TRANSLATIONAL RESEARCH: Burns Research to Burns Prevention—Translational Research and the Prevention of Thermal Injury

Prof. John Pearn1, Mr Cody  Frear1

1Burns Unit Lady Cilento Children’s Hospital, South Brisbane, Australia

The challenge to those who work in the domains of thermal safety is how best to translate research findings into practice.Extensive research into the causes, clinical effects and treatment of thermal injury has generated an extensive corpus of knowledge about the prevention of thermal injury; and has generated an extensive doctrine concerning optimal first aid responses by bystanders–  that once tissue injury has occurred, secondary complications might be reduced. Such secondary effects include infection, the degree and quality of scarring, and the duration of hospitalization. Such knowledge has practical relevance only if apposite preventive doctrine and first aid knowledge is taught and applied in real life, both by potential victims and those ( parents, bystanders and victims) at the accident-site itself. The portals for primary prevention are targeted education of risks, improvements in physical design, and safety legislation. Secondary prevention applies to first aid management. Translational research in the primary domain of burns prevention has shown that safety legislation is the most effective stratagem to reduce thermal injury. Greater exposure to first aid instruction has undoubted benefits for secondary amelioration of side effects; but its role in primary prevention, although logical and anticipated, remains unaddressed and therefore unproven. This paper advocates several specific pathways by which the knowledge generated by research might be better translated into practice.

This is a dual (tandem) presentation (3 min–2min– 2min–3 min) presentation. Professor John Pearn is a senior researcher in trauma prevention; and a Member of the Australian Resuscitation Council for 20 years. For 10 years( 1990-1999) he was the National Director of Training for St John Ambulance Australia, responsible for all published doctrine on the first aid management of the burnt victim. Cody Frear is a medical scientist and full-time Doctorate student ( University of Queensland) based in the Burns and Trauma Unit of the Lady Cilento Children’s Hospital in Brisbane.

Dr Walter Roth 1861-1933: The Australian Pioneer of Fire Safety and Burns Prevention

Prof. John Pearn1

1Burns Unit, Lady Cilento Children’s Hospital, South Brisbane, Australia, 2Faculty of Medicine, University of Queensland, Brisbane, Australia

Dr Walter Edmund Roth (1861-1933), whilst a medical student in London(1887) and subsequently a school teacher and later doctor (1892- 1907) in Australia, was an international pioneer in the domain of fire safety and the prevention of thermal injury. His lectures, detailed publications and advocacy for the prevention of burns had their catalyst in the aftermath of  catastrophic fires in the entertainment theatres of England and Europe.He introduced these concepts to Australia.From his base in Sydney Roth gave public lectures and published( in London) a major text on fire safety. Dr Roth was an extraordinary man,his being also an Australian pioneer in anthropology, the promotion of Aboriginal welfare and dignity, numismatics and botany. His publications in the context of fire safety included architectural details of firewalls, fireproof curtains, fire-escapes, proscenium curtains in theatres, and first aid for burns victims. He was the first to recommend the use of water in the first aid treatment of burnt victims, in an era when contemporary doctrine was to cover the burnt tissues with flour and oil. This paper presents for the first time the contributions of this pioneer of public health and preventive medicine , in the field of thermal injury and its prevention. Roth’s legacy is the high standard of thermal safety enjoyed by citizens of the  twenty-first century; and the scientific treatment of their burns.

Prof John Pearn is the paediatrician to the Lady Cilento Burns Unit , Children’s Health Queensland. A former Surgeon General to the Australian Defence Force and Head of the Department of Paediatrics at the University of Queensland, he has written extensively on the history of trauma, and its prevention and management in diverse domains. He is a founder of the Australian and New Zealand Society of the History of Medicine; and has served for 15 years on the Committee of the International Society of the History of Medicine.


The effect of moisturizers or creams on scars: A systematic review

Ms Tanja Klotz1,2, Mr  Zachary Munn2, Mr  John E. Greenwood1, Mr  Eduardo Aromataris2

1Adult Burn Service, Royal Adelaide Hospital, Adelaide, Australia, 2The Joanna Briggs Institute, University of Adelaide, Adelaide, Australia


The author previously surveyed burn therapists across Australia, Canada and the United States of America on moisturizers recommended to burn patients for scar management. The survey revealed that 53 therapists recommend 29 different moisturizers demonstrating the variability in practice. Further survey questions revealed minimal use of evidence to guide practice.


