Results from a National Burn Prevention and First aid Treatment Education Campaign

Dr Leila Cuttle1, Dr Belinda  Wallis2,3, Ms Jacquii Burgess3, Ms Erin Meyers1, Dr Cate Cameron4,5, Prof Roy Kimble1,3,6, Mr Steve Huff7

1Centre for Children’s Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation at Centre for Children’s Health Research, South Brisbane, Australia, 2Larchill Consulting, Hawthorne, Australia, 3Centre for Children’s Burns and Trauma Research, University of Queensland, Centre for Children’s Health Research, South Brisbane, Australia, 4Jamieson Trauma Institute, Royal Brisbane & Women’s Hospital, Herston, Australia, 5Menzies Health Institute Queensland, Griffith University, Logan, Australia, 6Children’s Health Queensland, Lady Cilento Children’s Hospital, South Brisbane, Australia, 7iPug (Injury Prevention Using Gamification), Maroochydore, Australia

Abstract:

Public knowledge of correct burn first aid treatment is poor and burn injury preventative behaviours need to be promoted. Over the past year, we have utilised a smartphone app-based campaign to provide burn prevention and treatment messages and resources to the Australian public. Animations and infographics were developed to target the most common mechanisms of burn injury for adults and children. These were delivered to the public by several different methods: an app (Cool Runnings) which could be downloaded onto participant’s phones, media releases, dissemination by partner organisations, Facebook marketing and public events. Different strategies were trialled to increase reach and public knowledge. The impact of the campaign was measured by: the number of interactions with the app or the messages, extra sharing and promotion of the materials within participant social networks and changes in knowledge, assessed by surveys. Social media-based strategies reached more people than other methods. Marketing strategies which generated the most public support and changes in knowledge will be reported, to enable other effective burn education campaigns to be developed in the future.


Biography:

Dr Leila Cuttle is an NHMRC Career Development Fellow and biomedical researcher, based at the Centre for Children’s Health Research, Queensland University of Technology and Lady Cilento Children’s Hospital. She has been conducting burn research for the past 16 years and is passionate about burn prevention and developing better evidence-based burn treatments. Leila is an expert at facilitating biological research at the clinical interface and has lead clinical trials, laboratory work and public health/injury prevention projects.

The Viability of Primary Human Skin Fibroblasts Exposed to Heat: The Lethal Dose for 50% Death is 48˚C.

Ms Elissa Henderson1, Ms Margit Kempf2, Ms Emily Jones1, Ms Sara Kong1, Ms Ella Pearson1, Ms Anastasia Kearns1, Dr Leila Cuttle1

1Queensland University of Technology, Brisbane, Australia, 2University of Queensland, Brisbane, Australia

Abstract:

Scald burns are common injuries that can cause lifelong suffering, particularly for children. To prevent burn injuries, attempts have been made to set maximum water temperatures from household faucets, however, there is little evidence of adherence to these guidelines and poor evidence to support them. Prior burn research has mostly focussed on new dressing or treatment methods, but more needs to be understood about the cellular mechanisms involved in heat-affected cells or injury progression. Primary normal human skin fibroblasts were cultured for a period of 6 days and then exposed to a range of temperatures from 37˚C to 54˚C for a period of 1 hour, followed by a 1 hour recovery period. An MTT assay was used to assess the relative cell viability of heat-treated and control cells. Several cell morphology changes were visible when cells were exposed to heat, including: rounding of cells, loss of adherence to cell culture flasks, and degradation of both the nuclear membrane and plasma membrane. The LD50 for 1 hour of heat exposure was determined to be 48˚C for primary fibroblasts. This study supports previous research that thermal damage to cells occurs at 43˚C. This study has provided a reproducible method that can be used to examine the effect of heat on primary human cells grown in culture and can further be used to develop burn therapies that limit heat injury and burn wound progression.


Biography:

Elissa is student in her third year of a Bachelor of Biomedical Science. Having previously completed a Bachelor of Business, her future career aspirations are to continue in the field in medical research.

Promulgating the signals of Burn Prevention and Correct First Aid Treatment of Burn Injury

Ms. Wong Tze Wing

1Burns Centre, Prince of Wales Hospital, Shatin, Hong Kong, Hong Kong Hospital Authority, Hong Kong

Abstract:

Introduction:Burn incidents happen are always unexpected. There were increasing trends of burn injuries in the community. Burn injury is preventable. Public needs to recognize that a safe home environment contributes to the prevention of burn & scald accidents. However, it is an important message to disseminate to families with babies or toddlers particularly. Also, home safety environment is important element for the elderly living alone.

