The implications of alcohol and drug related burns in a tertiary burns centre

Dr Peter Meier1, Dr Helen Douglas1, Dr  Jeremy Rawlins1

1State Burns Service WA, Perth, Australia

Introduction: In Australia it is estimated that alcohol accounts for 3.3% of total disease burden, costing 15.3 billion dollars per year, with illicit drug use adding a further 1.8 billion dollars. The national health survey 2014-15 revealed 17.4% of Australians consumed more than recommended safe daily levels of alcohol, and an estimated 2.9 million Australians aged 14 and over had tried illicit drugs in the preceding 12 months. The aim of this study was to assess the incidence and financial cost of alcohol and drug related admissions in the Western Australian Burns Service.

Methods: Data was retrospectively collected on 123 consecutive patients who had reported consuming alcohol and drugs prior to sustaining burns between 2015 and 2017 from the State Burns Service of Western Australia (WA) using the electronic case note database.

Results: Of the 123 patients who reported sustaining burns after consuming alcohol and or drugs; the mean TBSA injury was 5.2% and mean length of admission 5.8 days. Nine patients reported drug use only, 12 reported drug and alcohol use and 102 reported alcohol only. The average cost of each admission was $13,094 and the total theatre costs for this patient cohort totalled $4,085, 826.

Discussion: Alcohol and drug related burns constitute a significant morbidity and financial burden to the public health system in Western Australia. Despite focus shifting more recently to the impact of methamphetamine use, alcohol remains the most frequently abused substance precipitating burn injury.

Peter Meier is a registrar in burns and plastic surgery in WA

Barriers to adequate first-aid for paediatric burns at the scene of the injury

Mr Cody Frear1, Dr Bronwyn Griffin1, Prof Kerrianne Watt1,2, Prof Roy Kimble1

1Centre for Children’s Burns & Trauma Research, Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, Australia, 2College of Public Health, Medical and Veterinary Sciences, Townsville, Australia

Issue Addressed

The recommended first-aid therapy for burn injuries, 20 minutes of cold running water (CRW), offers a free and effective means of improving health outcomes across a range of metrics. Nevertheless, low rates of adequate first-aid still persist nationwide among paediatric burns patients. The aim of this study is to analyse first-aid interventions for paediatric burns across Queensland to identify any possible socioeconomic or demographic barriers to the delivery of first-aid at the scene of the injury.


A cross-sectional study was performed on consecutive patients treated by the Lady Cilento Burns Unit. First-aid interventions were evaluated as either “adequate” or “inadequate”, and then descriptive analyses were conducted to examine differences between the groups in age, ethnicity, nationality, and socioeconomic status, among others.


From 2013 to 2016, parents of 2,522 burns patients were interviewed. Overall, 31.5% received adequate CRW at the scene of the injury. Rates of adequate CRW did not significantly differ with sex, ethnicity, or nationality. However, several factors were associated with inadequate first-aid, including very young age and early adolescence (p<0.001), rural or remote location (p=0.045), low socioeconomic status (p=0.030), radiant heat and flame burns (p<0.001), as well as burns occurring at recreational sites and in the street (p=0.001).


Large deficiencies were observed in rates of adequate first-aid across all ages and demographics. The most undertreated groups indicate that first-aid training is particularly needed among caregivers of the very young, adolescents aged 15-16, those living rurally or remotely, and the socioeconomically disadvantaged.

Cody C. Frear is a medical student at The University of Queensland. He joined the Centre for Children’s Burns & Trauma Research in 2016. His research focuses on first-aid therapies for paediatric burns.

Using telehealth to support therapy provision to children in regional Victoria with hand burns

Ms Ioanna Coutsouvelis1, Ms Rose  Biggins1, Dr Susan Greaves1

1The Royal Children’s Hospital, Parkville, Australia


Introduction: The Royal Children’s Hospital (RCH) Burns clinic is a tertiary multidisciplinary clinic with Occupational Therapy (OT) required during both the acute and later stages of healing. Therapy includes thermoplastic splints, scar management and implementation of exercise programs; the ultimate goal to maximise hand function for participation in daily living activities.

Of the 227 children who presented to RCH with new hand or wrist burns in 2016, 34% were from regional or rural areas. Follow up appointments involves families travelling long distances with associated time, costs and interruption to family routines.

This project aims to increase provision of interventions with families and by regional/rural OT through the use of Telehealth mediated assistance.


An audit of Burns clinic records identifies children from regional/rural areas who receive OT only follow-up at RCH. Children with local OT services available are referred for ongoing therapy with support provided by RCH OTs via Assisted Telehealth.

Un-assisted Telehealth is offered where local services are unavailable or have been declined and an in-person review with a clinician is not deemed to be clinically required.

