Burns through the ages: A Comparative Review of Chemical burns at the Tasmanian Burns Unit

Dr Rory Middleton1, Dr Thomas Whitton1, Dr Jennifer Martins1

1Royal Hobart Hospital, Hobart, Australia


Background: Although accounting for only a small percentage of total admissions to hospital for burns, chemical burns require special consideration due to their potential for delayed presentation, progression of tissue destruction and these burns frequently require surgical intervention. There has been an ongoing need for increased awareness and education about the risks of chemical burns and their management which have previously been outlined in many Burns centres, including the Tasmanian Burns Unit.
Method: We performed a search for patients of all ages admitted to the Tasmanian Burns Unit between 2008-2019 for chemical burns. 42 patients were identified and their cases reviewed. The results of this review were then compared with the findings of Ricketts and Kimble (2003).
Results: In comparison to the data collected by Ricketts and Kimble (2003), the majority of patients continue to be men between the ages 20-49 years, however the mean age has increased by 6 years to 38 years of age. There is a slight change observed in the location that the injury occurred, with 50% occurring in a domestic, and 38% occurring in an industrial setting. The most common causative agents were cement (33%) and Sodium hydroxide (31%). There was a 56% decrease in cases involving either sulphuric acid or hydrofluoric acid when compared to the previous study. The upper and lower limbs were involved in 79% of cases, with the face being involved in 24% of cases. The mean total surface area affected was 2.2% (compared with the previous 3.4%) and the mean length of stay was 5.5 days, a decrease from 9 between the years 1989-1999. Management of injuries continued to consist of various surgical and conservative management options which include debridement and split-thickness skin grafting as well as various dressings.
Conclusion: In comparison with the findings of Ricketts and Kimble (2003), there appears to be ongoing potential in both community and professional education for the prevention and management of chemical burns, with an emphasis on early management.
References: 1) Ricketts S and Kimble F, 2003. ‘Chemical injuries: the Tasmanian burns unit experience’. ANZ J Surg 73 (1-2): 45-48


Rory Middleton is a RMO at the Royal Hobart Hospital, interested in pursuing a career in Plastic Surgery.

A recall to action: improving the Australian consumer safety system to mitigate burn injuries

Mr Cody C. Frear1,2,3, Dr. Bronwyn Griffin1,2,3, Professor Roy Kimble1,2,3

1Centre For Children’s Burns And Trauma Research, The University Of Queensland, South Brisbane, Australia, 2The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Level 5, South Brisbane, Australia, 3The University of Queensland Faculty of Medicine, Herston, Australia


Background: Product recalls provide an essential tool in safeguarding consumers from harm due to defective and dangerous goods. Of the many hazards that might instigate a recall, burns are among the most common, with 15% of recalled children’s products in the USA posing a risk of thermal injury. Australian consumer safety policies have drawn scrutiny for the wide discretion they give to suppliers issuing voluntary recalls. This study sought to investigate the goods recalled due to burn hazards, the recall campaigns mounted by their suppliers, and the effectiveness of these campaigns.

Results: From 1993 to 2019, burn hazards were responsible for the recall of 221 Australian goods, which remained commercially available for a median of 214 days (IQR 80 – 608). The most commonly recalled product categories included candles/candle holders (15.8%), hot water bottles/bottle warmers (11.8%), and children’s toys/clothing (10.0%). Only four recall campaigns sought to improve product returns/repairs by offering incentives (e.g., gift cards) to adherent consumers. Additionally, <40% of the recalls in 2017-2019 were distributed through their suppliers’ social media accounts. Further results will be presented for the average proportion of returned/repaired units and number of incident reports submitted following recall implementation.

Discussion: Recalls resulting from burn hazards encompassed a large range of household and children’s goods. There was wide variability in the measures employed by recall campaigns. A lack of public reporting by suppliers of the scope and outcome of their recalls limits their accountability and hampers efforts to establish effective recall standards.


Cody C. Frear is an MD/PhD candidate at the University of Queensland. Prior to starting medical school, he conducted immunology and virology research at the National Institutes of Health in Washington, D.C., and the Biodesign Institute in Tempe, Arizona, inspired by his experiences volunteering at an HIV/AIDS clinic in The Gambia. Following his undergraduate studies, he worked as a medical scribe in an Emergency Department, where he developed an interest in trauma research. This interest led him to the Centre for Children’s Burns and Trauma Research in Brisbane. He is currently completing his PhD, which focuses on the efficacy of negative pressure wound therapy in the management of acute paediatric thermal injuries. His other areas of study include burns first aid and the proteomics of burn wound exudate.

What We All Can Learn from the Typical Tasmanian Teenager Burn Injury

Dr Ingrid Salna1, Mrs Rebbeca Schrale1, Mr Andrew Castley1

1Royal Hobart Hospital, South Hobart, Australia


Background: Epidemiological data can assist to target safety prevention and management of burn injury. It is well documented that children and older adults most commonly sustain burn injury; however adolescent and young adults have also been identified as a group at higher. The incidence, injury characteristics, and outcome have not yet been precisely defined.

