Practice of first aid in burn related injuries in a developing country

A systematic review of health care workers' knowledge and related factors towards burn first aid

The present systematic review was conducted to investigate the knowledge of health care workers (HCWs) regarding first aid in burns. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Knowledge', 'First aid', 'Health personnel' and 'Burns' from the earliest to 1 February 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 3213 HCWs participated in seven cross-sectional studies. Of the HCWs, 44.50% were physicians. The studies included in this systematic review were conducted in Saudi Arabia, Australia, Turkey, the UK, Ukraine, and Vietnam. The knowledge rate of HCWs related to first aid for burns was 64.78 out of 100, which indicates their relatively desirable knowledge. The factors of first aid training experience, age, and experienced burn traumas had a significant positive effect on the knowledge of HCWs related to first aid for burns. Also, factors such as gender, nationality, marital status, and job position had a significant relationship with the knowledge of HCWs about first aid for burns. Therefore, it is suggested that health care managers and policymakers implement training programs and practical workshops related to first aid, especially first aid for burns.

Caregivers' knowledge with burned children and related factors towards burn first aid: A systematic review

This systematic review aimed to examine the caregivers' knowledge with burned children and related factors towards burn first aid. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Knowledge", "First aid", "Caregiver", "Burn", and "Child" from the earliest to the December 1, 2022. The quality of the studies included in this systematic review was evaluated by using the appraisal tool for cross-sectional studies (AXIS tool). A total of 11 763 caregivers of children with burns were enrolled in 14 studies. Of the participants, 78.81% were female and 41.15% had a university education. The mean score of caregivers' knowledge with burned children towards burn first aid was 51.44 out of 100. The knowledge of caregivers of burned children towards burn first aid had a significant positive relationship with the level of education, first aid training, age of caregivers, history of burn, number of children, monthly income, social status, and attitude. In addition, caregivers' knowledge had a significant negative relationship with the number of children. Furthermore, there was a significant relationship between caregivers' knowledge and level of education, monthly income, smoking, and previous knowledge of first aid. The level of caregivers' knowledge with burned children towards burn first aid was moderate. Therefore, health managers and policymakers can improve the knowledge of caregivers of burned children towards burn first aid by creating suitable platforms for face-to-face training as well as online training using websites.

Knowledge and Practice of Burn Management Among Physicians Using Burn Manikin in Ha'il, Kingdom of Saudi Arabia

Background Burn is a skin injury that results in the death of the impacted cells. Burn injuries are frequently unintentional and very avoidable. With proper management, the outcome is improved, and the need for surgical intervention is reduced. This article discusses healthcare providers' knowledge and practice of burn first aid and management to highlight the need for the enhanced practice of burn management and first-aid skills. Objective This study aims to assess the knowledge and practice of burn injuries management among healthcare workers in different specialties in Hail city. Methods  A cross-sectional study was conducted via an interviewer-administrated face-to-face questionnaire and video recording of a simulated case of burn injury collected from our skill lab at Hail University and evaluated by a board-certified plastic surgeon. Result The study analyzed 119 physicians (mean age = 36.3 years, SD = 6.7) managing burn cases. Of these, 59.7% were male, and 40.3% were female. The mean evaluation score was 7.71 (SD = 2.84). None of the factors studied, including gender (p = 0.353), age (p = 0.970), education level (p = 0.127), specialty (p = 0.871), professional experience (p = 0.118), working sector (p = 0.178), nationality (p = 0.742), or participation in burn management course (p = 0.131), had a significant effect on burn management skills of physicians. However, some groups had higher mean evaluation scores than others. Further research is needed to explore potential reasons for the observed differences in mean evaluation scores among different groups of physicians. Conclusion We discovered that most physicians were found to have poor practical knowledge of proper burn management, and most of them had not engaged in a burn first aid training, therefore more courses targeting physicians who may meet burn patients are required.

