Burn Dressings for Superficial Burns for First Aid (FA): Scoping Review

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This Review is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final Review will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: None

Task Force Scoping Review Citation

Markenson D, Berry DC, Douma M, Singletary E, Zideman D, on behalf of the International Liaison Committee on Resuscitation (insert) First Aid Task Force(s). Burn Dressings for First Aid Scoping Review and Task Force Insights [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force, 2019 December 29. Available from: http://ilcor.org

Methodological Preamble

The continuous evidence evaluation process started with a scoping review of Burn Dressings for Superficial Burns for First Aid conducted by the ILCOR First Aid Task Force Scoping Review team. Evidence for adult and paediatric literature was sought and considered by the First Aid Task Force.

In 2015, the International Liaison Committee on Resuscitation (ILCOR) Consensus on First Aid Science with Treatment Recommendations (CoSTR) found no evidence that a wet dressing compared with a dry dressing is beneficial for the care of a burn {Singletary 2015 S299; Zideman 2015 e229}. One additional study showed no benefit for a topical penetrating antibacterial compared with petrolatum gauze or for a topical nonpenetrating antibacterial versus dry dressing {Heinrich 1988 253}. Because of ambiguity in the wording of the 2015 PICO (‘wet’ compared with ‘dry’ dressings), the review was retired and replaced with the current PICOST. This scoping review only evaluated first aid management, focusing on superficial burns as deeper burns would require debridement and other advanced interventions outside the scope of traditional first aid in the first aid setting.

PICOST

The PICOST (Population, Intervention, Comparator, Outcome, Study Designs, and Timeframe):

Population: Among adults and children with superficial thermal injuries

Intervention: does any specific type of dressing applied in the first aid setting

Comparators: compared with another type of dressing

Outcomes: any clinical outcome

Study Designs: Randomized controlled trials (RCTs), controlled clinical trial, clinical trial, comparative study, non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, case-control, cross-sectional, epidemiologic), case series (n>5), survey and retrospective are eligible for inclusion. Unpublished studies (eg., conference abstracts, trial protocols), editorials, commentary, case reports, and animals were excluded.

No study design restrictions were applied for the grey literature search.

Timeframe: All available dates included in EMBASE, Medline, Cochrane, EBM reviews and NHS Economic.

Search Strategies

Database(s): MEDLINE (Ovid), Embase (Ovid), Cochrane Database of Systematic Reviews (Ovid)

ACP Journal Club (Ovid), Database of Abstracts of Reviews of Effects (Ovid), Cochrane CENTRAL Register of Controlled Trials (Ovid), Cochrane Methodology Register Database (Ovid)

Health Technology Assessment Database (Ovid), National Health Service Economic Evaluation Database (Ovid) and CINAHL (Ebsco)
Search Strategy:

#

Searches

Results

1

Burns/

43692

2

Burn?.tw,kf.

59357

3

(thermal adj2 injur*).tw,kf.

5669

4

or/1-3 [BURNS]

71306

5

Bandages/ or Bandages, Hydrocolloid/ or Occlusive Dressings/

20601

6

(bandage? or dressing?).tw,kf.

27248

7

or/5-6 [DRESSINGS]

37774

8

(((plastic or cling or saran) adj2 wrap) or cellophane).tw,kf.

1411

9

(burnaid* or burn-aid* or burnshield* or burn-shield* or hydrogel? or hydrocolloid* or hydro-colloid* or hyaluronic? or hyaluronate?).tw,kf.

54208

10

(gauze? or film? or foam? or adhesive? or adherent? or non-adhesive? or non-adherent? or occlusive? or spray-on? or spray?).tw,kf.

326567

11

(gel? or ointment? or cream?).tw,kf.

329903

12

(honey? or mud? or aloe vera? or alginate? or vaseline? or zinc? or silver?).tw,kf.

209885

13

or/8-12 [DRESSINGS OF INTEREST]

874388

14

4 and 7 and 13

1294

15

exp Animals/ not (exp Animals/ and Humans/)

4639065

16

14 not 15 [ANIMAL-ONLY REMOVED]

1088

17

(comment or editorial or news or newspaper article).pt.

1360799

18

(letter not (letter and randomized controlled trial)).pt.