Results: Data reported includes: number of telehealth reviews completed; corresponding travel time and kilometres saved; family and regional clinician satisfaction with telehealth mediated assistance.

Clinical Implications: Telehealth mediated assistance for OT management of children with hand burns living in regional/rural areas reduces burden of travel, supports local therapists to develop skills in managing paediatric hand burns and increases efficiency of RCH OT services.

Ioanna Coutsouvelis is an occupational therapist at The Royal Children’s Hospital, Melbourne. She is primarily working in hand therapy with paediatric burns and plastics patients. She is currently completing a project to implement assisted telehealth for rural/regional children with hand injuries.


Unrelenting anaemia in an extensive burn injury

Dr Dinuksha De Silva1, Dr Aruna Wijewardana1, Dr Esther Ting1, Prof Ian Kerridge1,2, Dr John Vandervord1

1Royal North Shore Hospital, St Leonards, Australia, 2Northern Blood Research Centre, Kolling Institute, Sydney, Australia

Burn injuries exert enormous physiological stress on the body. Anaemia has been documented as a complication following severe burn injury (Curinga et al., 2011). The cause of anaemia in this setting is multifactorial and differs with the stage of injury and recovery, so requires a tailored approach to management. Anaemia occurring 1-2 weeks following burn injury results largely from acute blood loss from thermal injury and surgical wound management, red blood cell (RBC) sequestration and direct, non-immune haemolysis. The physiological contributors to chronic anaemia following severe burns are less well characterised but include nutritional deficiencies, reduced bone marrow erythropoiesis, erythropoietin resistance and reduced iron availability with secondary iron deficiency.

This report outlines the experience of a dedicated burns centre in managing a patient with extensive (>80% total body surface area) chemico-thermal burn wounds. We will describe the progress of treatment during the course of the 170-day hospital admission, and discuss challenges resulting from the haematological manifestations of the burn. Accounting for initial fluid resuscitation requirements and operative blood loss, it became clear that the patient was suffering a persistent normocytic anaemia. The haemoglobin count continued to fall despite replacing relevant substrates and transfusing blood products. All other haematological parameters remained within normal limits.

This report discusses the course, diagnosis and management of persistent anaemia in a patient with severe burns at a tertiary Australian burns centre. We present the results of specialist haematological investigation, and putative contributors to the anaemia.

Dr De Silva is a resident medical officer who has worked with the Severe Burns Unit and Plastic Surgery Department at Royal North Shore Hospital. As a medical student he was selected to travel to Fiji as part of a surgical outreach program run by Interplast. He has a special interest in Burns and Reconstructive Surgery.

The cost of a large burn

Mr Christopher Bartimote1, Dr Aruna Wijewardana2, Dr John Vandervord2, Dr Jeon Cha2

1The University Of Sydney, Sydney, Australia, 2Plastics, Burns and Maxillofacial Reconstructive Surgery, Royal North Shore Hospital, St Leonards, Australia


A large total body surface area (TBSA) burn requires extensive management and reconstruction that is provided by multidisciplinary teams, who are located in specialist referral centres. The severity of these injuries and extensive reconstruction, often in unstable patients, can result in costly hospital admissions.


The aim of this study is to determine the actual cost of a large burn that was managed at Royal North Shore Hospital (RNSH) Acute Burn Service and to identify areas for potential cost reduction.


A retrospective case study was conducted on a patient who was admitted to the Burns, Plastics, Maxillofacial and Reconstructive Surgery unit at RNSH. Following ethics approval, data was accessed via electronic medical records to determine the cost of management. Expenditures were calculated using a costing spreadsheet.


The patient suffered a 35% TBSA burn following a motor vehicle accident, where he was admitted to RNSH Acute Burns Service for 94 days. The total cost of management was AUD$660,154.11. The most significant costs were length of stay (AUD$268,510.00), operative management (AUD$166,080.34), materials (AUD$108,617.31) and staffing (AUD$89,206.11).


A large TBSA burn is a significant injury, requiring extensive inpatient management. It was found that the cost of management was AUD$660,154.11. The most significant costs were length of stay, operative management, materials and staffing. Further research is required to minimise the costs of large TBSA burns.

Christopher Bartimote is a 3rd year medical student from the University of Sydney. He has a strong background in Physiotherapy, in which he received the Dean’s Scholar Award for ranking first in his class upon graduation. He has interest in burns management, health economics and rural medicine.

Tea and coffee in hospitals and nursing homes – a preventable cause of burns

Dr Ed Riordan1, Dr  Pratik  Rastogi1, Ms Siobhan Connolly1, Dr Jeon Cha1

1Royal North Shore Hospital, Randwick North, Australia

Purpose: Although a substantial amount of literature exists on quantifying and reducing the incidence of tea and coffee related burns in household settings, little research has been carried out into their incidence in facilities such as hospitals and nursing homes (Burgess et al 2016).

