Rates of Compliance With First Aid Recommendations in Burn Patients

Abstract

Several techniques (such as cooling and covering) are recommended in the first aid management of burn injured patients, both for lay persons and for EMS. Few studies have examined the rates of compliance with these recommendations. This study is a burn registry query performed in a suburban academic medical center with a regional burn unit. Patients seen by the burn service between January 2008 and February 2009 were included. Demographics, injury characteristics, rates of implementation of first aid, and method of transport to medical care (self vs ambulance) were recorded. Rates of implementation are reported as proportions with confidence intervals (CIs) and rates of implementation in those transported by self vs ambulance and work-related vs nonwork-related burns are compared using chi tests. Two hundred eleven burn patients were entered in the registry during the study period. Mean age was 27.0 (SD, 22.1) years, 44.3% were female, 95.2% were thermal burns, and 29.9% were transported by ambulance; 72.7% (95% CI, 66-78%) reported cooling their burn before presentation for medical care. Of those, 39.9% reported using tap water to cool their burn (95% CI, 33.4-46.8%), whereas 25.2% used ice (95% CI, 18.4-33.5%), and 8.9% used a cooling blanket (95% CI, 5-15%). Only 22.2% reported having applied a dressing before arrival in the hospital (95% CI, 16.9-28.5%). There were no significant differences between the groups who transported themselves to care in comparison with those who were brought in by ambulance in terms of cooling with water (P = .516), cooling with ice (P = .063), or application of dressing (P = .506). Further, no differences existed between those reporting cooling of the burn and those who did not in terms of patient characteristics. Rates of first aid administered for burn injury by lay persons before arrival at a burn center are high. A substantial percentage of people continue to use ice to cool their burns despite evidence of its potential detrimental nature. There is no difference in the rates of first aid implementation in those who did and did not contact EMS. The initial call to EMS might be used to instruct lay persons in appropriate burn first aid while awaiting the ambulance.

A review of community management of paediatric burns

“…Only 12 children were transferred to the burns unit without any wound cover. Taira et al reported that dressings were applied in only 22% and Australian literature reports on burn victims treated by local hospitals receiving wound cover in only 33-70% of cases [24]. Rea reported that only 5% of 208 children admitted had cover on admission in the UK [25].…”

Pre-hospital care received by injured children less than five years admitted to the Lady Ridgeway Hospital for Children, Colombo

“…A study done in the USA regional burn unit revealed that out of 211 patients' records, 72.7% recorded cooling their burn before being admitted to hospital (14). In this study it was revealed that four had unsterile cream applied on the burn wound which will cause infections later.…”

Childhood unintentional injuries: Supervision and first aid provided

“…More in line with our results is a study in Ghana where 33% of patients presented to the hospital without prior first-aid treatment [19] as well as a study in the USA in which 23.7% of patients did not receive first-aid treatment. [20] Poor living circumstances may also contribute to the absence of first-aid care. For instance, the lack of running water in-house will preclude the initial management of a burn injury.…”