The pre-hospital role of nurses for a mass casualty burns incident

Associate Professor Brett Aimers

In 2009 the ‘Black Saturday’ bushfires devastated Victoria, claiming 173 lives, injuring 414 others and displaced more than 7,500 people. More than 400 separate fires occurred on and after 7 February 2009. Prior to this disaster, the role of Australian nurses in preparing for and responding to a mass casualty burns incident was not fully understood, considered or appreciated.

This presentation will explore the challenges encountered in coordinating a national pre-hospital response to a mass casualty burns incident and, more importantly, the significant leadership, clinical and support roles performed by nurses during this disaster.

Toxic shock in paediatric burns

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

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

Toxic Shock Syndrome (TSS) is an endotoxin mediated disease usually caused by Staphylococcus aureus. While difficult to diagnose, due to symptoms mimicking those of other childhood diseases, mortality rate in those diagnosed are approximately 28%. Children under the age of 4 are yet to develop the antibodies for the exotoxin called toxic shock syndrome toxin-1(TSST-1), therefore are more susceptible.

In our unit, we had not had a diagnosed case of TSS in over 30 years, however two cases have been identified in the past year. Child 1, a 5mth old who sustained  a 9% scald burn. Diagnosis of Staphylococcus aureus TSS, was diagnosed through punch biopsy. This child required admission to PICU and was intubated for a period of 3 days. Overall admission to PICU being 5 days and discharged home day 20. Child 2, a 2yo girl admitted with 5% scald burn. She required admission to PICU however not intubated. Her total length of stay in PICU being 4 days with an overall stay of 14 days. Treatment included a combination of IV Ab’s and IVIg in child 2. Time to reepithelialisation being 40 days and 38 days.

Toxic shock is an uncommon complication of a burn injury however it should still be considered for those presenting with common childhood symptoms. With the high mortality rate, it is important to have accurate diagnosis. Even though specialised units may not have had much exposure, they need to have awareness of the condition.

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

Securing enteral tubes in paediatric facial burns; overcoming the challenge

Ms Linda Quinn1, Dr Lachlan  Farmer1, Dr Edward Gibson1, Dr Amy Jeeves1, Dr Rebecca Cooksey1, Mr Darren Molony1, Dr Michelle Lodge1, Mr Bernard Carney1

1Women’s And Children’s Hospital, North Adelaide , Australia

Securing enteral tubes in paediatric facial burns; overcoming the challenge.


Enteral feeds are important in paediatric burns patients with an injury >15% total body surface area (TBSA) to ensure their increased metabolic demand for protein and calories is met. Securing nasogastric tubes (NGT) or trans-pyloric tubes (TPT) in this cohort is especially difficult when the face is also involved and frequent dislodgement is common. This can lead to prolonged healing time and aspiration as well as the need for frequent replacement of the NGT or TPT.


The Home Enteral Nutrition Service (HENS) at the Women’s and Children’s Hospital has introduced the AMT BridleTM , nasal tube retaining system for a range of patients to prevent accidental or intentional tube removal. One of the indications is for difficulty in attaching the tube to the face e.g. burns or excoriation. The Burns Service were experiencing difficulties with securing both NG and TPT to a 90% TBSA burn patient and it was suggested that a bridle may assist.

This presentation will discuss this method of securing enteral feeding tubes, our experience with using it in two major burn patients and our plans for its future use.

Linda has worked at the Women’s and Children’s Hospital for the majority of her 30 year nursing career post registration. She has extensive paediatric surgical experience and has specialised in paediatric burns nursing since 2006. She has post graduate qualifications in both paediatric and burns nursing.

Reducing Fluid Resuscitation through a nurse titrated Protocol

Ms Jing Hui Loh1, Dr Xi Wern Loh1, Dr  Vui Kian Ho1, A.Prof. Si Jack Chong1

1Singapore General Hospital, Singapore, Singapore

Introduction: Fluid creep is a significant problem in the resuscitation of burn patients and has been linked to increased morbidity and mortality. Parkland formula may contribute to fluid creep. We hypothesized that a nurse-titrated fluid protocol would reduce the amount of fluids given to burn patients while avoiding adverse outcomes due to under-resuscitation.

Methods: Adult patients  with >15% total body surface area (TBSA) burns admitted of our institution within 24 hours of injury from Oct15 to Apr17 were enrolled in a prospective observational study. Patients were commenced on a fluid resuscitation of 3ml/kg/%BSA in the first 24 hours, with half of the volume to be infused in the first 8 hours. 5% albumin was added at a rate of 0.4ml/kg/%BSA/16h. The infusion rate was titrated to maintain a mean arterial pressure of >60mmHg and a urine output of 0.4-0.6ml/kg/h.

