Understanding burn injuries in Aboriginal and Torres Strait Islander children: baseline results from the Coolamon Study

Dr Kate Hunter1, Professor Rebecca Q.  Ivers1,2, Dr Tamara Mackean1,3, Ms  Julieann Coombes1,4, Professor Kathleen Clapham5, Professor Roy Kimble6, Professor Andrew J.A. Holland7

1The George Institute For Global Health, Newtown, Australia, 2Southgate, Flinders University, Adelaide, Australia, 3The Southgate Institute for Health, Society and Equity, Flinders University , Adelaide, Australia, 4The University of Technology, Sydney, Australia, 5Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia, 6Lady Cilento Children’s Hospital; Centre of Children’s Burns & Trauma Research, Queensland Children’s Medical Research Institute, University of Queensland, Brisbane, Australia, 7The University of Sydney School of Medicine, The Children’s Hospital at Westmead, The Faculty of Medicine and Health, Sydney, Australia

Abstract:

Background: Aboriginal and Torres Strait Islander (First Nations) children are over-represented in burn injury hospitalisations, yet little is understood about the burn injury, care received and access to services. This study aims to describe the burden of burns, access to care, and outcomes in First Nations children with serious burns. This paper presents the baseline data.
Methods: In 2015-2017, First Nations children aged under 16 years (and their families) presenting with a burn to one of five tertiary paediatric burn services in Australia were recruited. Data were collected via participant interviews and medical records and includes sociodemographic data, burn injury and first aid treatment, mode and timing of transportation to hospital, health related quality of life and impact of the injury on family. The study is governed by an advisory group comprising representatives from the investigators, Aboriginal community members, and Aboriginal health organisation.
Results: Of 204 children recruited, 64% were male, 45% were aged less than two years, children were more likely to have received first aid at the site of the injury if it was a scald burn compared with a flame burn (95% vs 79%).
Discussion: Burns sustained by children in this cohort were largely scald and contact burns in boys. Although first aid was applied in most cases, timing to first aid differed by burn type.


Biography:

Dr Kate Hunter is a Senior Research Fellow at The George Institute for Global Health and a conjoint senior lecturer at the University of NSW. She leads a large body of work in Aboriginal and Torres Strait Islander health research. In her current research in burn care Dr Hunter draws on her earlier career as an RN working in burn units in both Australia and the US. Her research interests include assessing equitable access to health services for Aboriginal and Torres Strait Islander people. Dr Hunter is supported by a NSW Health Early Mid-Career Fellowship.

Exploration of the psycho-social impact of burn injuries on Aboriginal and Torres Strait Islander children and their families.

Ms Hayley Williams1,2, Dr Bronwyn Griffin1,3, Dr Kate Hunter4, Professor Kathleen Clapham5, Professor Rebecca Ivers4, Professor  Roy Kimble1,2

1Centre for Children’s Burns and Trauma Research, Lady Cilento Children’s Hospital, Brisbane, Australia, 2Faculty of Medicine, University of Queensland, Brisbane, Australia, 3School of Nursing, Queensland University of Technology, Brisbane, Australia, 4The George Institute of Global Health, University of New South Wales, Sydney, Australia, 5University of Wollongong, Wollongong, Australia

Abstract:

Background: Pain from burn injuries and their treatment can be highly distressing for children and adolescents. While Aboriginal and Torres Strait Islander children reportedly have more than twice the rate of burn injuries than non-Indigenous children, little is known of the psychological impact of burns on these children and their families. To date there is also limited availability of psycho-social interventions designed for Aboriginal and Torres Strait Islander children with burn injuries and their caregivers. This study uses Indigenous research methodologies to explore the impact of burn injuries on Aboriginal and Torres Strait Islander children and their families.

Methods: Participants are caregivers of Aboriginal or Torres Strait Islander children aged <16 years accessing burns care at an Australian tertiary burns service. One-on-one yarning sessions incorporating Dadirri deep listening are being carried out to allow caregivers to share their experiences of their child’s burns care and its impact on their family. Grounded theory approaches will be used to explore the psychological and social impact of burn injuries on the injured children and their families.

Results: Data collection and analysis has commenced, and emerging categories will be presented.

Discussion: Aboriginal and Torres Strait Islander children with burn injuries and their families have ongoing support needs that require additional attention. Following these results, caregivers will be invited to take part in yarning circles with other caregivers to form support networks and discuss strategies that will inform the development of resources/interventions to meet their psycho-social support needs and priorities.