Method: The NSW Statewide Burns Injury Service Database was used to identify scalds requiring attendance (inpatient or outpatient) at tertiary burns centres between 2005 and 2016.

Results: 15,387 scald burns were identified, with 5058 (32.8%) related to tea or coffee; 2124 involved beverage preparation (hot taps, urns, and teapots), and 2934 were due to spillage of the tea or coffee cup. 44 (1.5%) of these cup spillage burns occurred in care facilities, with 22 patients requiring inpatient stays, and 15 requiring skin grafts at a mean grafted TBSA of 2.75%.

Conclusion: A significant number of scalds are related to spills from hot tea or coffee cups. The proportion of these that occur in inpatient facilities is low (1.5%), but may be relatively easily preventable, as simple interventions such as enforcing a delay between pouring of the tea or coffee and its dispensing can be readily implemented. A 10 minute delay has been shown to be sufficient for coffee and tea with milk to cool to close to the optimal drinking temperature (based on scald risk and taste), and represents an identifiable figure that can be feasibly incorporated into beverage service protocols at hospitals and nursing homes (Brown and Diller 2007; Jamnadas-Khoda et al 2009).

Currently a resident at Royal North Shore Hospital, having previously worked at Wollongong Hospital, and completing a PhD with the University of Sydney


The need for ECMO in a paediatric burns patient

Mrs Kristen Storey1, Dr  Bronwyn Griffin2, Professor Roy Kimble1,2

1Lady Cilento Children’s Hospital, South Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, South Brisbane, Australia

Extracorporeal membrane oxygenation (ECMO) can be a lifesaving modality for children with respiratory failure. There is however, very little current literature documenting the use of ECMO in paediatric burns. We present a case study of a 3 year old child who sustained a 17% scald burn. Five days post burn, she deteriorated quite quickly while on the ward. She suffered from Acute Respiratory Distress Syndrome (ARDS), requiring admission to Paediatric Intensive Care Unit. She quickly deteriorated requiring ventilation, within 24hrs she had progressed to the oscillator. Day 2 within PICU saw further cardio- respiratory deterioration requiring VA ECMO.

We are fortunate that within our hospital we have an Extracorporeal life support team (ECLS) that has the ability to react within minutes of receiving a call. This child required ECMO for a period of nine days. While initial thoughts were that she would require skin grafts to the majority of the burn, due to her illness it was unsafe to perform this. She successfully healed within 44 days and has only required scar management in the form of pressure garments and silicone gel.

Without the ECLS team, the outcome for this child could have been very different. This is the first case with burns we have had within our hospital that has require ECMO treatment, however it emphasises the importance of having access to these critical teams.

I am the Clinical Nurse Consultant at the Lady Cilento Children’s Hospital in Brisbane

Online software to prescribe burn specific exercise programs

Ms Rachel Edmondson1, Ms Joanne Glinsky2, Ms Julie Bricknell1, Ms Louisa Wardrope3, Ms Stephanie Wicks4, Ms Kate Thompson4, Ms Cheri Templeton4, Ms Lisa Harvey2, Ms Anne  Darton5

1Severe Burn Unit, Royal North Shore Hospital, St Leonards, Australia, 2John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Sydney, Australia, 3Severe Burn Unit, Concord Repatriation General Hospital, Concord, Australia, 4Severe Burn Unit, the Children’s Hospital at Westmead, Westmead, Australia, 5Agency for Clinical Innovation Statewide Burn Injury Service, St Leonards, Australia


Ongoing independent exercise and stretches are essential for optimal functional and cosmetic outcome post- burn injury.

For years burn therapists have relied on the distribution of generic musculoskeletal hand-outs, stick figure diagrams and more recently the use of patients’ own mobile phones to photograph or video their individualised exercise programme on discharge.

PTX or is a well-recognised, freely available, web-based resource that allows physiotherapists to create professional looking exercise booklets for patients/ clients to be guided through their home exercise programme. Up until now, there has not been any burn injury specific exercises included in their catalogue.


In collaboration with the PTX team, the NSW Burn specialist physiotherapists have embarked on the development of appropriate, meaningful and specific exercises for our unique adult and paediatric burn injured population. The photos and drawings will be of burn survivors demonstrating the specific burn exercises.


These burn specific exercises, as for the existing PTX exercises, can be searched and compiled into exercise programs for patients and can be edited and exported in numerous formats as well as to the patient’s mobile interactive app. Therapists can then remotely monitor patient’s exercise compliance.


The website is a free and valuable resource for physiotherapists working in the area of burn injury across the ANZBA community as well as across the rest of the world. The addition of the burn exercises will enhance PTX to over 1200 exercises specific to multiple diagnoses.


