Improving Physiotherapists’ Capabilities in the Management of Complex Paediatric Burn Injuries in the Paediatric Intensive Care Unit through Simulated Learning

Ms Crystle Gambetta1,2, Mrs Sarah Wright2

1Pegg Leditschke Children’s Burns Centre, Brisbane, Australia, 2Children’s Health Queensland HHS, Brisbane, Australia


Background: Burn injuries requiring admission to paediatric intensive care unit(PICU) although less frequent, are often larger TBSA injuries with associated increased morbidity. Physiotherapy management for these children is multifaceted, requiring specialised knowledge and skills to manage respiratory and musculo-skeletal compromise. QCH physiotherapy delivers a 7-day service requiring staff with limited critical care or burns experience to manage these children at weekends. CHQ has delivered targeted simulated learning to pre-& post registered physiotherapists across Queensland for 10 years. It has demonstrated a significant increase in confidence, capability and self-efficacy in acute cardiorespiratory care[1], however a burns scenario had not been developed that targeted the technical and non-technical skills required for this speciality.

Aim: To develop and deliver a simulated scenario, will increase confidence and self-efficacy of physiotherapists managing complex burn injuries within a tertiary PICU setting.

Method: Single centred study(QCH) involving physiotherapists working weekends. Burns SME(subject matter expert) in collaboration with simulation team to develop a scenario for a burn injury, requiring ventilation within the PICU. Specific learning objectives embedded for situational awareness, clinical decision making, communication and teamwork. Descriptive and qualitative data to be collected, including self-efficacy and reactionnaire® to evaluate outcomes.

Results: Burns injury scenario developed with targeted objectives that will provide physiotherapists with the capabilities to deliver safe and effective care. Data and feedback regarding the model of training will be presented.

Conclusion: Scenario well received by simulation team and to be included with the training of all QCH weekend staff (approx.40).

[1]Wright et al.Pediatr Crit Care Med.2014;15(4):1006


Crystle has  9 years experience primarily in paediatrics and worked at Queensland Children’s Hospital for 4 years extensively with the burns service.

Her areas of interest include rehabilitation of lower limb burn injuries as well  as training and supporting physiotherapists across the State regarding physiotherapy in burns and plastics.

Maintaining adequate training for effective burns disaster response

Dr Alexandra O’Neill1, Ms Joanna Camilleri1, Prof Suzanne Rea2, Winthrope Professor Fiona Wood2

1Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Australia, 2Burn Injury Research Unit, University of Western Australia, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth, Australia


Introduction: Burn Mass Casualty Incidents (BMCI) are one of the most difficult events for hospitals to manage due to the extreme burden on the healthcare system due to the high demand for nursing and medical care, significant resource requirements and the unpredictability of events in ostensibly risk-free populations. Effective management of BMCI depends on comprehensive pre-incident planning. It has been 10 years since a BMCI directly affecting Western Australia and in that time the unit has relocated to a new institution. Methods: A 12-question survey was emailed to all staff involved in the response to a major burn disaster at the state’s tertiary burns hospital. Questions were designed to determine staff members previous involvement and training in major burns disasters and compare results with a similar study conducted in 2009. Results: A total of 498 staff members completed the survey with an overall response rate of 12%; 53% nurses, 30% doctors, 15% allied health and 2% were executives. A total of 773 courses had been completed by staff however 39.4% of all certifications had expired. Only 26% had participated in any disaster training exercises compared with 67% in 2009.  Conclusions: In the 10 years since a BMCI affecting WA hospital-wide training and education has declined significantly resulting in reduced staff preparedness for BMCI. Education, training and repetition of exercises are key elements of a disaster management and as such tertiary centres need to implement regular education and simulation even in times of calm to ensure best outcomes.


Calf Augmentation. 2018. O’Neill, A & Briggs, P. Oral Presentation 16th International Congress of Oriental Society of Aesthetic Plastic Surgery (OSAPS).