In the past five years (2009-2013), the average burn admission was 68% of total admission in Burns Centre. Most of victims were injured due to careless or knowledge deficit. And numbers of burn or scald admissions had no or improper first aid treatment. However, the application of first aid treatment is critical in affecting the consequence on depth of burn wound and recovery process. Therefore, community promotion and education on Burn prevention and First aid intervention are mandatory.

Objectives:

  1. To increase public awareness in prevention of burn injury
  2. To disseminate the concept of correct first aid treatment after burn injury
  3. To reduce the risk of secondary burn or scald injury

Methodology:In 2014 onwards, correct first aid education on burn injury was conducted to patients and carers in Burns Centre. Our primary nurses provided educational talks about First aid intervention to them and evaluate regarding the intervention provided upon these incidents. Also, information pamphlets for First aid treatment were given to them for reminder.

Three Health Carnivals were conducted in 2012 -2014 in Hong Kong. Booths on Burn Prevention and Correct first aid treatment were displaced to disseminate these important message. Games were designed to attract the public to participate the event. Knowledge on Burn prevention, Home safety and Correct first aid treatment were delivered to them (including elderly and parents). Finally, a lot of citizens enjoyed these events.

Reference:Hospital Authority Statistical Report 2008-2013, Hospital Authority.


Biography:

Ms. Wong Tze Wing is Nurse Consultant In Burn and Plastic Specialty in Prince of Wales Hospital, Hong Kong Hospital Authority. She has extensive experience in burn management and regularly teaches and coaches nursing colleagues in Hong Kong. She also takes part in advances in burn care and is an EMBS course Nurse coordinator.

Chemical Injury: Experience with an Advanced Approach

Mr Jozef Verbelen1, Mr Hendrik Hoeksema1, Dr Karel Claes1, Prof. Stan Monstrey1

1University Hospital Gent, Gent, Belgium

Abstract:

Objectives:Chemical burns are a specific kind of injury requiring customized therapy.
Water is still considered to be the golden standard in emergency rinsing of chemical injuries but there are additional options involving hypertonic solutions based on amphoteric and chelating molecules.
In March 2012 we started applying two varieties of the above-mentioned agents in the emergency management of chemical injuries. One agent is specifically intended for decontamination of hydrofluoric acid splashes (Hexafluorine®). The other solution (Diphoterine®) is indicated for all further kinds of acid or alkaline splashing.
Question remained if the modern solutions really made a difference.

Methods:We retrospectively compared emergency treatment of chemical injuries admitted in our hospital between January 1st 2008 and December 31st 2015. In the “control” group only water was used. In the “advanced approach” group, according to indication, the previously described hypertonic solutions were applied, possibly preceded by rinsing with water.
Both research groups were statistically (SPSS 23) compared for composition (gender, age, burn cause, triage), need for surgery and days of hospitalization.

Results:112 patients were included for statistical analysis, 66 in the “control” group and 46 in the “advanced approach” group.
As far as composition is concerned both research groups were comparable.
Statistics revealed significantly less surgery (p<0.0001) and a significantly shorter hospital stay (p=0.031) in the “advanced approach” group when compared to the “control” group.

Discussion / Conclusion: In our hospital, patients with chemical injury clearly benefited from the application of an advanced approach, involving hypertonic solutions based on amphoteric and chelating molecules, in the emergency treatment of this kind of trauma.


Biography:

1989: Graduated as a nurse

2006 Master degree in Nursing

2009 Burn Care Coordinator (Burn Centre University Hospital Gent, Belgium)

Towards a Standard Model of Pre-hospital Burn First Aid – one step forwards, two steps back.

Mr Nicholas Goodwin1

1Ambulance Victoria, Doncaster, Australia

Abstract:

At ANZBA 2011, the author presented material on the use of hydrogel burns dressings in pre-hospital care  also exploring trends in burn first aid via a sample of recommendations from peak bodies, EMS, First Aid organisations and other parties. Considerable variation was evident and this has previously been reported .

A 2018 evaluation of a similar subset of current practice recommendations shows much work remains to reach consensus in all sectors involved in pre-hospital burn care on common parameters for burn first aid – i.e. – a “standard model”.

Crucially, lack of consensus amongst both recommending authorities and pre-hospital responder organisations continues to undermine efforts to educate the lay public in burn first aid now further distracted by the internet and social media commentariat, a particularly advantageous environment for commercial product marketing and the promotion of “alternative” therapies .

