hospital Melbourne, Royal Children’s Hospital Brisbane and now the Queensland Children’s Hospital.

Griffin has contributed significantly to the body of acute burn care research. Her research into burns first aid gained global recognition, reaching 24 different countries, leading to several podcast, blog invitations as well as consultation.

Dr Griffin is a Fellow and Research Committee member of the College of Emergency Nurses Australia, regularly leading workshops and teaching. She is a member of the Steering Committee of the Burns Registry of Australia and New Zealand and the Injury Prevention Committee for the Australia and New Zealand Burns Association regularly utilising registry data for research projects and developing injury prevention campaigns.  CII Griffin also acts as a member of the Queensland Statewide Trauma Clinical Network representing Queensland Children’s Hospital. Her research contributions have recently been recognised with the awarding of the Centre for Children’s Burns and Trauma Research Centre Medal.

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