Children's Hospital Burns Research Institute
Education and Prevention
First-aid Management of Minor Burns in Children: A Prospective Study of Children Presenting to the Children's Hospital at Westmead
McCormack RA, Dr Erik La Hei, Dr Hugh Martin
A study performed at the CHW entitled "First-aid management of minor burns in children: a prospective study of children presenting to the Children's Hospital at Westmead, Sydney" attempted to identify the adequacy of first-aid care following minor burns in Children.
109 children who presented with minor burns (less than 10% body surface area) over a 5 month period were studied. Adequate initial first-aid was given by parents or carers in only 24 of the 109 cases. Of the other 85 cases, appropriate first-aid was often not commenced when the families sought medical attention. It was not given in 14 out of 14 children who first presented to their GP, in 22 of 31 children who presented to their local hospital, and in 22 of 38 who presented who presented here to the CHW. 2 children first contacted other health professionals and in neither case was appropriate first-aid commenced. This study showed that there was a need to educate both parents and health professionals through all levels of health care regarding appropriate first aid for burns.
Our recommendations for the first-aid treatment of minor burns are:
- remove all clothing immediately and then cover unburnt areas with either dry clothes or a blanket
- run cold tap water directly onto the burn for at least 20 minutes
- continue cooling through transportation to hospital either via a fine mist spray or
- frequently changed soaked dressings
- never use ice
- it is important to note that starting first-aid at any time within the first 3 hours after a burn is beneficial
Emergency Medicine of Severe Burns Course
Dr Hugh Martin
The Emergency Management of Severe Burns course is designed primarily for doctors and nurses who need to treat burns patients in an emergency. It's a one day intensive course teaching how to recognise, assess, stabilise and transfer patients with major burns as a part of multi-trauma. It deals only with management in the first 24 hours.
On registration, candidates are sent a manual for pre-reading as well as later reference. A series of brief lectures highlighting major points is followed by interactive teaching for the rest of the day. The course concentrates on:
- A brief consideration of the body's response to thermal trauma
- The Primary Survey; airway, breathing, circulation etc., including airway management
- Resuscitation
- Assessment of burn area and depth
- Correct fluid administration
- Some specific aspects such as electrical & chemical burns, paediatric burns, need for escharotomy
- Identification & technique of transfer of patients
The day ends with two assessments, one a multiple choice paper and the other a practical test on a moulaged volunteer, followed by a social get together with the faculty. The faculty is drawn from burns surgeons and nurses, as well as experts from Intensive Care, anaesthesia, and Emergency Medicine. The course has been rigorously assessed from an educational point of view, and all instructors have undergone specific training in teaching the course.
Social Work: Principles and Guidelines for Burn Patient Management
Sandra Spalding
The document Principles of Clinical Practice for Social Work in a Burns Unit is being developed for the NSW Severe Burns Injury Service (SBIS). Social Workers from the 3 hospitals comprising the NSW SBIS (The Childrens' Hospital at Westmead, Concord Repatriation and General Hospital and Royal North Shore Hospital) met in 2002 and agreed on the 16 principles which identify the aims and objectives of social work interventions in order to achieve the best possible outcomes for burns patients and their families.
Sandra Spalding, Senior Social Worker at Children's Hospital Westmead, prepared the document including the Combined Statements and Specific Paediatric Statements for each principle. Specific Adult Statements were contributed by social workers from the adult units. The document, currently in draft form is nearing completion with the expectation that it will be finalised by the end of 2004.
Physiotherapy and Occupational Therapy: Burn Scar Management
Anne Darton, Frank L, Justine Snedden, Cheri Templeton, Michelle Carne
In NSW a statewide burns service has been established to enhance the quality of care of burn injured patients. The 3 existing burn units in Sydney, that is Concord, RNSH adult burn units and the Children's Hospital at Westmead burn unit were selected to be part of the statewide service. Therapists from the 3 sites have the opportunity to meet regularly to discuss issues of concern. As such it was realised the process by which the 3 units are used as a resource by various hospitals throughout the state is very haphazard. Considerable time is spent on the phone discussing problems with therapists who have little or no burn experience and who have often not examined the burn area in question. This then necessitates further phone calls to establish the full assessment and hence direct the appropriate management of the burn, all with only dialogue and no visual information. To streamline and improve this process a poster was designed. The poster contains basic therapy treatment modalities as well as photographic examples of burns with varying depths as well as grafts. The aim is that the poster will be displayed in the treatment rooms of other hospitals for easy visual reference. Contact details for the burn units are also highlighted on the poster. To follow up the effectiveness of the poster, questionnaires will be distributed to the hospitals at 6 months.
