1051 Prehospital paediatric burn care: a re-audit. The adequacy of cool running water first aid

Abstract

<h3>Background</h3> Appropriate initial management of paediatric thermal burns is key to the prevention of complications and improvement in patient outcomes. Interestingly, research revealed significantly poorer knowledge of burns first aid (FA) management among healthcare workers, when compared with non-healthcare workers. Guidelines recommend all patients receive twenty minutes of cool running water up to three hours following injury. The administration of cool running water not only serves an analgesic function but is also associated with significantly reduced odds of skin grafting. The present re-audit evaluates the FA care of paediatric burn patients with a focus on the adequacy of cool running water. <h3>Objectives</h3> Our aim is to determine the adequacy of cool running water FA provided in the management of children with thermal burns. The FA treatment of paediatric burns was specifically examined in the context of pre-hospital and emergency department (ED) care. A target of 100% compliance with current guidelines was set. <h3>Methods</h3> Retrospective study of patients presenting to ED with thermal burns in a three-month period between 2019 and 2020. Electronic records were identified by coded diagnosis of ‘burn’ or ‘scald’ to evaluate the practice of cool running water FA in pre-hospital &amp; ED settings as recorded by nursing and medical staff. Demographics, mechanism of burn, percentage (%) body surface area, nature and duration of prehospital &amp; ED FA were recorded and compared with the baseline data from the first cycle. <h3>Results</h3> Twenty-seven (27) patients were identified with an average age of 2.9 years. Upon reaudit, contact burns from the oven door remained the most commonly cited mechanism of burn injury (37%). Compared to the first cycle, adequate documentation of cooling time was significantly improved (28% vs. 8%). In the prehospital setting, the rate of adequate cooling completed among children doubled upon reaudit from 12% to 24% respectively. In contrast to the first cycle where only 29% of children with inadequate prehospital FA went on to complete adequate cooling in ED, this figure rose by over 100% in the second cycle to 66%. Among children presenting to the ED with suboptimal prehospital FA, the completion of adequate cooling was lowest among those under 2 years of age and those who has previously completed between 10 to 20 minutes of cooling prior to attending. <h3>Conclusions</h3> The initial care provided in prehospital and ED setting continues to fall short of current guidelines calling for twenty minutes of cooling with running water. Despite emphasising the need for ongoing education on the importance of adequate cooling in both healthcare and public domains, the reaudit represents a substantial improvement in FA practice and documentation from the first cycle. Re-education combined with multidisciplinary team (MDT) engagement may have contributed to the improved results. Our findings call for continued education on burns management among medical staff and the introduction of campaigns to increase the public’s awareness of appropriate FA, to include time parameters for appropriate treatment and its association with improved outcomes.