To systematically collect and collate all relevant evidence on moisturizers effect on scars. The objective is to provide knowledge on the properties of the moisturizers clinicians should be looking for, and/or specific ingredients that a moisturizer should have in order to have a positive (or negative) effect on scar outcome.


Keloids and hypertrophic scars were included but atrophic scars were not. Databases searched included PubMed, CINAHL, Embase and Web of Science.


1570 studies were identified in the structured search. After removal of duplicates there were 1419. These were screened leaving 138, 64 of which were excluded once title and abstract was reviewed.  Of the 74 articles left, 11 were identified as suitable to be put in a subgroup on the topic of Imiquimod use post excision of keloid scars. The remaining 63 articles were assessed for quality. The final critical appraisal included 7 studies in the Imiquimod group and 22 studies in the group examining the effect of moisturizers on scars. Meta-analysis of the imiquimod group and narrative synthesis of the effects of various moisturizers on scars will be presented.


The results demonstrate that well structured research is desperately needed to guide clinical practice.

Tanja has been working in burns for the last 12 years as the Senior Occupational Therapist at the Royal Adelaide Hospital adult burn service. She is also a senior clinician in hand therapy at the RAH. Last year she started her Masters in Clinical Science with JBI at the University of Adelaide with an aim to improve the evidence for scar management.


Fitting all the pieces together: minor burn management in NSW

Ms Kelly Waddell1

1Children’s Hospital At Westmead, Hornsby Heights, Australia

The Children’s Hospital at Westmead (CHW) is the only tertiary referral centre for children from birth until 16 years of age in New South Wales. With an ever increasing population and increasing demand on the service, the CHW along with several paediatric outpatient ambulatory care clinics across metropolitan, regional and rural NSW developed a joint outreach burns service (JOBS)for minor burn management.

These clinics are fully operational and have daily access to both the NP and medical teams at the CHW, whilst keeping children and their families close to home and their normal social supports and routine.  These clinics provide primary level care with the support of the tertiary referral centre using the same wound care techniques, whilst also providing education to regional and rural residents and staff. Now that these clinics are established the next phase of the puzzle is being developed, here these clinics with support from ministry of health are  developing to become the burns hub for the local health district providing direct education and resources for the smaller rural centres in their region.

This presentation is a review of how the service has grown over the last five years, it will discuss the achievements gained in these clinics, how challenges have been handled and show how the JOBS network is now developing to expand minor burn care completely in the local region.

Nurse Practitioner for paediatric burns and kidsburns.

ESMB Key coordinator


The risk of scarring in paediatric burn injury

Prof. Fiona Wood, Hilary  Wallace2, Mark Fear2, Lisa Martin2

1Burns Service Wa, City Beach, Australia, 2Burn Injury Research Unit UWA, Perth, Australia

Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification.

The study examined the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological comorbidities

Including the incidence of asthma, eczema diabetes and skin pigmentation.

A prospective study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS).

The overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (> 1mm) and 80.4% for children without raised scars (≤ 1mm). After adjustment for other variables each 1% increase in burn %TBSA increased the odds of raised scar by 15.8% (95% CI = 4.4% – 28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR=11.621; 95% CI= 3.727-36.234) and multiple surgical procedures (OR=11.521; 1.994-66.566).

Greater burn surface area, time to healing of longer than 14 days and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors. Cell based therapies facilitating dermal salvage and donor site reduction has the potential to reduce the time to healing.

Fiona Wood has been  the Director of the burns service of WA

since 1991 and been actively involved in all aspects of burn care and research

Camp Cooee: educating and engaging with clinicians about the long-term and life-long issues facing paediatric burns survivors

Dr Alan Pham1, Sandra Spalding1,2, Cheri Templeton1,3

1The Children’s Hospital at Westmead Burns Research Institute, The Burns Unit and the NSW Severe Burns Injury Service, The Children’s Hospital at Westmead, Westmead, Australia, 2Department of Social Work, The Children’s Hospital at Westmead, Westmead, Australia, 3Department of Physiotherapy, The Children’s Hospital at Westmead, Westmead, Australia