  Possible problems:
> contractures + deformities
> gait interference - achilles shorten
> partial/total hip dislocation
Children's Burn Camp
Cheri Templeton, Sandra Spalding
The Children's Hospital at Westmead has been running childrens' camps for approximately 45 children aged between 10 - 18 years since 1989. Initially camps were run entirely by hospital staff. We quickly learned that the children needed more challenging activities and sought camp sites with qualified instructors or employed private contractors to provide physical activities.
In 2003 we initiated a mentor programme by inviting a young adult survivor to attend the camp and participate in the group sessions. This was extremely successful and will be continued. Plan to survey satisfaction following the 2005 camp.
Risk Management Plan for Children's Burn Camps
Cheri Templeton, Sandra Spalding
The Children's Hospital at Westmead continues to hold annual 4-day camps for paediatric burn survivors despite the impact of the shake up in the insurance industry resulting in a massive increase in public liability costs. Hospital administration realised the importance of the camps and was keen to work together with us to find a way to manage the inherent risks. These risks include the physical, emotional and sexual safety of the children, hospital staff and external program organisers.
Hospital administration suggested detailed documentation of responsibility and accountability of staff and protection of all involved. This led to the development and subsequent approval of our Burns Camp Risk Management Policy. This paper will outline the sometimes arduous attention to detail required in such a document.
This Risk Management Plan will be included in the ANZBA Web site and we are also looking to publish this document.
The Burns Support Foundation - Camp Corroboree
Cheri Templeton, Sandra Spalding
Care of the patient and the whole family is essential to promote emotional, psychological and physical recovery following a burn injury. It is widely accepted that the quality of family support is an important element in a patient's post-burn adjustment. As Partridge et al wrote, providing a combination of counselling and social skills training can make an enormous difference.
The Burns Support Foundation established in 1990 provides annual family camps. Camp Corroboree caters for adults, adolescents and paediatric burn survivors and their families. Camps have been run for 12 years with a total of 14 camps to date. The principal goal is to assist psychosocial adjustment by providing an environment which encourages interaction between families who have similar needs and have shared similar experiences. A survey of 48 participants was conducted and results show high levels of satisfaction particularly related to the opportunity to meet other survivors and their families and the psychosocial group sessions run by Sandra Spalding (social worker, CHW). The survey showed that while many camp goals are being achieved there are areas that need improvement. For example a number of respondents indicated that they had difficulty "connecting" with other campers and strategies have been implemented to address this by having experienced campers nominate themselves as mentors and also by having games, puzzles etc around on tables which has encouraged interaction. We plan to continue to survey participants camp experience. The role of the camps in family recovery is important as it is not covered in their overall treatment plan.
 Play Therapy in Burns Patients
Lisa Carnovale
Play Therapy helps children with burns overcome their fears and anxieties, by normalising the environment, and through developmental and medical play. Play Therapy gives children opportunity to have fun and provides motivation for other areas of needed therapy. Play Therapy provides children with support during painful procedures, such as burns baths and dressing changes. Through the use of distraction and relaxation, play therapy gives the child coping skills and a feeling of empowerment in painful procedures.
Kidsafe
Greg Stead
The importance of child safety within any home and child care environment cannot be underestimated.
Kidsafe House, situated in the grounds of the Children's Hospital at Westmead, has been constructed like a typical family home with a lounge/dining area, a kitchen, bathroom, nursery, laundry and outdoor play area. Throughout the house, displays and information are provided about childhood hazards and injury prevention in and around the home, including areas for potential burns and scalds.
Kidsafe NSW is an independent, not for profit, non-government organisation dedicated to the reduction and prevention of unintentional death or injury to children and making a safer world for our kids. You can check out our website at www.kidsafensw.org
Kids Health
Candace Douglass
Kids Health is a health promotion unit within the Children's Hospital at Westmead that incorporates a resource centre and a bookshop.
We aim to improve the health of children in New South Wales by creating supportive environments for good health. For example, Health Promotion education can help families and communities develop the skills needed to make healthy and safe choices for children. The Health Promotion team works with hospital departments and with public organisations to develop health promotion programs that promote and protect the health and wellbeing of children. Recent areas of work have included child development, obesity prevention, road safety (including pedestrian safety, child restraints, driveway safety and bicycle safety), injury prevention, passive smoking prevention and sun protection. With plans over the coming months to concentrate on documentation covering aspects of burns related injuries, such as first aid, diet and nutrition and coming to terms with scarring.
We also offer information to parents, carers, professionals and students on specific childhood health conditions, in addition to general parenting queries. Information is presented in a number of ways from fact sheets (able to be downloaded from the website www.chw.edu.au/parents/kidshealth), books, videos and cassettes to telephone enquiries and education pamphlets.
This document was published on Friday, 13 May, 2005
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