Oral Presentation ANZBA Annual Scientific Meeting 2024

Co-Designing Strategies for the Implementation of 20 Minutes of Cool Running Water into Emergency Clinical Practice for Acute Burn Injuries (21097)

Maleea D Holbert 1 2 , Yvonne Singer 2 , Tina Palmieri 3 4 , John Rose 5 , Kevin Mackey 6 , Sonia Singh 5 , Nathan Kuppermann 5 , Fiona Wood 7 8 , Victor Joe 9 , Tanesha A Dimanopoulos 1 2 , Roy M Kimble 1 , Robert Katzer 10 , Bronwyn R Griffin 1 2
  1. Queensland Children’s Hospital, South Brisbane, QLD, Australia
  2. School of Nursing and Midwifery, Griffith University, South Brisbane, Queensland, Australia
  3. Burn Division, Department of Surgery, UC Davis Health and UC Davis School of Medicine, Sacramento, California, United States
  4. Shriners Children’s Northern California, Sacramento, California, United States
  5. Department of Emergency Medicine, UC Davis Health and UC Davis School of Medicine, Sacramento, California, United States
  6. Sacramento Fire Department, City of Sacramento, California, United States
  7. Burns Department, Perth Children’s Hospital, Nedlands, Western Australia, Australia
  8. Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
  9. Department of Surgery, Division of Trauma, Burns, Critical Care & Acute Care Surgery, UC Irvine Health, Orange, California, United States
  10. Department of Emergency Medicine, UC Irvine Health, Orange, California, United States

Current best-practice, evidence-based, first aid for acute burn injuries consists of 20 minutes of cool running water (20CRW) administered within the first three hours of a burn. To facilitate the integration of 20CRW into clinical practice in the United States, this investigation aimed to identify barriers and facilitators to implementing 20CRW within both prehospital emergency medical services (EMS) and in-hospital emergency departments (EDs). This included one tertiary verified burn referral hospital and a large EMS provider in the same county.

We used a sequential mixed methods design to identify barriers and facilitators to 20CRW implementation and co-design implementation strategies. EMS and ED clinical stakeholders involved in acute burn patient management were invited to complete an online questionnaire to explore their perceived barriers and facilitators to delivering 20CRW. Data were coded using the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with clinical stakeholders were then conducted to tailor implementation strategies to local EMS and ED contexts, and further explore identified barriers and facilitators.

A total of 371 (210 EMS and 161 ED) clinicians participated in the questionnaire. Semi-structured interviews were conducted with 22 clinicians (14 EMS and 8 ED). Key facilitators identified included relative advantage, evidence strength and quality, networks and communication, culture, implementation climate, tension for change, and opinion leaders. Major barriers included adaptability, available resources, and lack of external policies and incentives. Some factors, such as complexity and patient needs and resources, were identified as both positive and negative determinants of 20CRW implementation.