Method: retrospective review from The Burns Registry of Australia and New Zealand in those aged 11-19 years of age in Tasmania, in the last five years.

Results: 194 teenagers, aged 11-19 years of age have presented to the Royal Hobart Hospital. This included 147 in the outpatient setting and 47 managed initially managed as an inpatient. The number of presentations per year remained consistent, at an average of 38 per year. The average age was 16 years, with a larger proportion of patients in the 16-19-year-old age group (64%). The most common mechanisms of injury ranged was scald (35%), contact (30%) and flame (23%) occurring during leisure activity excluding sports (19%), followed by cooking/preparing food/drink (19%) and working for income (12%). Burn injuries occurred most commonly in the teenager’s home (47%, n=91), followed by other residence (e.g. friend’s home in 14%). There were only a small number of injuries occurring in school or other institution (5%). There were six self-harm injuries (3%), five of whom were female and nearly all occurring from flame. The average total body surface area burn was 1.8%, with half of these being superficial and only 2% being described as full thickness in depth. Hand(s) were most commonly affected (36%), followed by upper limb (25%)

Conclusion: there is a predictable number of burn injuries in Tasmania. We expect one new teenager to burn themselves every 1.5 weeks, most commonly males aged around 16 years. They commonly occur from exposure to hot substances during leisure time or cooking activities, with half occurring in the home. Overall, in Tasmanian teenagers, there is a need for better education for preventing burn injuries in the home as well as better preventative programs for deliberate self-harm.


Dr Ingrid Salna is a current unaccredited plastics registrar at the RHH, but she originally completed her medical school training in South Australia.

Clinical epidemiological analysis of burns in the elderly

Dr Jason Diab1, Ms  Rebecca Lebler1, Dr Andrea Issler-Fisher1 , Ms Christine Parker1, Prof Peter Kennedy1, Prof Peter Haertsch1, Dr Justine O’Hara1, Professor Peter Maitz1

1Concord Hospital, Concord, Australia



Burns in the elderly pose challenges to management where they are not only at risk of physiological changes associated with ageing, but the additional comorbidities predispose them to multi organ failure. These factors are often associated with a trauma and indirectly a thermal injury that lead to higher morbidity and mortality. Although this represents a small percentage of burns admissions, their length of stay and mortality are often complicated by other factors and require holistic care.


A retrospective audit was conducted at Concord Burns Unit from June 2016 to June 2019 at the Concord Repatriation General Hospital. The study group included all adult patients over the age of 65 years whom were admitted to the unit. The aim of this study is to provide an understanding of the clinical characteristics of elderly patients whom presented with burns. The secondary objective is to provide educational awareness about holistic care for nursing, medical and patient education to this cohort. Demographic and clinical data extracted included age, gender, ethnicity, total body surface area (TBSA), burn etiology, status at discharge, hospital admission duration, and burn intensive care unit length of stay (LOS). Differences were analysed using the student’s t-test for continuous variables and Chi-Square test for categorical variables.


There were 143 patients aged over 65 years whom were admitted to the concord burns unit with 60.8% men. The average age was 76.5 years (+/- 8.52 years)with a median TBSA of 3.00% [0.25 – 45%]. The most common season affected was winter (36.4%). The most common mechanism of injury was scald (52.4%), followed by flame (31.5%) with the lower limbs being most affected (37.8%). Overall, there was inadequate first aid amongst all patients (54.5%). There is a mean statistical difference amongst men and women for mechanism of injury (t=-2.721, p=0.007), age (t=-2.949, p=0.004), seasons (t=2.701, p=0.008), and discharge destination (t=-2.261, p=0.025).


Although trauma is one of the leading causes of death in the elderly, thermal injury is one of the principal mechanisms of injury. Education regarding prevention strategies and first aid treatment should be implemented to decrease morbidity and mortality.


Jason is a SRMO at Concord Burns Unit with an interest in public health epidemiology of burns and reconstructive surgery.

Regional burns outreach program : Raising awareness in a developing nation

Dr Andrew Cheah1, Professor Kok Chai Tan1, Associate Professor Chee Liam Foo1, Dr Tzuemn Ling  Low1, Adj Asst. Professor Si Jack Chong1

1Singapore General Hospital, Singapore, Singapore


Background: The burden of Burn injury in Bangladesh is significant, every year approximately 800000 people in Bangladesh sustain Burn injuries. In 2003, it was the 5th leading cause of childhood injury, with a total of 173,000 children sustaining Burn injuries. In 2016, Sing-Health and the Bangladesh Ministry of Health and Family Welfare launched the 3-year long Bangladesh Burns Capacity Enhancement training program. The program aims to train and educate specialists and nurses in Bangladesh in the prevention and management of burns, rehabilitation and reconstructive surgery.

Objective: We aim to increase Burn awareness in Bangladesh by the development and placement of Burns Awareness posters in public areas.