Biography:

Hayley Williams is an Aboriginal researcher with family ties in Tingha and Inverell in north-eastern NSW. Hayley has a Bachelor of Social Science and Postgraduate Diploma in Psychology, and is currently completing a Doctor of Philosophy exploring the psycho-social impact of burn injuries on Aboriginal and Torres Strait Islander children and the cultural safety of burns care. Hayley is passionate about improving the health and wellbeing of Aboriginal and Torres Strait Islander people, and has a particular interest in emotional traumas and the resilience of Aboriginal and Torres Strait Islander children and adolescents.

Improving health literacy and shared decision making between clinicians and Aboriginal and Torres Strait Islander paediatric burn patients.

Ms Hayley Williams1,2, Dr Bronwyn Griffin1,3, Dr Kate Hunter4, Professor Kathleen Clapham5, Professor Rebecca Ivers4, Professor  Roy Kimble1,2

1Centre for Children’s Burns and Trauma Research, Lady Cilento Children’s Hospital, Brisbane, Australia, 2Faculty of Medicine, University of Queensland, Brisbane, Australia, 3School of Nursing, Queensland University of Technology, Brisbane, Australia, 4The George Institute of Global Health, University of New South Wales, Sydney, Australia, 5University of Wollongong, Wollongong, Australia

Abstract:

Background: Paediatric burns care can be overwhelming and impact on the patient and family’s ability to acquire and retain important information. Caregivers of Aboriginal and Torres Strait Islander children with burn injuries have indicated strong desires for more detailed information and engagement in decisions regarding their child’s treatment. Burns clinicians have a vital role to ensure patients and families understand their treatment and are able to participant in knowledge sharing and decision making. However, little research has explored burn clinician’s understanding of their role and ability to develop health literacy among patients and families.

Methods: Burn clinicians providing treatment to Aboriginal and Torres Strait Islander children will be interviewed directly following the children’s appointments. ‘Thinking aloud’ sessions involving unfiltered verbal sharing of thoughts, followed by five-itemed exit interviews will be used to explore burn clinician’s information sharing and perceptions of patient and families understanding. Grounded theory approaches will be used to analyse burn clinicians understanding of the development of health literacy skills.

Results: Data collection and analysis has commenced, and emerging categories will be presented.

Discussion: Burn clinicians have a responsibility to provide patients and families with clear, comprehensive, and culturally appropriate health information. However, few resources and supports are available to aid them to do this effectively. These results will inform the next phase of the study in which burn clinicians will be invited to discuss solutions that will inform the development of resources/interventions to support them in their role of developing health literacy among their patients and families.


Biography:

Hayley Williams is an Aboriginal researcher with family ties in Tingha and Inverell in north-eastern NSW. Hayley has a Bachelor of Social Science and Postgraduate Diploma in Psychology, and is currently completing a Doctor of Philosophy exploring the emotional impact of burn injuries on Aboriginal and Torres Strait Islander children and the cultural safety of burns care. Hayley is passionate about improving the health and wellbeing of Aboriginal and Torres Strait Islander people, and has a particular interest in emotional traumas and the resilience of Aboriginal and Torres Strait Islander children and adolescents.

Aboriginal and Torres Strait Islander children with a serious burn injury – multidisciplinary teams describe what informs their care

Ms Sarah Fraser1, Associate Professor Julian Grant1, Dr Tamara Mackean1, Dr Kate Hunter2, Mrs Ngara Keeler3, Professor Kathleen Clapham4, Associate Professor Warwick Teague5, Professor Tom Potokar6, Professor Rebecca Ivers2

1Flinders University, Bedford Park, Australia, 2The George Institute for Global Health, Newtown, Australia, 3Aboriginal Health Council of South Australia, Adelaide, Australia, 4University of Wollongong, Wollongong, Australia, 5University of Melbourne, Melbourne, Australia, 6University of Swansea, Swansea, United Kingdon

Abstract:

Objective: To investigate factors informing burn care for Aboriginal and Torres Strait Islander children.
Design: In-depth qualitative study with semi-structured interview questions.
Setting and participants: Multidisciplinary team members who provide care for Aboriginal and Torres Strait Islander children in six tertiary burn units across five Australian jurisdictions.
Results: Results from 76 interviews suggest burn care in Australia is informed by a web of complex factors including evidence, resources and resourcing, individual clinician decision making processes and beliefs, and models of care. A western biomedical health paradigm governs healthcare system policy for burn care. The allocation of resources informs the provision (or not) of care; as does expert information and direction from senior clinicians. Participants reported jurisdictional specific models of burn care to inform care for Aboriginal and Torres Strait Islander children; which were developed using service and team experience, population data and other evidence derived in a western paradigm.
Conclusion: Burn care for Aboriginal and Torres Strait Islander children in Australia is performed in a western biomedical paradigm that participants report is not always aligned with Aboriginal and Torres Strait Islander families’ concepts of health and healing. System resources to support services and individuals targeting good burn care for Aboriginal and Torres Strait Islander children are required.