In vivo therapeutic evaluation of a cellulose acetate hydrogel cross linked with ethylenediaminetetraacetic-dianhydride containing propolis ethanolic-extract for treating burns

An increasing interest in regenerative medicine has been an approach with natural products used for assorted skin treatments. Propolis from Apis mellifera species of bees have shown high acceptance due to antimicrobial and anti-inflammatory properties. However, just a few propolis types presents stronger effects in controlling inflammation. The current work describes an organic propolis recently isolated, named as OP6, that presented strong anti-inflammatory influences in vivo when associated with EDTA cross-linked hydrogel, used as a curative device in second-degree burns in a murine model. We developed a cellulose acetate hydrogel cross-linked with ethylenediaminetetraacetic dianhydride (HAC-EDTA) as a polymeric matrix for a bandage based on an ethanolic extract of propolis at 15%, 30%, and 60% (w/v) for treating second-degree burns. In vivo studies were carried out in Wistar rats divided into three groups: negative control (only lesion), positive control (lesion with HAC-EDTA film), and treatment group (lesion with the HAC-EDTA + OP6 at 15%, 30%, and 60%). Each group was randomized and equally subdivided into two subgroups according to the period of bandage wearing (7 and 14 days). Previous work of this research group selected the propolis OP6 sample source as the best candidate for the in vivo study. HAC-EDTA + OP6 15%, 30%, and 60% films demonstrated a concentration-dependent release rate, with the highest amount of propolis released after tests (484.3 mg) by HAC-EDTA enriched with the highest concentrated extract of propolis. HAC-EDTA + OP6 films were efficient in preventing infections, promoting lesion retraction, and tissue regeneration. The HAC-EDTA + OP6 30% treatment was more efficient, revealing a reduced inflammatory process and stimulating skin regeneration. The designed HAC-EDTA + propolis films were shown as promising tools for second-degree burns treatment, accelerating healing process to a full recovery tissue repair after 14 days.

Duration of cooling with water for thermal burns as a first aid intervention: A systematic review

BACKGROUND

Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations.

AIM

To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications?

METHOD

We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness.

CONCLUSION

The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation.

Knowledge, Attitudes, and Practices toward First Aid Management of Skin Burns in Saudi Arabia

Background: Burns are considered a serious health affection that leads to several consequences affecting a person both physically and emotionally. Herbal and traditional medicine have become popular remedies among patients worldwide. Aim: This study explores common practices followed in burns as first aid management. Methods: A cross-sectional study was conducted in the Eastern province of Saudi Arabia using a designed questionnaire distributed electronically through different social media. The questionnaire consisted of socio-demographic details, history of burns, causative material, and practices followed in response to burns. Results: 461 individuals have participated in this study. The commonest reason for burns was hot water or steam. The majority of the respondents (63%) had a satisfactory response to self-aid alone at home. The most common first aid options for managing burns at home were cold water alone 195 (42%), any sort of cream alone 177 (38%), or both 317 (69%). Overall, the result shows no statistically significant difference between the outcome of burn injury and the most commonly used burn aids. Conclusions: Most people use creams and water as the first-aid management of burns, while a good number of people use traditional medicine. Overall, people who receive hospital treatment after getting first aid at home give a better outcome.

Epidemiology, aetiology and knowledge, attitudes, and practices relating to burn injuries in Palestine: A community-level research

The aim of this study was to identify the epidemiology, aetiology as well as the knowledge, attitudes, and practices relating to burn injuries in Palestine. A mixed‐method approach was used. A survey was distributed to a total of 1500 households selected by randomised approach. The survey was standardised based on World Health Organisation's guidelines for conducting community surveys on injury. Additionally, there were 12 focus group discussions and 10 key informant interviews to collect rich qualitative data. In the West Bank and Gaza, 1.5% of Palestinians had experienced serious burn injuries in the 12 months. The total sample of 1500 yields a margin of error (plus/minus) = 2.5% at a 95% level of confidence and a response distribution (P = 50%) with 3% non‐response rate. Of the 1500 households approached, 184 reported a total of 196 burn injuries, with 87.2% occurring inside the home: 69.4% were females and 39.3% were children. The main source of reported cause of burn was heat and flame (36%), electric current (31.6%), hot liquid (28.6%), and chemicals (2.7%). The most common first aid for burns was pouring water (74.7%). People in rural, refugee, and Bedouin settings had the highest incidence of burns. This study provides the burn prevalence rate, explanatory factors that contribute to the frequency of burns in Palestine. Making burn prevention a higher priority within the national policy is crucial.

A Rapid Review of Burns First Aid Guidelines: Is There Consistency Across International Guidelines?

