Burns and Scalds

Join us twice a month for our insightful podcasts with leading expert guests, who will look at the latest 'hot topics' in wound care to update and inspire you.

This year the NZ Wound Care Society Wounds Awareness Week campaign is focusing on Burns and Scalds.

Join 3 leading Burns experts, who will discuss this important topic including prevention, mechanism of burn injury and the future in burns care.

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SPEAKER:

Welcome to Smith and Nephews Closer to the Zero podcast, bi monthly podcast with leading experts in wound care hosted by Smith and Nephew. Helping health care professionals in reducing the human and economic cost of wounds. 00:00:00

RUTH:

Hello and welcome to the podcast today, discussing burns and scalds. This year, the New Zealand Wound Care Society Wound Awareness Week campaign is focusing on burns and scalds, and we have three leading burns experts with us who are going to discuss this important topic, including prevention, mechanism of burn injury and the future in burns care. So we'd like to welcome our special guests, Dr Deirdre Seoighe, Jackie Beaumont and Deborah Murray from New Zealand. Welcome to our guests. 00:00:15

Deirdre:

Thank you for having us. 00:00:44

RUTH:

Thanks for joining us and Deirdre Seoighe is an internationally trained plastic and reconstructive surgeon and currently works in Waikato Hospital in New Zealand where she's the clinical lead for burns for the Waikato region. Deborah is the clinical nurse specialist at the National Burn Centre in Auckland and has worked in burns care for almost 30 years. Jackie is a clinical nurse specialist also at the National Burns Centre and has been involved in burns care for over 20 years. So it's really great to have you and all these many years of experience to discuss this important topic of wound care. So perhaps Deirdre, you would like to talk about why you're so passionate about working in burns. 00:00:45

Deirdre:

Hey Ruth, thank you for having us on the podcast today. It's lovely to join you. So, I guess for me, it's working with an incredibly passionate team of burn professionals. I trained with Jackie and with Debbie at Middlemore Hospital. When I worked in Ireland, we had nurses there as well who were really passionate about the care we gave burns patients and also that we're passionate about the care because we're passionate about those patients. You know, we have these patients, we know we're in this for the long haul with these patients. We meet them at probably the lowest point in their lives with, usually, terrible injuries if they're making it to a national or regional burn centre. And we know we're going to be part of that journey with them, and it's a privilege to be on that road with them, and also, to let them know that we're going to be there from the start, right through to the very end, though the end often a long way off. They're with us for many years after their burn injury. So working as part of the multidisciplinary team is a privilege, looking after these patients. It's what we do. It's why we get up in the morning. It's why we're involved in burns care. It's not always the easy or the glamorous side of plastic surgery, but it's great to work with this group of people. 00:01:28

RUTH:

That's fantastic work that you do. So, perhaps to start off with then, Deborah, can we talk about some aspects of prevention and perhaps the importance of burn first aid? 00:02:44

DEBORAH:

So, alongside caring for patients, we're equally as passionate about burn prevention. Obviously, if we can prevent a patient getting an injury and coming into our care, then that's a fantastic thing. We know that Burn prevention is, it's hard work, in the sense that there's a lot of patience and persistence and perseverance around burn prevention programs. There's some research that talk about messages need to be repeated 11 times to get change within a targeted population. So, we really do have our work cut out for us and so any opportunity to get involved in prevention, so, podcast like this are amazing, a great opportunity for us, and alongside working with a team like the New Zealand Wound Care Society that have put together and developed the Wound Awareness Week, we're really aiming to get messages out there around burn prevention, but also the burn first aid message. We like to include that alongside any prevention campaigns as well. We know that we can't prevent all injuries, but if we can minimise the damage that's done or reducing the burden of that burn injury by making sure people are providing really good gold standard burn first aid. We know that that will make a difference for patients. That will reduce the risk, reduce the damage and lessen the injury that that patient sustains. And we've done a lot of work around the promotion of the right messages, and so, we're looking at gold standard burn first aid. We're talking about 20 minutes of cool running water (1) and we know when we look at our data that that doesn't always happen. So there was still some work to be done around that. So a big part of what we do is really try and promote that message. 00:02:56

RUTH:

And that's really important, isn't it? And is there anything, Jackie, from, you know, from actually what we should be doing in first aid that you want to mention today? 00:04:57

JACKIE:

So, as Deborah's already mentioned, the gold standard for first aid is 20 minutes of cool running water. That application of water is effective for up to three hours post injury. (1) So, you know, if patients aren't near water or don't have access to running water at the time of injury, if they do get to a medical facility or anywhere that does have running water, they've got three hours to perform that first aid. Another method of first aid is also removing any clothing that the patient is wearing because the clothing retains the heat, so we - and any nappies on children - it can hold the heat into the burn area. We also advocate removing jewellery, particularly necklaces and rings and wrist wear, because if that area is burnt, swelling can occur in that area and that can stop blood flow to those areas, which can obviously increase the damage as well.(1) 00:05:07

RUTH:

Some really important messages there, isn't it? So, Deirdre that’s about some of the first aid, but when is it advisable to seek further medical advice, and further intervention? 00:06:28

Deirdre :

So obviously, burns are a very common traumatic injuries. The vast majority of burns that occur, we know from our data are small burns and that applies to both adults and children. So, it's only a very tiny percentage of burns that we would see, but of those small burns, even a small burn in what we call a primary area, so in the face of the hands or the perineum, even a small burn in those areas can have quite significant consequences in terms of aesthetics and function. So if a parent is concerned about a burn, they should definitely phone their GP. If it's a large burn and they're very concerned, you know, the first aid that Jackie and Debbie have spoken about, and then bring that child to a hospital, call an ambulance, cool the child while you're waiting, all the first aid that we've just mentioned. But you know where a parent is concerned, they should at least contact their local doctor. If a large area or very concerned, bring the child to the hospital, call an ambulance. They're very important. 00:06:42

RUTH:

And so, in the different age groups, I guess, and populations, you know, some of the mechanisms of burn injury and causes, what are the common sort of reasons that people do suffer with a burn? 00:07:44

Deirdre:

So in children, the data shows us that it's scald injuries, are vastly more common and most injuries in children are accidental. So you find when you have a child with a burn, you almost have two patients. You have a parent who's devastated by the injury and you have a child who has the burn injury. 00:07:57

But in terms of in the home, the two places where we see burns happen to children are the kitchen and the bathroom. So, I guess it makes sense because that's where you're more likely to have scalding hot water. It's just little things and just practical advice to parents. If you're running a bath, don't put all the hot scalding hot water in first. Run the cold water first, add the hot water as you need it or you know, run it lukewarm first. If you have boiling hot water coming out of a tap, no one needs that. You need to get to a plumber or you need to get a thermostat adjusted. So just little practical things like that, because once a kid is in a bath, they can't get out of the bath. If you leave them unattended in a bath and they help themselves to the hot tap again, they can't get out if it's a slippery bath and the water's too hot. In a kitchen, there's so many places in a kitchen where a child can burn themselves. It's hot water, it's hot stove tops. So either contact burns to their hands or pulling pots down on top of themselves. Little things like facing the handles of pots towards the wall, away from the edge of the stove top, using the rings or the elements at the back of the stove rather than the ones at the front, taking away stools and chairs that kids can climb up to get onto the stove top, because remembering it's very hot for quite a while, afterwards. Having a very short cable on a kettle so that it doesn't dangle down and get caught on drawers when they're opened. It's all of the practical things for parents and most of us as parents do these all the time, and you really only have to let your guard down once, and most of us have done it. You know, taking hot trays out of an oven. It's lovely to have the kids helping you cook, but we have to remember that the kitchen is a dangerous place for a child.

RUTH:

That's really good advice, isn't it, and perhaps in the adult population then, what are the common causes? 00:09:57

Deirdre:

So adults we, I mean, we see scald burns on adults as well. This time of year in New Zealand, particularly hot water bottles bursting on people who are trying to keep themselves warm at night. Though the pattern of burns on adults tends to be a bit more different. We see a lot more flash burns and flame burns. We see, you know, burns from accelerants, backyard burning, when they're throwing petrol on a bonfire or cans exploding in a bonfire. We see chemical burns on adults as well, you know, ordinary household chemicals that can be quite caustic, cement burns in adults. We really, there's very little out there that we as human beings won't burn ourselves on given half the opportunity. We see a wide variety, though a different pattern of burns on adults and again, more common to see smaller burns than larger burns in the adult population. And like Debbie and Jackie have said, the same first aid that you would have for children, you apply that to adults as well. 00:10:06

RUTH:

OK, so, perhaps Jackie, did you want to discuss some further information about some of the data around burns? 00:11:04

JACKIE:

Yes, so the Burn Registry of Australia and New Zealand (2) provide an annual report and as just Deirdre mentioned, the report for the year, July 2019 to June 2020. Those, they identified that the specific age group for paediatrics were between 13 months old and 24 months old, and 52% of all injuries during that time are related to scald injuries, and the predominant standout is actually cups of tea and coffee. So, children of that age, they're just started to be inquisitive, they're reaching up to the bench, they can’t see and as  Deirdre has mentioned, having things placed back on the bench because they can just reach that cup of tea or cup of coffee and pull that down on themselves and sustain a significant injury. The next... marker of an injury is  contact burns, again in the kitchen. Predominantly about 25% of children with injuries actually are contact burns. So, putting their hands up against oven doors or in New Zealand, we have a number of open fires, but with the glass door, they put their hands on the glass door if there's no fire guards in the way. And we also have treadmill injuries. So just with the rotation of the treadmill and littlies crawling with their hands, they put their hands onto the treadmill as it's going - yes - and it can cause very deep significant burns to primary areas. 00:11:13

RUTH:

Deborah, did you have any of the information from the Burns Registry you wanted to share? 00:13:27

DEBORAH:

Just really a shout out to the information that's in that Burns Registry, to be honest. There's an awful lot of data looking at mechanism and what brings patients to hospitals, but also a whole lot of information around treatments that patients receive in hospitals and it's actually a really useful database for anybody that's wanting to do any prevention activities or developing any initiatives, through to anybody wanting to do any research. I guess, for the purpose of this podcast, we're particularly interested in the prevention aspect of things and that really is a useful tool, and if you're looking at New Zealand specific data, Safe Kids also develop a report every year and they have got some amazing resources and some data really quite specific to New Zealand and certain areas in New Zealand as well, and there's also an awful lot of information about New Zealand legislation and standards. So there's some really good ideas there to develop a program that's actually relevant to your area. We know that communities are best served to promote and implement prevention activities and so if people are interested, there are some amazing resources out there that can really help hone those programs to the right people in the right areas, just to get the best results. 00:13:53

RUTH:

Yeah and how would people access the Burns Registry? 00:15:29

DEBORAH:

It's very easy to access. It's through Monash University (2) and you can jump on their website and there's a report there for each year. I think they're up to the eleventh year that the data has been collected and it's a really detailed report, about 50 odd pages long, but there's a lot of detail in it... even to the point of benchmarking outcomes. So it's quite a useful document on many different levels. 00:15:34

RUTH:

OK, thank you. So perhaps moving on then, Deirdre, what are the latest advances in burns care and the future that you see in this area? 00:16:08

Deirdre:

So in terms of the future, it's really reiterating what everyone was saying, it's prevention. I mean, if we can prevent the burn from happening, that's just preventing untold pain and scarring for patients. So prevention is really the number one thing that we need to work on, but obviously with the best will in the world, burns will happen. We have made advances. I mean, certainly and there's no doubt that companies like Smith and Nephew and other companies that have continued to develop new dressings that we can use (AUDIO DROPS) and those developments are so important. So important for our patients in terms of dressings that reduce the bacterial load, dressings that promote wound healing, dressings that are less painful to apply and remove, all of those advances are really important. We have, lately, we've had Biodegradable Temporising Matrix BTM added to our arsenal and that's certainly changed a lot of our practice. I guess the Holy Grail for us as Burns surgeons would be to develop a like for like replacement. So to be able to replace full thickness injuries with a full thickness autologous skin and we don't have that yet. So that's really what we're aiming for and certainly there's a lot of research, and every conference you go to, there'll be somebody adding more and more to that knowledge base, and that's really important, and to see that being funded and developed is really important. But also, to see education and training, and to see people, you know, to educate nurses in the community, to educate our district nurses on how to apply these dressings appropriately. How to look after a skin graft in the community is really important, and so, to see that education and training, and to see it being supported is really important. People doing the Emergency Management of Severe Burns course. Jackie and Debbie do marvellous work promoting that around the country and educating people in terms of the EMSB. So that's all part of the future of burns. It's the prevention. It's the education when they do happen. It's the dressing changes. It's the fabulous new dressings that we have. And then ultimately the like for like, skin for skin replacement. 00:16:20

RUTH:

Yeah, well let's hope that sort of can develop and that is the future. So, look, it's been fantastic to talk to you all today and to hear your perspectives, but perhaps just to summarise and to finish off today, Jackie, what would be your take-home message for our audience today? 00:18:36

JACKIE:

I can't stress enough the importance of first aid and applying that first aid within the first three hours. So, 20 minutes of cool running water can never be underestimated.(1) 00:18:59

RUTH:

Yes, that's so important, in that message, I think getting that out is really important. Deborah, do you have a take-home message you'd like to give our audience? 00:19:16

DEBORAH:

I might be jumping the gun a bit with your advertising the Wound Awareness Week, but I think really just, a few comments about the importance of education. I think it's really important that people out there, clinicians out there in the community know what they're doing, but also know when to ask for help. We've already mentioned briefly when to seek medical or specialist medical assistance and I think it's really important to understand what your limitations are within your practice and where to go to for help. And with that in mind, we have our Wound Awareness Week from the 26th of July to the 1st of August, and there will be many opportunities for people in the community to engage in some educational opportunities. We've got the webinar. We've got the podcast and we're running a series of workshops over the course of that week, throughout the country. So that's a great opportunity for not only upskilling and learning, but also to network. We know that clinicians getting together and networking, and learning from each other is really important, and this is an opportunity to do that.(3) 00:19:27

RUTH:

Yeah, thank you and Deirdre, do you want to have a last word? 00:20:39

Deirdre:

Oh, I guess the fact that somebody is listening to this podcast and if they're learning anything from it and educating themselves in terms of burns and hearing the passion from the burns team, I think that's awesome to think that might have helped somebody and that, good for them, listening to it and educating themselves and keep going on that journey of learning how to look after these very important patients. 00:20:44

RUTH:

Thank you and we will have some resources attached to this podcast, and as it's been mentioned, it is the, New Zealand Wound Care Society Wound Awareness Week (3)from the 26th of July. So please check out the resources and activities that they've got going on there. So thank you very much, all of you, for joining us today and to our very special guests, and don't forget to tune in for our next podcast and we'll see you soon. So bye for now. 00:21:09

JACKIE:

Thank you. 00:21:38

DEBORAH:

Thanks Ruth, bye now. 00:21:39

Deirdre:

Bye, thank you. 00:21:40

SPEAKER:

Smith and Nephew are proud to support clinicians in the prevention and treatment of burns to ensure positive patient outcomes. Our diverse burn portfolio ensures that we are able to treat burns in any care setting. Whether it is a minor burn to manage at home or a major burns treated in hospital. Our range includes SOLOSITE to hydrate and sooth burns, a wide range of dressings to cover and protect the wound, and also CICA-CARE silicone gel sheets for the treatment of scars (4). For more information, contact your local Smith and Nephew representative or email us at profed.anz@smith-nephew.com 00:21:42

SPEAKER:

The information presented in this podcast is for educational purposes only. It is not intended to serve as medical advice. Products listed, outline of care are examples only. Product selection and management should always be based on comprehensive clinical assessment. For detailed product information including indications for use, contraindications, precautions and warnings please consult the products applicable instructions for use, prior to use. Helping you get closer to zero wound infection. 00:22:25

References:

1. https://anzba.org.au/care/first-aid/

2. https://www.monash.edu/medicine/sphpm/branz/home

3. https://www.nzwcs.org.nz/

4. Quinn KJ. Silicone gel in scar treatment. Burns 1987; 13 (supp) : S33-S40.

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Speakers

Deborah Murray

Clinical Nurse Specialist, National Burn Centre, Auckland, New Zealand

Deborah has worked in burn care (adults and paediatrics) for almost 30 years.  She has held a number of positions within that time and has been in a Clinical Nurse Specialist (CNS) role since 2000.

She is currently one of two CNS’s at the National Burn Centre at Middlemore Hospital in Auckland working across the entire continuum of care.  Her role involves case management of complex patients, coordination of outpatients, quality & risk management, education and research.

Deborah has been actively involved in the Australia New Zealand Burn Association (ANZBA) for many years.  Until recently she was the New Zealand representative on the Board and is a past member of the ANZBA Nursing Executive Committee.

She is currently the New Zealand key coordinator for the Emergency Management of Severe Burns course.

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Dr. Deirdre Seoighe

F.R.C.S. (Plast.)

Deirdre Seoighe is an internationally trained plastic and reconstructive surgeon. She has a masters in surgery and is a fellow of the Royal College of Surgeons in Ireland. She carried out a fellowship in burns surgery at Middlemore Hospital, Auckland. Currently she works in Waikato Hospital, New Zealand, where she is the clinical lead for burns for the Waikato region.

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Jackie Beaumont

Clinical Nurse Specialist  National Burn Centre, Auckland NZ

Jackie has been involved with caring for burn patients for over 20 years.  Her interest in burn care was cemented as a newly qualified nurse and she has held a number of roles within different burn centres ranging from inpatient care, including intensive care patients, and outpatient care.  She is currently a Clinical Nurse Specialist at The National Burn Centre, Middlemore Hospital, in Auckland.

She has completed a Bachelor of Medical Science in Acute and Critical Care Practice and has a Masters in Burn Care.

She works collaboratively across other services within the New Zealand National Burn Service to develop best practice guidelines to improve patient care.  She has also presented some of this work at national and international conferences.

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