Biography:

Sarah is a registered nurse and currently works in a state-wide quality improvement coordinator role at the Aboriginal Health Council of South Australia. Sarah is one of four PhD candidates on a large study investigating burn injury in Aboriginal and Torres Strait Islander children.

Management of First Web Space Contracture in a Severely Burned Patient

Dr William A. Ziaziaris1, Dr Heather Greig1, Dr David A. Stewart1

1Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia

Abstract:

Introduction:Burns of the hand are common, most often affecting young males. Hands are involved in approximately 30-60% of all burn injuries and seen in up to 80% of severe burns.

We present an interesting case of a severely burned patient with complex vascular anatomy who required free tissue transfer to correct a first web space contracture of the right hand.

Case Report: A 42 year-old male was admitted to the Severe Burns Unit of Royal North Shore Hospital with 82% total body surface area flame burns in January 2017. Along with other affected regions, both upper limbs sustained full thickness, circumferential burns.

The patient developed a flexion deformity of the right little finger along with a contracture of the first web space and was referred for reconstructive management in 2018.

Fusions of the distal interphalangeal joint of the little finger and the first carpometacarpal joint were performed, with thumb fixation in a pronated position. The web space was released and a groin free flap based on the superficial circumflex iliac artery pedicle was inset. The patient had an uncomplicated post-operative course and was discharged after 10 days.

Discussion: Due to the paucity of healthy, non-burnt tissue, options for reconstruction in this case were limited. Web space deformity is common post thermal injury to the hand and occurs secondary to scar contracture and banding. The major goal of contracture correction is to deepen the web space using local advancement flaps, Z plasty, V-to-M plasty or free tissue transfer.


Biography:

Resident medical officer, Royal North Shore Hospital, Hand and Peripheral Nerve Surgery

Development of a new model of care for burn injuries in Aboriginal and Torres Strait Islander children

Prof. Rebecca Ivers1,2,5, Dr.  Kate Hunter1, Dr. Tamara Mackean1,2, Ms.  Julieann Coombes1, Prof. Kathleen  Clapham3, Prof.  Roy Kimble4, Prof. Andrew Holland5,6

1The George Institute For Global Health UNSW, Newtown, Australia, 2Southgate Institute for Health, Society and Equity, Flinders University  , Bedford Park, Australia , 3Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia , 4Lady Cilento Children’s Hospital, University of Queensland, South Brisbane, Australia , 5Sydney Medical School, University of Sydney, Camperdown, Australia , 6The Children’s Hospital at Westmead , Westmead, Australia

Abstract:

Background: Little research examines burn care in Aboriginal and Torres Strait Islander children, despite significant burden. The objective of this study was to describe the burden of burns, access to care, and outcomes in Aboriginal and Torres Strait Islander children with serious burns, and inform development of a new model of care.
Methods: Aboriginal and Torres Strait Islander children under 16 years of age presenting to a paediatric burn unit in four states were recruited. Quantitative data were collected via participant interview and clinical data to capture outcomes and impact, including cost. Qualitative research and patient journey mapping was conducted to identify barriers to care. The study is governed by an Aboriginal advisory group and uses Indigenous methodologies as a frame of reference.
Results: 204 participants and their families were recruited and followed over 2 years; in-depth interviews with 76 clinical burn team members from 5 states, and 18 family members were conducted. Results highlight significant systemic barriers to accessing care, and significant personal and economic impact on families. Findings will be presented back to clinicians, peak bodies and patients/carers and a consensus based approach used to inform development of a new model of care.
Discussion: There are numerous systematic barriers to care for Aboriginal and Torres Strait Islander children, and the results of this study will inform development of a new model of care that explicitly considers the care of Indigenous children, and incorporates interventions for system wide cultural safety.


Biography:

Rebecca Ivers is director of the Injury Division at the George Institute for Global Health, where she leads a team of 40 researchers, project managers and students. She is a NHMRC Senior Research Fellow and has Professorial appointments at the University of NSW, University of Sydney and Flinders University and is visiting Professor at UTS Sydney. Professor Ivers is an injury focused public health researcher with significant expertise in the design and conduct of randomised and pragmatic trials. Her research focus cuts across prevention and treatment of unintentional injury in Australia and globally and her work includes leading an extensive range of research programs on injury in Aboriginal and Torres Strait Islander people.