The author suggests adoption of an international standard model of burn first aid within a seamless continuum of care that begins at the “000” emergency call taker desk and merges lay interventions with EMS care to facilitate consistent and beneficial clinical management of the patient from incident right through to the ED door.

This creates an easily “saleable” message in public education, promotes confidence in lay practice and informs specific role playing for each responder within the care chain.

Such an approach also provides a vehicle for further research through retrospective analysis of the standard model of care via an easily accessible cohort of patients and pre-hospital responders respectively all receiving and delivering equivalent practices. Clarity derived from such analysis enhances prospects for improving the clinical benefit of the pre-hospital element of burn care via nuance or modification of parameters.


Biography:

Paramedic with Ambulance Victoria for 28 years, 17 years as an intensive care paramedic (MICA). Published first systematic review on the use of hydrogel burns dressings in pre-hospital burn first aid 2015/16. Oral presentation of findings at 2011 ANZBA conference. Contributed to development of 1st aid and hydrogel documents for the British Burn Association 2018. Also supplied information and material input for the Faculty of Pre-Hospital Care Royal College of Trauma Surgeons document, “Management of Burns in Pre – Hospital Trauma Care” 2018.

Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: A prospective randomised controlled trial protocol

Miss Maleea Holbert1,2, Dr Bronwyn  Griffin1,2,3, Professor Roy Kimble1,2,3

1Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, The University of Queensland, Brisbane, Australia, 2Pegg Leditschke Children’s Burns Centre, Lady Cilento Children’s Hospital, South Brisbane, Australia, 3Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Australia

Abstract:

Hydrogel dressings have gained widespread use in the pre-hospital setting for acute burn injuries (Fein et al., 2014), with anecdotes to suggest these dressings provide analgesia via an evaporative cooling effect (Cuttle et al., 2008). Empirical evidence is lacking on the analgesic properties of Burnaid® hydrogel dressings for the treatment of acute burn injuries, and to date no studies have been conducted investigating the effectiveness of hydrogel dressings in paediatric burn patients. This study will determine if Burnaid® is an effective treatment for reducing pain in the acute burn period. It is hypothesised that Burnaid® will provide superior pain relief in comparison to plastic wrap, which is the current recommended acute wound covering for burn injuries. A single-centre, superiority, two-arm parallel group, randomised controlled trial is being conducted to assess the effectiveness of Burnaid® hydrogel dressing as an analgesic adjunct to first aid for the treatment of paediatric burns. Participants include children aged between 0 – 16 years with an acute thermal burn injury (total burn surface area of < 20%) presenting to the Department of Emergency within 24 hours of the burn occurring. Participants are randomised into one of two treatment groups: 1) Plastic wrap (control arm) or 2) Burnaid® (intervention arm). The primary outcome is the intervention effect on reducing acute pain. Recruitment for this trial commended in September 2017 and is expected to be finalised by October 2018. This study replicates a real-world scenario in order to identify clinically significant analgesic and would healing effects.


Biography:

Maleea Holbert is a PhD Candidate at the Centre for Children’s Burns and Trauma Research. Her current research is investigating the effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries.

3,4-Methylenedioxy-β-Nitrostyrene Ameliorates Experimental Burn Wound Progression by Inhibiting the NLRP3 Inflammasome Activation

Prof. Ligen Li1, M.D Meng jing Xiao1

1Burn and Plastic Surgery, First Affiliated Hospital of General Hospital of PLA , Haiding District, Beijing, China

Abstract:

Background: Burn wound progression remains a challenging problem in the clinic. Secondary tissue damage caused by unlimited inflammatory response is considered to be one of the key factors contributing to this clinical problem. Nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome has recently been found to play important roles in immune activation and the inflammatory response after burn/ trauma. This experimental study aims (1) to observe the expression and distribution of NLRP3 inflammasome in burn wounds of a rat burn model and (2) to study whether inhibiting the NLRP3 inflammasome activation would ameliorate burn wound progression.

Methods: A deep second-degree burn was inflicted on the backs of Wistar rats. The expression of NLRP3 inflammasome components and interleukin-1β were determined by Western blot and coimmunoprecipitation. The distribution of NLRP3 inflammasome was assessed by immunohistochemical staining and double-labeling immunofluorescence. Neutrophil infiltration, wound perfusion, burn depth, and wound healing time were assessed. Results: Burn induced remarkable NLRP3 inflammasome activation and cleavage of interleukin-1β. The NLRP3 inflammasome was observed mainly in macrophages of the zone of stasis. 3,4-Methylenedioxy-β-nitrostyrene significantly inhibited NLRP3 inflammasome activation and inflammatory cytokine production in burn wounds. Consequently, neutrophil infiltration was reduced, wound perfusion was restored, burn wound progression was ameliorated, and wound healing was accelerated.