Rachel Edmondson BSc (Hons) Physiotherapy

Graduated from Manchester University, UK in 1993.

Extensive experience working in both UK and Australia.

Worked at Royal North Shore Hospital, Sydney as a senior physiotherapist since 2003 and has been the senior burns and plastics physiotherapist for 7 years, providing specialist services to patients within NSW with burn injury or extensive tissue loss.

Member of the NSW Burns Prevention committee and provides burns education to undergraduate physiotherapists at Sydney University, Charles Sturt University and the University of Western Sydney.

Investigating strategies to improve access to rehabilitation post burn injury for rural paediatric patients: Feedback from Winston Churchill Fellowship study tour

Miss Stephanie Wicks1

1The Children’s Hospital At Westmead, Westmead, Australia

The New South Wales (NSW) Paediatric Statewide Burn Injury Service (SBIS) provides specialised treatment for patients from across NSW accounting for >800 000km² and a population of approximately 7.5 million people. Many patients seen by the service travel considerable distances to access specialised scar management therapy in Sydney. From 2011-2015, a total of 4467 patients were treated at The Children’s Hospital at Westmead for a burn injury (NSW SBIS & ANZBA database). Of these patients, 40% resided out of the Sydney metropolitan area. Recovery from a burn injury is a lengthy process and distance from a specialised burn unit adds significant emotional and financial burden to the already traumatised child and their family. In particular, rural patients with hand burns were over represented (43% of the total population of hand burns 2011-2015) which further makes management challenging due to complex nature of managing scarring of the paediatric hand. With this significant clinical issue in mind, I applied for and was granted the Dr Lena Elizabeth McEwan and Dame Joyce Daws Churchill Fellowship for 2016. This fellowship will allow me to travel to a range of specialised burn units across the USA, Canada and Europe to investigate the strategies used by these centres to optimise opportunity for therapy to be provided for rural burns patients in their local area health services. This presentation will detail the key fellowship findings and recommendations which may assist therapists in improving access to therapy locally for rural patients.

Stephanie is a senior Physiotherapist with over 7 years experience in the management of paediatric burn injuries. She was awarded the Dr Lena Elizabeth McEwan and Dame Joyce Daws Churchill Fellowship for 2016 and has just completed this fellowship looking at strategies to improve access to therapy post burn for rural patients.


Considerations for treatment, diagnosis and risk factors for critical care polyneuropathy

Miss Andrea Mc Kittrick1, Dr  Rachel Kornhaber2,3, Dr Denis Visentin2, Professor Michelle Cleary2, Professor Josef Haik3,4,5, Dr Moti Harats3,4

1Royal Brisbane & Women’s Hospital , Alderley , Australia, 2School of Health Sciences, University of Tasmania, Rozelle Campus, Sydney, Australia, 3Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel, 4Sackler School of Medicine, Tel Aviv Unversity, Tel Aviv, Israel, 5Talpiot Leadership program, Sheba Medical Center, Tel Hashomer, Israel

Considerations for treatment, diagnosis and risk factors for critical care polyneuropathy.

Background: Critical care polyneuropathy is a neuromuscular weakness that may be experienced in severe burn patients managed in intensive care with prolonged ventilation (Chan, Ng & Vandervord, 2010). Reducing long-term functional impairment requires early diagnosis. However, early diagnosis remains difficult with varying levels of sedation.

Aim: To identify the precipitating factors that contribute to the development of critical care polyneuropathy in severe burn injury.

Methods: An integrative review was undertaken, using a systematic approach. Research papers and case reports from the international literature were included in the review.                                Results: The research studies identified an incidence of critical care polyneuropathy of 4.4% amongst a surveyed population comprising 2755 burns patients with a mean total burn surface area of 40%.  While the risk factors have been poorly reported across the studies, the survey identified prolonged ventilation, failure to wean from a ventilator, larger and deeper burns and the occurrence of sepsis as causative factors.

Conclusion: Early identification of critical care polyneuropathy and subsequent intensive therapy is an important aspect in patients’ recovery that may strengthen activity and exercise tolerance. The long-term impact of critical care neuropathy therefore warrants further longitudinal investigation, and this review highlights the need for more systematic measurement and reporting of risk factors and assessment.

Chan, Q., Ng, K., & Vandervord, J. 2010, ‘Critical illness polyneuropathy in patients with major burn injuries’, Eplasty, Vol. 10, pp. 568-574.

Andrea Mc Kittrick is an Occupational Therapist at the Royal Brisbane & Women’s Hospital in Brisbane. She completed a Masters of Science in Hand Therapy in 2015. Andrea is the current Chair of the Allied Health Group of ANZBA and is part of an international research team collaborating with the University of Tasmania and The National Burns Center at Sheba Medical Centre in Israel.


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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