We conducted a rapid review of current international and Australian/New Zealand guidelines on first aid for burns to identify any critical variation and any recent major changes in the literature that would warrant a significant change to current recommendations. A search was conducted to identify Australian/New Zealand and international first aid guidelines for burn care using guideline databases, and we compared key recommendations from each guideline relating to burns first aid. A literature search of relevant databases (Medline, Embase, Cochrane Database of Systematic Reviews, PROSPERO international register of systematic reviews, and ClinicalTrials.gov databases) was conducted to identify existing and in-progress research published on the topic of first aid for burn injuries. Seven guidelines were identified from the Australia/New Zealand region, and 11 international guidelines were identified from the United States of America and Europe. All Australian and New Zealand guidelines recommended a cooling duration of 20 minutes and made some mention of when to refer a burn for medical evaluation, while international guidelines saw cooling duration variation, a number of guidelines failed to mention referral criteria. The review of published systematic reviews and clinical trials revealed a lack of new evidence in the last six years. Our rapid review identified key variation between first aid guidelines for burns that would benefit from the development of an international consensus on management. We identified no new significant evidence that would alter guideline recommendations and did not identify any upcoming reviews or clinical trials on this subject.

Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020

Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities - led in part by the World Health Organisation Emergency Medical Team (EMT) initiative. Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not - the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters. Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to: 1) review literature on burn care in MCIs; and 2) define and agree on recommendations for burn care in MCIs. The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.

Knowledge and Practice of Burn First Aid Among Saudi Arabian Medical and Non-Medical University Students

Burns are serious injuries, resulting in high morbidity and healthcare costs. Effective first aid improves outcomes. The aim of this study was to assess the knowledge and practice of first aid for burn injuries among medical and non-medical students in Saudi Arabia. A cross-sectional study (N = 408) was conducted, in which a questionnaire was administered assessing students' experience with burns, as well as their hypothetical responses to vignettes involving patients with burn injuries. Although most students reported having personal experience with burns, and had received some information regarding burn first aid, only about half were able to provide correct responses regarding first aid techniques, and medical students were no more accurate than non-medical students in their responses. Results suggest that members of the Saudi Arabian population may lack appropriate knowledge about burn first aid, and education and public information resources may help to remedy this problem.

Management of paediatric burns in low- and middle-income countries: assessing capacity using the World Health Organization Surgical Assessment Tool

BACKGROUND

Burns are a leading cause of global disease burden, with children in low- and middle-income countries (LMICs) disproportionately affected. Effective management improves outcomes; however, the availability of necessary resources in LMICs remains unclear. We evaluated surgical centres in LMICs using the WHO Surgical Assessment Tool (SAT) to identify opportunities to optimize paediatric burn care.

METHODS

We reviewed WHO SAT database entries for 2010-2015. A total of 1121 facilities from 57 countries met the inclusion criteria: facilities with surgical capacity in LMICs operating on children. Human resources, equipment and infrastructure relevant to paediatric burn care were analysed by WHO Regional and World Bank Income Classifications and facility type.

RESULTS

Facilities had an average of 147 beds and performed 485 paediatric operations annually. Discrepancies existed between procedures performed and resource availability; 86% of facilities performed acute burn care, but only 37% could consistently provide intravenous fluids. Many, particularly tertiary, centres performed contracture release and skin grafting (41%) and amputation (50%).

CONCLUSIONS

LMICs have limited resources to provide paediatric burn care but widely perform many interventions necessary to address the burden of burns. The SAT may not capture innovative and traditional approaches to burn care. There remains an opportunity to improve paediatric burn care globally.

A systematic review of epidemiological patterns and proposed interventions to address pediatric burns in Nigeria

Background:

Unintentional injuries from burns comprise a significant proportion of public health morbidity in Nigeria. In order to understand the type and impact of burns on youth in Low-and-Middle-Income countries, the epidemiology of burns must be adequately assessed.

Methods:

This review describes the epidemiological patterns of burn occurrences in the pediatric populations and proposes interventions using the Haddon Matrix to address injuries in specific populations in Nigeria. A literature search was conducted using the Proquest, CINAHL, and PubMed databases at the Johns Hopkins University library (January 1, 1990 to August 14, 2018), on burns or thermal injury among pediatric populations in Nigeria. The review focused on the forms of injury, risk factors and potential interventions.

Results:

Ten studies were identified and the main risk factors for burns were socioeconomic status, overcrowding, and involving young girls in traditional cooking roles. The main types of injuries include scald injuries (50%) and fire burns (45%) affecting mainly children aged 14 and below with significant regional epidemiological variations. We created a novel intervention to develop countermeasures and reduce the number of pediatric burns based on biological, physical and sociocultural environment..

Conclusion:

Interventions such as improved supervision of children, improved emergency infrastructure and culturally sensitive first aid education and treatment can help ensure a reduction in morbidity and mortality resulting from burns. Epidemiological studies can provide an accurate depiction of the burden of burn injuries in different regions of Nigeria.