Conclusions: In this study, the authors demonstrated that burn induced NLRP3 inflammasome activation and inflammatory response in wounds, which may be associated with burn wound progression. Treatment with 3,4-methylenedioxy-βnitrostyrene inhibited NLRP3 inflammasome activation, ameliorated burn wound progression, and promoted wound healing.


Biography:

Li Ligen, Professor of Burn and Plastic Surgery , the First Affiliated Hospital of General Hospital of the Chinese People’s Liberation Army, has done some clinical and experimental studies on prevention and treatment to the progressive deepening of deep second degree burn wound .

Saving Lives Is Not Enough

Kristina Stiles2, Mr David Wales1

1Kent Fire And Rescue Service, Tovil, Maidstone, United Kingdom, 2London and South East England Burn Network., London, United Kingdom 

Abstract:

Within the UK burns community, the role of the Fire and Rescue Service (FRS) has generally been understood as being limited to the rescue and removal of a casualty from an area of active risk. Responsibility for subsequent care then passing as quickly as possible to healthcare colleagues where medical/welfare care is provided pre, peri and post hospital. Managing incidents this way makes sense when viewed from the perspective of the traditional role and responses of each agency.
However, it has become evident that this “sum of the parts” approach does not provide the best outcome or end to end experience for the casualty. It may also have inhibited thinking about the potential aim and role of the FRS. And yet, they are an underutilised asset who could greatly contribute to better outcomes and reduced treatment costs.
Following six years of collaboration, the authors produced a report (titled “Saving Lives is Not Enough”) which suggested a new way to approach pre-hospital burns care. This was adopted by Kent FRS and is attracting widespread interest.
The authors conclude that a casualty (or customer) centred model, shared aim and greater end to end dialogue between the professions offers a better approach. This would support identification of the earliest or most effective interventions and allow for a partnership model to drive improvement.
Within the context of the conference theme, the report proposals offer great potential to avoid or reduce scarring through enhanced scene based first aid including early and full burn cooling


Biography:

David is an experienced fire officer and award winning researcher and presenter. His pioneering work on human behaviour in dwelling fires has led to new understanding and insights which are influencing both UK and international thinking. This includes the adoption of a customer experience approach to service design and delivery. He has worked with his co-author and the UK burns community since 2012, resulting in the publication last year of a report titled ‘Saving Lives is Not Enough’.

Appropriate First Aid in Chemical Burn Injury

Dr Daniel Calandro1, Dr Suzanne Rea1, Prof. Fiona Wood1

1State Burns Service, Western Australia, Murdoch, Australia

Abstract:

Burn injuries are common and debilitating, but can be appropriately managed, with timely and adequate first-aid dramatically improving burn outcomes. This study assessed first-aid performance in chemical burns, which has an increased risk in Western Australia (WA) due to its large industrial sector.

51 Adult patients presenting to the State Burns Service of WA with exclusively chemical burns between April and December 2016, were assessed for appropriate burns first-aid care with respect to stop, cool, and cover methods and timing.

Key Demographics: 78% of burns occurred in men. 61% affected trades-persons and related workers. 51% of burns occurred at work vs. 31% at home. 51% of burns were to the upper limb and hand; TBSA for all burns was 1.2%. PPE worn in 26% of burns, with 71% of that worn in the workplace.

Key First-Aid: Stop first-aid data was available in 80% of patients, with 34% receiving appropriate methods. Cooling first-aid data was the best documented area, available in 98% of patients, with 33% receiving adequate cool running water for >20 minutes <3hrs from injury. Appropriate dressings were used in 22% of burns. Patients who received adequate cooling first-aid required less inpatient care, shorter hospital stays, and fewer surgeries.

Conclusions: This was the first study evaluating exclusively chemical burn first-aid in WA, identifying patterns of chemical burn injury, with trades-persons at highest risk, and found that practices under-performed when compared to local and national mixed-type burn studies; supporting the need for strategies to improve first-aid performance and outcomes.


Biography:

Daniel grew up in country Victoria. His academic journey began with a triple major bachelor of science from the University of Melbourne in anatomy, physiology, and neuroscience; before a doctor of Medicine, and Master of Philosophy in Medicine, from the University of Sydney and University of Notre Dame. He works as a medical officer and medical research scientist; and currently aspires to complete surgical training in Australia

About ANZBA

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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