Methods: In an effort to raise awareness effectively, we conducted surveys in 2018 and 2019 to identify risks for Burn injury specific to the country. The surveys were conducted in English on Burns health-care professionals.

Results:  Of the 160 health-care professionals surveyed, 50% were nurses, 34% were doctors, and 16% were allied-health. 45% of the health-care professionals surveyed have had 1 to 2 years of experience managing Burns patients, 25% had 3 to 5 years of experience and 30% had more than 5 years of experience. 90% of health-care professionals agreed that there was no Burns awareness program in Bangladesh. 5 dangers for Burn injury were identified, from highest risk to lowest risk: hot water, oil lamps, overloaded power-sockets, exposed overhead electrical cables and kitchen fires.

Conclusion: Burn awareness is a key element in preventing Burn injuries. Positioning awareness messages appropriately is important for raising awareness effectively.


He, S., Alonge, O., Agrawal, P., Sharmin, S., Islam, I., Mashreky, S. and Arifeen, S. (2017). Epidemiology of Burns in Rural Bangladesh: An Update.

Mashreky SR, e. (2008). Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18242869 [Accessed 14 May 2019].


Prof Tan Kok Chai is a Senior Consultant with the Dept of Plastic, Reconstructive & Aesthetic Surgery.

Graduated from Monash University Medical School. Did basic surgical training in Australia before working in England to obtain Fellow of the Royal College of Surgeons (FRCS), England. Started Plastic Surgical training in Canniesburn Hospital Glasgow under Mr I A Mcgregor and David Soutar. Return to Singapore General Hospital Plastic Surgery Department and had HMDP at Emory University Atlanta Georgia Plastic Surgery Department.

E-cigarette burns: Management of a growing phenomenon

Dr Derek Liang1, Dr Charles Meares1, Dr Aruna Wijewardena1, Dr Vincent Choi1, Dr John Vandervord1

1Royal North Shore Hospital, St Leonards, Australia


Introduction: Since its introduction, e-cigarette use has increased in popularity over the last decade. E-cigarettes work via a lithium powered battery which heats up to vapourise a liquid that the user inhales. Burn injuries secondary to e-cigarette use are now presenting to our burns unit and may become more common with its increasing popularity. The mechanism of e-cigarette burns are multiple: contact burn from overheating of the lithium battery, flame and/or chemical burn from the exploding lithium battery and e-cigarette liquid. Due to its complex burn mechanism, it can be difficult even for an experienced burn surgeon to achieve a satisfactory outcome.

Case series: This is a case series of 2 patients who have presented to Royal North Shore Hospital in 2019 for e-cigarette related burns. First case is of a 64-year old female with a 1% TBSA full thickness contact burn to her right posterior thigh from the e-cigarette overheating in her pocket, which required debridement and skin grafting. Second case is of a 61-year old male with a 3% TBSA full thickness burn from his e-cigarette lithium ion battery exploding, which required debridement and grafting.

Conclusion: Whilst e-cigarette burns are usually minor in terms of burn size, the depth of burn can be significant due to their mixed mechanism. Given it’s increasing popularity, it is important to raise awareness about the prevention and ideal management of e-cigarette burns.


Dr Derek Liang is currently a Burn’s Registrar at Royal North Shore Hospital.

Assessing burns in the community pharmacy: a secondary prevention initiative

Dr Lisa Martin1,2,5, Miss Karis Butler2, Miss Siobhan Connolly4,5, All member of the ANZBA Prevention Committee5

1University Of Western Australia, Crawley, Australia, 2Fiona Wood Foundation, Mudoch, Australia, 3Burn Service of WA, Murdoch, Australia, 4NSW Statewide Burn Injury Service, North Shore, Australia, 5Australia and New Zealand Burn Association Prevention Committee, , Australia


Secondary prevention is aimed at early treatment to optimise outcomes. In burn injury, this involves good burn first aid and early appropriate management. Delays to medical attention can cause burn wound conversion, wound infection, and worse scarring due to surgical delays. Increasing community awareness of the need for appropriate medical attention is important.

Delays can occur because patients present to pharmacies for initial treatment and can be reluctant to seek other health care options. A CPD educational article for community pharmacists was produced by the ANZBA prevention committee. This provided role relevant information about burn first aid, wound assessment, dressing choice, referral reasons, and advice.

Two case scenarios were included; one which was a child with a small but deep contact burn requiring referral, and the other was an adult with a scald burn which did not require referral. In addition a quick reference card was created for pharmacists for free and accessible download from the PSA and ANZBA websites.

The aim of the initiative was to empower them in the management and referral of minor burns.



Lisa is a research fellow who has worked in burns research for the past ten years. Her nursing background was in critical care, followed by clinical trials and research nursing in general medicine and cardiology. She has recently completed a PhD in psychological recovery after adult burn and currently has secured funding for post-doctoral work to continue her work in this area. She has a strong interest in burn prevention and is an active member of the ANZBA prevention committee.



ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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