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Early intervention crucial for burn victims

11 Dec 2023

First responders can dramatically improve outcomes for burn victims, reducing the need for a graft by fifty per cent. Here Dr Helen Douglas, who works for the State Burns Service in WA, talks about the importance of the initial management of a burn, which is often within the purview of the remote area nurse.

Ear­ly and effec­tive inter­ven­tion is cru­cial for burns vic­tims, says Dr Dou­glas, a spe­cial­ist sur­geon in the field of burns. 

Prop­er treat­ment and speedy trans­fer times can make a huge dif­fer­ence … all before I get involved,” she says.

Dr Dou­glas, who works at the Fiona Stan­ley Hos­pi­tal in Perth, Perth Children’s Hos­pi­tal and The Scar Clin­ic Perth, is involved in the rur­al and remote Burns Man­age­ment Pro­gram fund­ed by WA Health and spear­head­ed by Sharon Rowe, Clin­i­cal Nurse Con­sul­tant on the unit, pro­vid­ing face-to-face men­tor­ing and train­ing in out­ly­ing towns. 

Dr Douglas’s men­tor is Fiona Wood, head of the State Adult Burns Unit at the Fiona Stan­ley Hos­pi­tal, whose spray-on skin made her a house­hold name after the Bali bombings.

The spray-on skin that Fiona has devised has been a game chang­er, says Helen. 

A postage-size piece of skin can be used for a whole palm-sized burn. It is like grass grow­ing,” she says.

This means we don’t see the kind of scar­ring that we used to see – a lot of it is thanks to this.”

One of Fiona’s ear­ly achieve­ments was the devel­op­ment of a skin cul­ture lab in the ear­ly 1990s, which she co-found­ed with sci­en­tist Marie Ston­er. Their spray-on skin prod­uct is a world-first and has been used on thou­sands of patients through­out the world.

Dr Dou­glas, who trained in plas­tic surgery, had always planned to spe­cialise in burns. 

It is so reward­ing,” she says, and cer­tain­ly cov­ers an amal­ga­ma­tion of work­ing with med­i­cine and with surgery, while offer­ing a vari­ety of work, deal­ing with every age group, every gen­der, every part of the body.”

Treat­ment

In terms of treat­ing burns, Dr Dou­glas points out that, as RANs know, cool run­ning water is best, with the cool treat­ment reduc­ing the depth of the burn. Soon­er is obvi­ous­ly bet­ter, but even intro­duced with­in the first hours of the injury, this treat­ment has its benefits.

How­ev­er, run­ning water is not always avail­able in a rur­al or remote set­ting,” Fiona says. If that’s the case, use a buck­et of cool water, [dur­ing trans­port] for exam­ple, and cool packs are ter­rif­ic at con­trol­ling symptoms.

The prob­lem with the buck­et of water is that the tem­per­a­ture of the water will grad­u­al­ly increase, but it’s much bet­ter than nothing.”

Def­i­nite­ly no ice, she says. That will do more damage.”

With any first response, the pri­ma­ry sur­vey is of course the same, Dr Dou­glas points out, with the need to fol­low the same process to ensure there are no life-threat­en­ing situations.

Of par­tic­u­lar note with­in the pri­ma­ry sur­vey are E for expo­sure (while you have to keep the burn cool, the patient has to be kept warm) and F is for flu­ids (ensur­ing enough flu­id is in the body to keep the patient’s heart pumping).

It’s best to give flu­ids oral­ly, and clear flu­ids are best, such as apple juice, but, unless they are head­ing for emer­gency surgery, milk can be used too.

The impor­tant issue is to keep the gut mov­ing, stop­ping it from going on strike,” says Dr Douglas.

You don’t want a bac­te­r­i­al infec­tion to start because the gut bar­ri­er has bro­ken down.

With all of this, it’s impor­tant to liaise with the Roy­al Fly­ing Doc­tor Ser­vice [or oth­er tele­health arrange­ment] for advice.”

Types of burns

Rur­al areas may expe­ri­ence a high­er inci­dence of mine site acci­dents, involv­ing indus­tri­al chem­i­cals, such as very strong acids and alka­lis, but in the home, pae­di­atric burns are also common.

Young chil­dren are like­ly to get burns from touch­ing some­thing hot or pulling some­thing hot onto them­selves, says Dr Dou­glas, while burn acci­dents with old­er chil­dren and teenagers can be from a flame and fric­tion, per­haps a motor­bike accident.

Scalds are a com­mon source of burns for chil­dren aged two to five, says Helen, as they are at the explorato­ry stage. And in terms of burns treat­ment, babies and tod­dlers are not mini-adults.

Their heads are big com­pared to the rest of their body,” she says. While in adults the head is nine per cent of the body, in new­borns, it is eigh­teen per cent, drop­ping one per cent each year. They are also more prone to low blood sug­ar lev­els and they have thin­ner skin. The upside is that chil­dren do heal quickly.”

Rur­al and remote health work­ers need to have the right items in their kit: this includes sil­ver dress­ings, which can stop bac­te­ria from con­t­a­m­i­nat­ing the raw wound.

Dr Dou­glas’ jour­ney to Australia

Dr Dou­glas, who grad­u­at­ed in med­i­cine in 2004, came to Aus­tralia from Eng­land in 2016 to com­plete her spe­cial­ist plas­tic surgery train­ing, and she’s been here ever since.

It was a no-brain­er for me. To have Fiona Wood as my men­tor was amaz­ing, and the job is incred­i­ble,” she says.

Fiona is a Fel­low of the Roy­al Aus­tralasian Col­lege of Sur­geons and the Roy­al Col­lege of Sur­geons of Eng­land and was award­ed the pres­ti­gious Ian McGre­gor Gold Medal for out­stand­ing per­for­mance in her spe­cial­ist exam­i­na­tions in 2015, before com­ing to Aus­tralia. She is also a mem­ber of the Aus­tralia and NZ Burns Association.

Dr Dou­glas is now mar­ried to a West Aus­tralian and has two children.

For fur­ther infor­ma­tion on man­ag­ing burns, read the CRANAplus Q&A on pae­di­atric burns.