The Children’s Hospital at Westmead Burns Unit has been running a paediatric burns survivor camp for the last 25 years, one of the longest-running camps of its kind in Australia. The camp is consistently staffed by a mixture of burns survivors, physiotherapists, social workers, nurses, and doctors. It offers burns survivors, a marginalized subgroup of the paediatric patient population, the opportunity to engage with each other and potentiates the development of long-lasting social support networks. It also allows front-line clinicians to understand first-hand the long-term consequences of their actions and decisions made acutely. Our presentation will briefly touch on the history of the camp, its aims, the key sessions that we feel are the cornerstones of each camp to help patients elucidate and begin to process complex psychosocial issues, behavioral management protocols, risk management strategies that other organisations interested in organising a similar experience could implement, and the selection and training process we use for adult-aged burns survivors who express an interest in becoming a camp mentor. We will focus on testimonials from mostly medical practitioners as well as other clinicians who have attended camps over the years, the insights they gained into the long-term impacts of their clinical decision-making and actions, and how these new insights have influenced their day-to-day practice.

Dr. Alan Pham is currently the burns registrar at The Children’s Hospital at Westmead, which is the referral center for all paediatric burns in New South Wales, Australia. His interests include safe, efficient, and consistent burns care delivery in both an inpatient and outpatient setting as well as the long-term care of patients with significant hypertrophic scarring as a result of their burn injuries. Current research interests include RCT’s comparing Suprathel, Biobrane, and Acticoat in the mid-dermal burn as well as the use of PDL and CO2 lasers to treat problematic scars in paediatric burns patients.

Morbidity & Mortality Meetings: Using safety science to drive effective discussion

Ms Yvonne Singer1,2, Ms Heather Cleland1,2,4, Ms Andy Kattula2, Dr Margaret Way3, Ms Nicole Rasmussen2

1Victorian Adult Burn Service, The Alfred, Melbourne, Australia, 2Alfred Health, Melbourne, Australia, 3Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia , 4Monash University, Department of Surgery, Melbourne, Australia

Learning from outcomes of care is fundamental to improving patient safety but it can also be a challenging and delicate matter. There is often a focus on what happened at the “pointy end” of care, and it can be difficult to unpack the underlying system factors.

To improve patient safety at the Victorian Adult Burn Service (VABS), PROCESS SCREEN, a structured checklist based in safety and quality improvement science, and developed in the Clinical Governance Unit at Alfred Health, has been implemented to facilitate Morbidity & Mortality Meeting (M&MM) discussions.

PROCESS, the first checklist, helps identify key events in the process of care and how these unfolded to determine where in the story we could do something differently next time. It explores themes of planning & decision making, recognising & responding, outcomes, communication & coordination, escalation, staffing & supervision. These events make the cornerstones of reviewing our systems of care.

SCREEN, the second checklist, helps staff identify factors in our systems of care that influenced why those events unfolded the way they did. It explores themes of standards of care, context & culture, routines and teams, environment, experience and training, and considers what we would do differently next time.

Using an illustrative scenario developed for training, this presentation provides a summary of the PROCESS SCREEN framework and how it is used at the VABS. PROCESS SCREEN has focused our efforts on system improvements, using a structured approach to engage clinicians in M&MM discussion and drive effective outcomes.


Yvonne was born at the Alfred and she went away for a while to go to school and came back as a Graduate Nurse in the 90s and hasn’t left.

Yvonne is the Burn Program Coordinator at the Victorian Adult Burn Service at the Alfred Hospital in Melbourne.  Yvonne has worked at the Alfred for over 25 years and has been working in the field of burns for over 15 years in various positions including Clinical Nurse Specialist, Educator and Care Coordinaor.

Yvonne is the Australian Vice President of the Australian & New Zealand Burn Association and past Chair of the ANZBA Nursing Committee. She is a member of the Steering Committee for the Burn Registry of Australia & New Zealand and a member of the ANZBA Burn Prevention Committee.

She is a 2007 Churchill Fellow and her interests include quality improvement, patient safety, registry science, clinical practice guidelines development, education, prevention and sustainable workforce planning

BRANZ Version 2: Turning Data into Information, & Information into Insight

Ms Yvonne Singer1, Ms Heather Cleland1, Professor  Belinda  Gabbe2, Ms Lara  Kimmel3

1Victorian Adult Burn Service, Melbourne, Australia, 2Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia, 3Department of Physiotherapy, The Alfred, Melbourne, Australia

The revised Burn Registry of Australia & New Zealand (BRANZ) implemented on July 1st 2016, includes a suite of modified quality indicators that have potential to improve the quality of care by monitoring performance and outcomes across Burn Services. This presentation provides a snapshot of two revised BRANZ QIs to showcase some of what’s new, what’s different, and the potential of the data.

