Study Objectives Best-practice burns first aid in Australia is currently defined as 20 minutes of cool running water (CRW) within three hours of injury. This research aimed to evaluate the clinical outcomes associated with applying this intervention and how well it is adhered to by both civilians and health care professionals, from first responders through to tertiary hospital emergency clinicians.

Methods These cohort studies utilized a prospectively collected registry of patients managed at an Australian tertiary children’s hospital. Multivariate logistic and Cox regression models were used to evaluate the relationship between first aid and patient outcomes (eg, skin grafting requirements, time to re-epithelialization, wound depth, hospital admission, length of stay, and operating room interventions). Further descriptive and logistic regression analyses were conducted to examine differences in adequacy between the groups in age, ethnicity, location and socioeconomic status, among others.

Results In our patient outcome cohort, 1780/2495 (71.3%) received adequate first aid. These patients experienced decreased odds of skin grafting (OR 0.6, 95% CI 0.4 to 0.8). Among ungrafted wounds, those cooled with any water were 1.3 (1.1-1.5) times more likely to achieve re-epithelialization per day post-injury. Healing times were significantly faster with adequate running water in burns requiring >9 days to re-epithelialize (HR 1.2, 1.0 to 1.3). Adequate first aid was further associated with reductions in full-thickness depth (OR 0.4, 0.2 to 0.6), hospital admission (OR 0.7, 0.5 to 0.9) and theater operations (OR 0.7, 0.5 to 0.9), but not hospital length of stay (HR 0.9, 0.7 to 1.2, p=0.48, Figure 1). Overall, 31.3% of children received adequate CRW from caregivers. Factors associated with caregiver inadequacy of CRW included very young age and early adolescence (p<0.001), rural location (P = 0.045), and low socioeconomic status (P = 0.030). Paramedics and general practitioners provided adequate cooling to 184/735 (25.0%) and 52/215 (24.2%) of their patients, respectively. Local general hospitals provided adequate CRW to 1019/1809 (56.3%) patients.

Conclusion Burn severity and clinical outcomes improves with the provision of cool running water, however deficiencies remain in the cooling of pediatric burns patients at all levels of initial management. Although adequate first aid delivery was poor across all demographics, it was significantly worse in children aged 0-2, adolescents aged 15-16, those living rurally, and the socioeconomically disadvantaged. There is a need in the health care community for improved education regarding the parameters and clinical benefits of cool running water first aid.