Results: 22 patients with a mean age of 36.6 years and a mean TBSA of 33.5% TBSA were included in the study. 6 (27%) were admitted to ICU. Mean volume of fluids given was 6334ml, a statistically significant 27.6% reduction compared to the mean predicted fluid volume of 9192ml based on Parkland formula (p=0.001). The mean number of intervention points per patient was 1.96.  8 patients had at least 1 episode of oliguria but no cases of AKI, ACS or need for RRT.

Conclusion: A nurse titrated fluid resuscitation protocol for burn patients was practicable, safe and effective in reducing fluid volumes required for resuscitation without an increase in secondary complications.

Ms Loh Jinghui has been instrumental in competing this study and presented the preliminary report to enthusiastic audience in Taipei in Apr 2017. Dr Chong SJ as PI and mentor is presenting her work at this conference


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

Phytophotodermatitis is a condition caused by a reaction of sunlight to skin that has had previous contact with a particular species of plant containing furcoumarin. While there are many plants that have been described as possible causes, the most common are lemons and limes. Contact with the plant along with prolonged exposure to UV light, can cause erythema and blistering of the skin similar to those of a superficial partial thickness burn.

We present a case study of a 9 year old girl who presented with extensive blistering from contact with limes. This young girl was admitted to our facility with blistering to approximately 10% TBSA. She had spent several hours over two days jumping on a trampoline with a collection of limes before noticing red marks forming on her legs. On presentation, she had blistering to bilateral lower legs, thighs and back. Treatment followed our hospital protocol of Mepilex Ag. While this condition usually causes quite superficial epidermal loss, they can be extremely painful and in some cases, including this one, hospitalisation is required for pain relief.

While we have seen a few cases of phytophotodermatitis over the past decade, they are uncommon. For those that have not visualised this condition previously, diagnosis can be inaccurate. We are presenting this to heighten awareness of this condition to those who have previously not seen it or have had limited contact with this.

I am the Clinical Nurse consultant within the Lady Cilento Children’s Hospital Brisbane

Burn Disaster e-simulation training module: Innovation promoting engagement and disaster readiness for Burn Nurses

Mrs Sheila Kavanagh1

1Royal Adelaide Hospital, Adelaide, Australia

In Australia and New Zealand, incidents generating multiple burn casualties are relatively uncommon. Maintaining staff readiness is an ongoing challenge. This electronically supported roleplay-simulation provides an avenue for the implementation of an inter departmental, cross agency educational activity designed to guide participants to critically reflect on the skills required to assess, prioritise, provide support and function effectively in a disaster situation. The experience is intended to be as realistic as possible and to give participants an accurate representation of the decision-making process operating in the real world. The incorporation of participants with diverse backgrounds significantly enhances learning outcomes, allowing for the integration of participant knowledge and perspectives.

Sheila Kavanagh was the nurse in charge of the Burns Unit for over 20 years.  An active role in the 2002 response to the Bali bombings gave her a unique insight into the Burn Nurses role in disaster response. She has a special interest in education and  disaster management for Burn Nurses.


Building a Nurse Practitioner model at Victorian Adult Burns Service (VABS)

Ms Hana Menezes1

1Victorian Adult Burns Service, Bentleigh, Australia

Building a Nurse Practitioner model at Victorian Adult Burns Service (VABS).

The Victorian Adult Burns Service (VABS) at Alfred Health provides a state wide service of multidisciplinary burns care for approximately 300 inpatients and 2000 outpatients per year.

This presentation will provide an overview of the Burns Liaison Nursing Service at VABS and the evolution of nursing roles from liaison to nurse practitioner.

Embedded within VABS, the Burns Liaison Nursing Service provides a resource in expert burns care that is available for the patient, family and clinicians caring for the patient. This liaison support overarches the entire patient journey.

The Burns Liaison Nursing model has expanded in response to service demand over the last decade. This gives context to the development of a unique role of an endorsed Burns Nurse Practitioner which has commenced at VABS in 2017.

  • The Burns Liaison Nursing model at VABS
  • Identified service needs
  • The Nurse Practitioner journey
  • Where are we now?
  • Looking in to the future of nursing at VABS?

Hana has been a Burns Liaison Nurse at the Victorian Adult Burns Service (VABS) for over a decade. Her previous nursing experience in ICU, she has recently been endorsed as a Nurse Practitioner in Burns.


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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