Clinical patterns and early outcomes of burn injuries in patients admitted at the Moi Teaching and Referral Hospital in Eldoret, Western Kenya

BACKGROUND

Burns are the fourth most common type of trauma worldwide and a major cause of mortality and disability in developing countries. Although burns are common in Kenya, the mortality and morbidity patterns are yet to be well studied and documented comprehensively.

OBJECTIVE

To evaluate burn clinical patterns, early outcomes and their associations among patients admitted with burn injuries at Moi Teaching and Referral Hospital (MTRH).

METHODS

A cross-sectional descriptive study was conducted at MTRH between January 2016 and June 2017. A total of 189 patients admitted to the hospital with burns were recruited into the study. An interviewer-administered structured questionnaire and chart reviews were used to collect data on sociodemographic variables, burn clinical characteristics and early burn outcomes. Associations between patient characteristics and early burn outcomes were assessed by multivariable logistic regression.

RESULTS

Of the 182 burn patients whose data was analyzed, the median age was 2.4 years (IQR = 5.8) years and 149 (82%) were children below 18 years. Majority (76%) of burns were due to scalds. The commonest burn locations were the trunk and upper limbs (56%). Only 40% of patients received prehospital intervention. The median Total Burn Surface Area (TBSA) was 14.5% and 74% of the patients had 2nd degree burns. The median length of hospital stay was 16 days (IQR = 28) and commonest complication was wound infection. Proportion of deaths due to burns accounted for 9.3% of the patients. A TBSA of 20%-30% (p = 0.01) was associated with presence of burn complications while a TBSA of >10% (p = 0.03) and time from burn to admission (p = 0.03) were associated with the length of hospital stay.

CONCLUSIONS

In our study, death was likely to occur in one in ten patients admitted with burns and TBSA was a predictor of presence of burn complications and length of hospital stay. There is a need for continued health education of the public on fire safety within the home environment for children and other vulnerable persons. Timely hospital intervention would also reduce burn complications as well as length of hospital stay.

First aid management of paediatric burn and scald injuries in Southern Malawi: A mixed methods study

BACKGROUND

In sub-Saharan Africa, burn and scald injuries occur more commonly in children aged less than five years, than in any other age group, and carry a high lifetime morbidity. The optimal first aid at the time of injury includes the use of cool running water, which can reduce pain, scarring, and skin grafting. Data on the types of first aid used in Malawi is lacking, as is an in-depth understanding of the underlying factors which may influence this health behaviour. This study sought to: (a) document the types of first aid after paediatric burn and scald injuries in Southern Malawi; and (b) explore factors affecting the choice of first aid used.

METHODS ANDFINDINGS

We conducted a sequential explanatory mixed methods study. Quantitative analysis of a prospectively collected database of all patients aged less than 17 years admitted to the only burn unit in Southern Malawi was followed by thematic analysis of semi-structured interviews with 15 adults who had witnessed a paediatric burn or scald injury. 1326 patients aged less than 17 years were admitted to the Queen Elizabeth Central Hospital between July 2009 and December 2016. Median age was 3.0 years (IQR 1.9-5.0) and male to female ratio 1:0.9. The commonest cause of injury was hot liquid (45%), followed by open fire (31%) and porridge (12%). First aid was applied in 829 patients (69%), the commonest applications used were water (31%) and egg (21%). There was a statistically significant association between the type of first aid and secondary education of the father (p = 0.009) or mother (p = 0.036); however, the type of first aid used was more likely to be egg rather than water. Analysis of qualitative interviews identified four main themes: perceived roles and responsibilities within the community, drivers of individual behaviours, availability, and trust. Participants reported using eggs as a first aid treatment, as these were readily available and were seen to reduce the occurrence of blisters and prevent peeling of the skin. By comparison, there was a strong underlying fear of using water on burn injuries due to its association with peeling of the skin. Intergenerational learning appeared to play a strong role in influencing what is used at the time of injury, and mothers were the key source of this information.

CONCLUSIONS

This study provides the largest description of first aid use in sub-Saharan Africa, strengthening the evidence that remedies aside from water are commonly used and that higher parental education levels do not translate to increased use of water, but rather use of alternative treatments. Our qualitative findings allow improved understanding of how first aid for paediatric burns is perceived in rural Malawi communities, providing insight as to why certain first aid choices are made and the possible barriers and facilitators to the adoption of water as a first aid treatment.

First aid is associated with improved outcomes in large body surface area burns

BACKGROUND

Animal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%).