Clinical Photography: using smartphone technology assists referrals to specialty units. 2016. O’Neill, A. Owen, R. & Rawlins, J. Oral presentation Royal Australasian College of Surgeons, Annual Scientific Congress 2016

Keloid scarring following red-inked tattooing in Bali. 2016. O’Neill, A & Van Dam, H Poster presentation Royal Australasian College of Surgeons, Annual Scientific Congress 2016

A Fraction Too Much Friction. O’Neill, A., Lam, J and Read, D. Australian New Zealand Poster presentation at Australian New Zealand Burns Association Annual Scientific Meeting, October 2013

Three Years of EMSB in Indonesia: A Journey in Standardizing and Escalating Burn Care in Indonesia

Dr Lisa Hasibuan1

1The Indonesian College Of Surgeons, Bandung, Indonesia


The first EMSB course in Indonesia was held in December 2013, but it wasn’t until the year 2016 that the course became the standard for the acute management of severe burns in our country and was held regularly. Supported by Royal Australasian College of Surgeons (RACS), ANZBA, with collaboration both the Indonesian College of Surgeons, and the Indonesian College  of Plastic Surgeons , we trained our faculty that is very committed in teaching the EMSB course in Indonesia.

After holding 45 courses—and the numbers are still growing—with 30 instructors and 7 coordinators, we have spread the skill and knowledge to our country ranging from Aceh to Papua. Through EMSB in Indonesia, 1070 participants are competent to handle acute management of severe burns with a 20% rate of re-sits for the written exam, 3% rate of re-sits for the simulation exam and 1% rate of participants that had to re-take the whole course.

Though the path has been started to have a standardized and qualified burn care all over Indonesia, still  many challenges to face other than training health professionals, such as  having every doctors participating for the National Burn Registry, building a good Burn Referral System and also educating the people about burn prevention. Our recent study showed that the public, especially those with low socioeconomic status have inadequate knowledge regarding burn prevention, burn first aid and initial management. These challenges are further heightened in the Indonesian national health insurance (BPJS) era, where hospital care budget is extremely limited, especially for long-term care such as burns patients.


Author is a senior Indonesian plastic surgeon and the Burn Unit head in Hasan Sadikin General Hospital, also involved in teaching plastic surgery residents. She took  the advanced training through ASPS/PSF/Smile Train International Scholarship Program  in the USA an an internship program in Japan. She has an interest in building Indonesian plastic surgery education,  and positioned as Curriculum Committee in the Indonesian College of Plastic Surgery. She is active as speaker in various scientific activities. She is the founder of Indonesian Burn and Wound Healing Society.

Analgesia Protocols for Burns Dressings: Challenges with Implementation 

Dr Shelley Wall1, Prof Damian Clarke1, Dr  Nikki  Allorto1

1Pietermaritzburg Burn Service, Pietermaritzburg Department Of Surgery, Pietermaritzburg, South Africa


Background: The aim of this study is to compare doctors’ knowledge regarding analgesia in paediatric burns patients in a setting where analgesia protocols are provided but not reinforced to a setting where the same protocols are used but with constant re-enforcement from burns surgeons.

Methods: We reviewed questionnaires completed anonymously by doctors managing burns children in the Pietermaritzburg (PMB) Hospital Complex and the referral hospitals.

Results: The questionnaire was completed by 43 doctors with 53% of the participants working in the referral hospitals. Procedural sedation was given by 98% of doctors. All PMB doctors giving procedural sedation used ketamine compared to 39% in the referral hospitals, which was statistically significant (X2 = 18.237; p < 0.001). Eighty percent of PMB doctors were aware of the correct doses of ketamine and compared to 8% of referral doctors. This was statistically significant (X2 = 21.778; p < 0.001). When assessing the adequacy of analgesia, all of the doctors from PMB used a scoring system or clinical impression. In the referral doctor group, 54% used a scoring system, 38% used the child screaming as an indicator of inadequate analgesia.

Conclusion: We have identified a discrepancy in knowledge between staff in an academic burn centre and those in peripheral referral hospitals. This discrepancy translates into differences in quality of burn analgesia which patients receive. Ongoing efforts must be directed towards changing the culture of district institution and strengthening attempts to standardize care across the region.


Shelley Wall is a general surgeon currently running the burns service at Greys Hospital in Pietermaritzburg in South Africa.


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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