Australia’s First Nation Children’s need for Culturally Appropriate Burn After Care

Ms Julieann Coombes1,3, Dr Kate Hunter1,2, Dr Tamara Mackean1,4, Professor Elizabeth Sullivan3, Professor Rebecca Ivers1,3, Professor Andrew Holland5

1The George Instuitute For Global Health, Newtown, Australia, 2University of New South Wales,Faculty of Medicine,, Sydney, Australia, 3University Of Technology Sydney, Sydney, Australia, 4Flinders University, Adelaide, Australia, 5University of Sydney, Sydney, Australia

Abstract:

Background:The lack of cultural safety and appropriate communication in health care in Australia is ongoing for First Nation people creating potential barriers to accessing health services.  We report on preliminary findings from a study investigating factors impacting access to culturally safe and appropriate after burn care.

Methods:Eighteen parents of children under 16yrs were asked to describe their journey in accessing appropriate burn after care. Interviews were conducted in family homes and communities. Indigenous research methodology was used throughout the study, including yarning for interviewing and Indigenous concepts of health to frame data analysis. Data was gathered in South Australia, Northern Territory, Queensland and New South Wales.

Results:Access for First Nation children and their families can be difficult due to the lack of finances, distance to services. Presently there are no known culturally appropriate resources to help families understand the process of medical intervention for the healing process to continue once the child has left the burns unit. Involvement of First Nation health workers working with health providers, the child and family members was found to be an important facilitator in improving access to ongoing health care.

Conclusion: There are significant barriers in accessing health care following a burn but also some clear facilitators. It is fundamental for First Nation families to have input into care received and the care that is needed for ongoing burn care to be effective. Barriers can be alleviated by First Nation Health workers support and involvement in the child’s health care.


Biography:

Julieann identifies as a Gamilaraay woman. She is a Registered Practice Nurse with extensive involvement in Aboriginal and Torres Strait Islander health. She is very active in local Aboriginal and Torres Strait Islander representative groups, has taught Aboriginal and Torres Strait Islander health in secondary and tertiary institutions and has represented Aboriginal and Torres Strait Islander nurses at the national level. Julieann’s focus areas are cultural awareness, equity, equality, health and education. She held the position for a 3-year term on the Board of Ethics for the Australian Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA). Julieann is an Aboriginal PhD Candidate at University of Technology, Sydney and is an Aboriginal Research Fellow at The George Institute for Global Health.

Burden of Burns in Australian Children

Mrs Courtney Ryder1, Dr  Tamara Makean1, Dr  Kate Hunter1, Dr  Holger Moller1, Professor Belinda Gabbe2, Professor Andrew Holland3, Professor Rebecca Ivers1

1The George Institute For Global Health, UNSW, Sydney , Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 3The University of Sydney, School of Medicine, Sydney, Australia

Abstract:

Background:In Australia inequalities are evident between Indigenous and other Australian patients, including injury rates, and length of stay. To better understand these differences this study reports a population comparison, including examination of contextual and clinical factors.

Methods:Data from October 2009–July 2017 were accessed from the Burns Registry of Australia and New Zealand. Patient inclusion criteria included Australian ethnicity, <16 years of age, with acute burn admissions. Numbers and percentages were reported over, patient demographics, injury mechanism and anatomical location, %TBSA, length of stay, ICD10-AM diagnosis and procedures.

Results:Of the 6710 patients, most were male (60.6%, n=4069), aged 1-4 years (53.4%, n=3585), and 10.2% (n=686) were recorded as Indigenous. Food and beverage scalds were the major cause of burns (26.1%, n=1752), with burns to the upper limbs (34.7%, n=2332) predominant. Coal or ash contact burns were more common in Indigenous children (13.9% vs 5.8%), along with burns to lower limbs (62.8% vs 49.5%) and streptococcus infections (5.5% vs 1.0%). Marginal differences, >10%TBSA were found (12.5% vs 10.1%). Longer length of stay >7 days was reported for Indigenous children (45.0% vs 19.4%). Slight variations were found in ICD10-AM procedures, sedation use (9.0% vs 11.4%), >3% split skin grafts (10.8% vs 7.1%).

Conclusion: A higher proportion of Indigenous children sustain a burn as a result of hot coal or ash contact. Despite similar burn severity, Indigenous children have higher rates of streptococcus infection and are more likely to have >3% split skin graft, which may contribute to significantly longer inpatient care.


Biography:

Courtney Ryder is an Aboriginal PhD student through The George Institute for Global Health at UNSW. Her studies are focussed on burns outcomes as part of a multi-site NHMRC funded study, understanding burn injuries in Aboriginal and Torres Strait Islander children: treatment, access to services and outcomes.

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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