METHODS

Data was prospectively collected for patients with ≥20% TBSA burns from 2004- 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes - mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury.

FINDINGS

390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12-1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI -13.6% to -6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI -19% to -4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI --0.29 to -0.08; P < 0.001).

INTERPRETATION

Adequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care.

A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis

Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.

Knowledge and practices related to burn first aid among Majmaah community, Saudi Arabia

Background:

Burns in developing countries account for significant morbidity and mortality which have been shown by increasing burn first aid awareness. In general, flames, scalds, and contact burns are the most common causes, but in children scalds are the most common.

Objectives:

This study aims to assess the general knowledge and practices related to burn first aid among Majmaah community.

Methods:

This study is a cross-sectional study. Data were collected in 2018 using convenience sampling technique. Saudi men and women age 18 years and older living in Majmaah were included in the study. Data were collected from 390 males and females. The sample size was collected using precision formula. Data were encoded into Microsoft Excel worksheets and imported to Statistical Package for the Social Sciences (SPSS^®) software for analysis.

Results:

A total of 390 individuals responded to the survey. Regarding the demographic data of the study participants, 49.2% were between 30 and 49 years old. Most of them were females (71.8%). Regarding burn first aid knowledge, 82.6% of the study participants knew that the first thing is to stop, drop, and roll when your clothes catch fire, 43.8% knew to apply cold water if hot oil spills on the hands, 41.0% knew that all burn injuries must be treated at hospital, whereas most of them 78.5% knew never to apply raw eggs or herbs to burn wounds.

Conclusion:

The knowledge of Majmaah community toward first aid is found to be low in spite of most of the respondents having a positive attitude toward first aid. The majority of the study participants (73.8%) were well-educated and had a bachelor's degree.

First aid improves clinical outcomes in burn injuries: Evidence from a cohort study of 4918 patients

BACKGROUND

Animal studies indicate treating burn injuries with running water (first aid) for 20min up to 3h post-burn reduces healing time and scarring. There is a lack of human data to support such a recommendation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes.

METHODS

Data was prospectively collected for patients with <10% total body surface area (TBSA) burns from 2007-2012. Multivariate regression analysis was used to determine the association of adequate first aid with four outcomes - wound depth, requirement for skin grafting, healing time (in non-grafted patients), and TBSA not grafted (in grafted patients). Adequate first aid was defined as the application of 20min of cool, running tap water up to 3h following the burn injury.

FINDINGS

4918 patients were identified. Adequate first aid was received in 58.1% (2859) of patients. It was associated with a statistically significant reduction in burn wound depth (OR 1.39; 95% CI 1.24-1.55; P<0.001) but was not associated with a reduction in TBSA (P=0.86) or requirement for grafting (P=0.47). In patients not requiring grafting, those who received adequate first aid were healed on average 10% (HR 1.10; 95% CI 1.03-1.18; P<0.01) or 1.9 days faster (95% CI -2.9 to -0.9; P<0.001). Adequate first aid in patients requiring grafting was associated with a 15% increase in TBSA that was not grafted (0.27%; 95% CI 0.01-0.52; P=0.04).

INTERPRETATION

Adequate first aid with 20min of running water is associated with improved outcomes. Benefits are seen in a reduction in wound depth, faster healing, and decreased grafting requirements. This has significant patient and health system benefits, and calls for promotion of 20min of running water globally in burns care.

Bystander Assistance for Trauma Victims in Low- and Middle-Income Countries: A Systematic Review of Prevalence and Training Interventions

OBJECTIVE

Lack of organized prehospital care may contribute to the disproportionate burden of trauma-related deaths in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends bystander training in basic principles of first aid and victim transport; however, prevalence of bystander or layperson assistance to trauma victims in LMICs has not been well-described, and organized reviews of existing evidence for bystander training are lacking. This systematic review aims to 1) describe the prevalence of bystander or layperson aid or transport for trauma victims in the prehospital setting in LMICs and 2) ascertain impacts of bystander training interventions in these settings.

METHODS

A systematic search of OVID Medline, Cochrane Library, and relevant gray literature was conducted. We included 1) all studies detailing prevalence of bystander-administered aid or transport for trauma victims in LMICs and 2) all randomized controlled trials and observational studies evaluating bystander training interventions. We extracted study characteristics, interventions, and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

RESULTS

Sixty-two studies detailed prevalence of bystander transport and aid. Family members, police, and bus or taxi drivers commonly transported patients; a majority of patients, up to >94%, received aid from bystanders. Twenty-four studies examined impacts of training interventions. Only one study looked at transport interventions; the remainder addressed first aid training. Interventions varied in content, duration, and target learners. Evidence was generally of low quality, but all studies demonstrated improvements in layperson knowledge and skills. Five studies reported a mortality reduction.

