How much do parents know about first aid for burns?
Introduction
This case is one of many seen in emergency departments across the world involving a preventable burn and potentially harmful first aid measure. Approximately 19,000 children attend the ED every year in the UK for treatment of burns [1], making childhood burns one of the most frequent paediatric injuries.‘A screaming 3 year old presents to the paediatric emergency department with a contact burn on the top of her right foot after a hot iron was left unattended. The mother unsure of what to do called her own mother for advice who suggested covering the burn in butter.’
Prompt and appropriate first aid aims to stop the burning process, to cool and cover the burn, and provide analgesia [2]. Current recommendations involve application of cool running water at a temperature of between 5 °C and 25 °C [3]; however there is no consensus on the optimum duration of cooling which ranges from 10 to 30 min [3], [4], [5], [6], [7], [8]. Cooling halts progression of the burn, removes any noxious agents, provides pain relief and may reduce oedema [2], [9]. It has also been shown to increase the rate of wound healing by promoting the rapid growth of epithelial cells [3], [10]. Excessive cooling should be avoided as this could induce hypothermia in a young child [2]. Ice or iced water should never be applied to a burn as the resulting vasoconstriction may lead to burn progression [2].
Polyvinylchloride film (cling film) is ideal for covering burns and scalds, as it is pliable, non-adherent, transparent and available in most households [11]. It is also relatively sterile as long as the first few centimetres are discarded prior to its use [2]. Cling film should be placed onto the burn in sheets as opposed to wrapping around the injury to prevent constriction [12]. Initial first aid has a major influence on the burn outcome in terms of reducing severity and the need for skin grafting [13], therefore parents’ knowledge of first aid is especially important.
We recently conducted a study of 1327 children under the age of 16 years with burns or scalds seen in emergency departments and burns units in England, Wales and Ireland and recorded the nature of immediate first aid that was provided in the home setting [14]. Seventy five percent (998/1327) received some form of first aid. The nature of the first aid was specified in 87% of these cases. Optimal first aid that included the use of cool running water and covering with cling film was only reported in 3 cases. Cold water was administered for an unspecified time period in 556 cases, cold compress was used in 107 and burn ointments or sprays in 101. A further 55 cases utilised inappropriate first aid measures that are contraindicated and included toothpaste, oil, butter, emollients and dry dressings. Overall 42% (556/1327) of immediate care involved cold water cooling and 29% (384/1327) had no immediate first aid or treatment that would be deemed detrimental. This survey suggests that first aid provision to children in the home setting is inadequate and prompted this further study that aims to determine the extent and source of parents’ knowledge of burn first aid and influencing factors.
Section snippets
Methods
The study was conducted in May and June 2011 at the University Hospital of Wales in Cardiff. A questionnaire (Appendix I) was designed by the paediatric senior lecturer (SM) based on first aid information gleaned from our previous epidemiological study. Medical student (MD) was the interviewer who administered and completed the questionnaires on behalf of parents attending daytime paediatric and adult emergency departments, paediatric outpatient and routine antenatal clinic appointments.
Results
In total, 106 parents were approached and completed the questionnaire (59 women, 47 men). Eighty eight percent of the respondents where White-British while the remainder were a mixture of other ethnic groups which is representative of the local Welsh population [18]. Twenty three percent of the respondents had left school by the age of fifteen. Thirty four subjects (32%) were found to have adequate knowledge, 27 (26%) inadequate and 39 (37%) poor; 6 (6%) would perform contraindicated or no
Discussion
Parents’ knowledge of first aid is particularly important as it is widely recognised that correct initial first aid can dramatically improve burn outcome and reduce associated pain [13]. Only 32% of our parents demonstrated adequate knowledge of burns first aid. Our study showed knowledge of first aid correlated with higher SE-S and previous completion of a first aid course.
Previous studies have highlighted the broad range of first aid used in the home; all conclude that burns first aid
Conclusion
Less than a third of parents had an adequate knowledge of burns first aid. Level of knowledge appears to be influenced by SE-S and first aid course attendance. In the light of these results, educational initiatives should be targeted at all new parents, prioritising those of low SE-S.
Conflict of interest
None
Source(s) of Funding
None
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