Introduction:Prehospital and community hospital healthcare providers in the United States must be prepared to respond to burn disasters. Continuing education is the most frequently utilized method of updating knowledge, skills, and competence among healthcare professionals. Since preparedness training must meet multiple educational demands, it is vital to understand how participants'work and educational experience and the program's content and delivery methods impact knowledge acquisition, and how learning influences confidence and competence to perform new skills.Purpose:The purpose of this exploratory, convenience sample study was to identify healthcare provider characteristics and continuing education training content areas that were predictive of self-reported improvement in competence after attending a mass-casualty burn disaster continuing education program.Methods:Logistic regression analysis of data from a post-training evaluation from nine, one-day continuing education conferences on mass burn care was used to identify factors associated with improved self-reported competency to respond to mass burn casualties.Results:The following factors were associated most closely with increased self-reported competency: (1) prehospital work setting (odds ratio (OR) = 3.06, confidence interval (CI) = 0.83–11.30, p = 0.09); (2) 11 or more years of practice (OR = 0.31, CI = 0.09–1.08, p = 0.07); and (3) practice in an urban setting (OR = 0.01, CI = 0.18–0.82, p >0.01). Confidence items included: (1) ability to implement appropriate airway management modalities (OR = 2.31, CI = 1.03–5.17, p >0.04); (2) manage patients with electrical injuries (OR = 4.86, CI = 1.84–12.85, p >0.001); (3) identify non-survivable injuries (OR = 2.24, CI = 0.93–5.43, p = 0.07); and (4) recognize special problems associated with burns in young children or older adults (OR = 2.14, CI = 0.87–5.23, p = 0.10). The final model explained 89.9% of the variability in self-reported competence.Conclusions:Interventions used to train healthcare providers for burn disasters must cover a broad range of topics. However, learning needs may vary by practice setting, work experience, and previous exposure to disaster events. This evaluation research provides three-fold information for continuing education research: (1) to identify content areas that should be emphasized in future burn care training; (2) to be used as a model for CE evaluation in other domains; and (3) to provide support that many factors must be considered when designing a CE program. Results may be useful to others who are planning CE training programs.

Accurate burn depth estimation remains one of the foundations of optimal burn care. The method by which burn depth is determined has traditionally been clinical examination alone. This continues to hold true in the United States, despite a plethora of literature supporting the use of more accurate modalities such as laser Doppler imaging (LDI). LDI has widespread use in burn centers in the United Kingdom and around the world. Thus, the reason for a lack of use in U.S. burn centers remains elusive. A survey of U.S. burn center directors was conducted to assess their current practices and attitudes with regard to burn depth estimation at U.S. burn centers in an effort to answer this question. Surveys were returned from 68 burn center directors (49% response rate). All respondents reported using clinical examination in their current practice for the daily evaluation of acute burns, with a biopsy being the next most commonly used modality. The most preferred modality was also clinical examination (60%), followed by LDI (6%) and biopsy (4%). The top three modalities ranked as "most promising" for daily use were clinical examination, LDI, and noncontact/high-frequency ultrasound. Directors identified the top three limitations to the use of new technology as cost (72%), availability (63%), and lack of support by evidence to date (35%). Future studies may need to focus on overcoming these perceived limitations before the widespread use of LDI or other new modalities will be realized at burn centers in the United States.

Many drugs exhibit altered pharmacokinetic parameters in burn patients. We prospectively evaluated the pharmacokinetics of ciprofloxacin in eight burn patients with active infections. Each patient received a 400-mg dose of ciprofloxacin intravenously (i.v.) every 8 h, with each dose infused over 1 h by using a rate control device. Blood samples for analysis of plasma ciprofloxacin concentrations, determined by high-performance liquid chromatography, were obtained immediately predose, at the end of the infusion, and 1, 2, 3, 4, 5, 6, and 7 h after the end of the infusion. Urine was collected from 0 to 2, 2 to 4, and 4 to 8 h following the same dose, and an aliquot was saved for determination of the ciprofloxacin concentration. Urine was also collected for 24 h prior to this dose for measurement of creatinine clearance (CLCR). Pharmacokinetic parameters were estimated by noncompartmental analysis. Mean maximum and minimum plasma ciprofloxacin concentrations were 4.2 +/- 1.1 and 0.70 +/- 0.55 microgram/ml, respectively. Mean values for clearance (CL), renal clearance (CLR), volume of distribution, terminal elimination rate constant, half-life (t1/2), and area under the concentration-time curve (AUC) were 29.1 +/- 17.5 liters/h, 13.5 +/- 10.1 liters/h, 1.75 +/- 0.41 liters/kg, 0.222 +/- 0.098 h-1, 4.5 +/- 3.9 h, and 20.7 +/- 16.6 micrograms.h/ml, respectively. CL was higher and t1/2 was shorter than noted in previous studies of acutely ill, hospitalized patients. A good correlation was noted between creatinine clearance CL(CR) and both total ciprofloxacin CL (r = 0.85) and CLR (r = 0.84). A moderate inverse correlation was noted between percent body surface area burned and total ciprofloxacin CL (r = -0.55). An AUC/MIC ratio above 125 SIT-1 (where SIT is serum inhibitory titer), which has been strongly correlated with clinical response and time to bacterial eradication, was achieved in five of eight patients (63%) with a MIC of 0.25 microgram/ml. At a ciprofloxacin dosage of 400 mg i.v. every 12 h, an AUC/MIC ratio above 125 SIT-1 would have been achieved in only two of eight patients (25%). We conclude that ciprofloxacin CL is highly variable, but generally increased, in burn patients compared with that in acutely ill, general medical and surgical patients. Because of an increase in CL, a ciprofloxacin dosage of 400 mg i.v. every 8 h is more likely to produce the desired response in burn patients than the same dose given every 12 h.