CONCLUSIONS

Heterogeneity in data reporting and outcomes limited formal meta-analysis. However, this review shows high rates of bystander involvement in prehospital trauma care and transport in LMICs and highlights the need for bystander training. Bystander training in these settings is feasible and may have an important impact on meaningful outcomes such as mortality. Categories of involved bystanders varied by region and training interventions should be targeted at relevant groups. "Train the trainer" models appear promising in securing community engagement and maximizing participation. Further research is needed to examine the value of bystander transport networks in trauma.

First Aid Practices and Health-Seeking Behaviors of Caregivers for Unintentional Childhood Injuries in Ujjain, India: A Community-Based Cross-Sectional Study

Data on types of community first aid use and treatment provided post-injury from many low‒middle-income countries, including India, are lacking. This cross-sectional study was conducted among children aged one month to 18 years of age, in Ujjain, India, to understand types of first aid given and health-seeking post-injury. A total of 1087 injuries in 1049 children were identified in the past year. A total of 729 (67%) injured children received first aid and 758 (70%) sought some form of health care. Children with burns received the most (86%) first aid, and most children (84%) with road traffic accidents (RTA) sought health care. Most children (52%) sought health care from a private health care facility; most children (65%) were transported to a health care facility within the golden hour. Motorbikes were the most preferred (50%) mode of transport. Only 1% of the injured used ambulance services. Commonly reported methods or substances for first aid included the use of coconut oil on wounds from falls (38%) and burns (44%), the use of antiseptic cream on wounds from RTA (31%), the application of turmeric for wounds from falls (16%), and rubbing of metal on a bitten area (47%). For most injuries, appropriate, locally available substances were used. Potentially harmful substances applied included lime, toothpaste, clay, and mud. The findings will help design community interventions to increase the provision of appropriate first aid for childhood injuries.

Burn first aid knowledge and its determinants among general population of Rawalpindi

OBJECTIVE

To assess the general knowledge and practices related to burn first aid treatment (BFAT) and to examine age, gender, socioeconomic status, education and previous history of exposure to burn (self/family member) as factors influencing burn first aid knowledge among the general population of Rawalpindi.

STUDY DESIGN

A cross-sectional, descriptive survey.

PLACE AND DURATION OF STUDY

Three major tertiary care hospitals of Rawalpindi, from August 2017 to May 2018.

METHODOLOGY

All consenting people ≥ 18 years of age, with or without a prior history of burn, accompanying patients to three major tertiary care centers of Rawalpindi were administered a pre-tested structured questionnaire. The questionnaire was divided into two sections; socio-demographic section and knowledge on BFAT. Those who were illiterate and could not fill the questionnaire were interviewed and their responses were marked by the researchers themselves. Data were analyzed using SPSS version 21.

RESULTS

A total of 400 participants comprising 205 (51.3%) males and 195 (48.8%) females with a mean age of 38 ± 10.3 years were included. The majority (58%) were educated up to 12th grade or higher. "Toothpaste" (47.5%) followed by "cool running water" (20.3%) were the two most frequently applied items following a burn injury. Only 8.8% respondents applied cold water for the ideal time duration. Overall, 83% of the participants provided correct answers for 25-50% of the survey questions. Socioeconomic and educational status of the participants had a significant association with burn first aid knowledge.

CONCLUSION

A significant limitation of knowledge regarding BFAT was seen among the general population of Rawalpindi.

The Importance of First Aid to Burned Patients: 30 Years of Experience at the Burns Centre in Pisa

The first aids to burned patients are fundamental for the evolution of the disease and the success of the next medical care in a Burns Center. In our 30-years experience, we can reassume that they must be provided to limit the cause of thermal damage, to evaluate and correct eventual respiratory or cardiovascular disorders, to find out the possible damage to different organs and the primary care on cutaneous lesions.

Response to: Practice of first aid in burn related injuries in a developing country

Traditional remedies for burns first aid are rarely compliant with current best practice. Greater Manchester is one of the most ethnically diverse regions in the UK. Our burns centre has noted the prevalent use of traditional remedies over recognised first aid prior to presentation. We review traditional burns remedies and highlight the importance of burns first aid education that is accessible to migrant communities.