Acute Kidney Injury (AKI) in severe burn injury is associated with adverse patient outcomes. The first six months of the revised BRANZ dataset will be analysed using the RIFLE Criteria to determine the incidence and factors associated with the development of acute kidney injury (AKI) in the first 72 hours of admission to an Australian/New Zealand Burn Service. RIFLE, developed to more accurately categorize severity of renal dysfunction, defines three grades of increasing severity of AKI: based on changes in either serum creatinine or eGFR and two outcome categories (loss and end-stage kidney disease).

Bloodstream infections increase the risk of complications and mortality in immuno-compromised, burn injured patients. The first 6 months of BRANZ data will also be analysed to determine the incidence of positive blood cultures and describe their pre-emptive management.

Improving the quality of burn care is a priority for all burn care professionals to ensure patients are provided the best opportunities for recovery and reintegration following injury. The BRANZ provides a unique opportunity for Australia & New Zealand Burn Services to benchmark and compare processes and outcomes to establish best practices and improve care.


Yvonne was born at the Alfred and she went away for a while to go to school and came back as a Graduate Nurse in the 90s and hasn’t left.

Yvonne is the Burn Program Coordinator at the Victorian Adult Burn Service at the Alfred Hospital in Melbourne.  Yvonne has worked at the Alfred for over 25 years and has been working in the field of burns for over 15 years in various positions including Clinical Nurse Specialist, Educator and Care Coordinaor.

Yvonne is the Australian Vice President of the Australian & New Zealand Burn Association and past Chair of the ANZBA Nursing Committee. She is a member of the Steering committee for the Burn Registry of Australia & New Zealand and a member of the ANZBA Burn Prevention Committee.

She is a 2007 Churchill Fellow,  and her interests include quality improvement, patient safety, registry science, clinical practice guidelines development, education, prevention and sustainable workforce planning

Update on the validation of PAT Burns (a psychosocial screening tool for paediatric burns patients

Miss Miriam Broadhurst1

1Flinders University, Adelaide, Australia


There is currently limited information on optimal methods of screening and identifying children and their families at risk of poor adjustment following paediatric burn injury.  At ANZBA 2015, the Burns Service, WCH presented the modified version of a psychosocial screening tool (PAT) for use in an Australian context with burns paediatric patients. We update our work on the validation of the PAT Burns and present preliminary data.


Families and children admitted to the service are assessed within two weeks (T1) and at 3-month follow-up (T2). Assessments include the PAT Burns and other standardised measures of child and parent functioning (i.e., posttraumatic stress, depression, anxiety, family functioning). Children aged 7 or older complete self-report measures in addition to their caregivers.


To date, 17 families have been recruited. Preliminary analysis of the PAT Burns indicates 36% of families fall in the clinical range indicating higher risk of psychosocial maladjustment. Despite modest sample size, correlational data show that increased risk as measured by the PAT Burns is associated with parental anxiety and stress (rs = .60-.66) and higher risk on the PAT Burns corresponds to child posttraumatic stress and unhelpful trauma beliefs (rs  = .23-.39), mood, anxiety problems and behaviour problems (rs = .23-.89).


Although data is preliminary, the PAT Burns appears to measure the key areas that appear to be predictors for maladjustment. Practical issues and challenges in relation to feasibility of screening and implementation in routine clinical practice will be addressed, and follow-up data available by October.

Second year Masters student at Flinders University working in conjunction with the WCH and Flinders University Staff to validate a screening tool for use in the Burns Unit.

The Burns Registry of Australia and New Zealand: Progressing the evidence base for burn care

Miss Heather Cleland1,2, Professor Belinda Gabbe3

1Alfred Health, Prahran, Australia, 2Department of Surgery Central Clinical School Monash University, Melbourne, Australia, 3School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Objective: Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation.

Design: BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles.

Participants: Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.

Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units.

Results: Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified.

Conclusions: Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.


Director of the Victorian Adult Burns Service Alfred Hospital Melbourne. Past President of ANZBA.


Chair of the BRANZ Steering Committee and Chief Investigator of the BRANZ

Member of the Editorial Board for  journal Burns

Member of the Donor Tissue Bank Committee, Victorian Institute of Forensic Medicine


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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