1043139

19

16 not (17 or 18) [OPINION PIECES REMOVED]

1063

20

("30612585" or "30266196" or "26177570" or "28029455" or "26655279" or "24274190" or "24018215" or "23543513" or "25742878").ui. [EXAMPLE STUDIES PROVIDED BY TEAM]

9

21

19 and 20 [ALL EXAMPLE ARTICLES CAPTURED IN SEARCH]

9

A secondary literature search was conducted on December 21, 2019, using Google Chrome to identify relevant literature not published in the four database searches above. Keyword search string included “Superficial burn AND First Aid AND Dressing." No date or country restriction were applied. However, websites were limited to accessible PDF documents, resulting in 387,000 hits. Fifty-three websites were reviewed for relevant literature. The literature search was updated to December 22, 2019.

Inclusion and Exclusion Criteria

Inclusion criteria

  • Randomized controlled trials (RCTs), controlled clinical trial, clinical trial, comparative study, non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, case-control, cross-sectional, epidemiologic), case series (n>5), survey and retrospective
  • Adults and pediatric (> 1-year-old) subjects with a superficial burn
  • Assessment and care in the prehospital or first aid environment
  • Assessment and care by non-healthcare providers or that provided by healthcare providers if within the scope of first aid
  • Available abstract

Exclusion criteria

  • Unpublished studies (e.g., conference abstracts, trial protocols), editorials, commentary, case reports, and animals are excluded in only search strategy one
  • Partial and full-thickness burns
  • Management in the emergency department

Data Tables

Database

Hits

MEDLINE (Ovid)

826

Embase (Ovid)

912

Cochrane Database of Systematic Reviews (Ovid)

48

ACP Journal Club (Ovid)

0

Database of Abstracts of Reviews of Effects (Ovid)

17

Cochrane CENTRAL Register of Controlled Trials (Ovid)

352

Cochrane Methodology Register Database (Ovid)

0

Health Technology Assessment Database (Ovid)

1

National Health Service Economic Evaluation Database (Ovid)

15

CINAHL (Ebsco)

405

Total citations

2576

Duplicates

1094

Total unique citations

1482

Database(s): EBM Reviews - ACP Journal Club 1991 to October 2019, EBM Reviews - Cochrane Central Register of Controlled Trials November 2019, EBM Reviews - Cochrane Database of Systematic Reviews 2005 to December 4, 2019, EBM Reviews - Cochrane Methodology Register 3rd Quarter 2012, EBM Reviews - Database of Abstracts of Reviews of Effects 1st Quarter 2016, EBM Reviews - Health Technology Assessment 4th Quarter 2016, EBM Reviews - NHS Economic Evaluation Database 1st Quarter 2016, Embase 1974 to 2019 December 06, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily 1946 to December 06, 2019
Search Strategy:

#

Searches

Results

1

Burns/ or Burns, Chemical/

82264

2

Burn?.tw,kf.

131915

3

(thermal adj2 injur*).tw,kf.

13038

4

or/1-3 [BURNS]

160018

5

exp Bandages/

41222

6

(bandage? or dressing?).tw,kf.

68760

7

or/5-6 [DRESSINGS]

91809

8

(((plastic or cling or saran) adj2 wrap?) or cellophane).tw,kf.

2936

9

(burnaid* or burn-aid* or burnshield* or burn-shield* or hydrogel? or hydro-gel? or hydrocolloid* or hydro-colloid* or hyaluronic? or hyaluronate?).tw,kf.

124753

10

(gauze? or film? or foam? or adhesive? or adherent? or non-adhesive? or non-adherent? or occlusive? or spray-on? or spray?).tw,kf.

706660

11

(gel? or ointment? or cream?).tw,kf.

728595

12

(honey? or mud? or aloe or banana? or alginate? or vaseline? or zinc? or silver?).tw,kf.

468821

13

or/8-12 [DRESSINGS OF INTEREST]

1925346

14

First Aid/ or exp Emergency Responders/

36305

15

(first aid* or first respon* or EMT or emergency medical technician* or EMT or emergency medical service or EMS or paramedic* or para-medic* or ambulance* or wilderness or out-of-hospital or prehospital or pre-hospital or pre-hospitalization or prehospitalization or pre-hospitalisation or prehospitalisation or (before adj2 hospital) or (before adj2 hospitalization) or (before adj2 hospitalization)).tw,kf.

327537

16

Wound healing/

206816

17

(wound? adj3 (treat* or care or manag* or heal*)).tw,kf.

200101

18

(burn? adj3 (treat* or care or manag* or heal*)).tw,kf.

27637

19

or/14-18 [FIRST AID]

670559

20

4 and 7 and 13 and 19

2620

21

exp Animals/ not (exp Animals/ and Humans/)

16971938

22

20 not 21 [ANIMAL-ONLY REMOVED]

1835

23

(comment or editorial or news or newspaper article).pt.

2005130

24

(letter not (letter and randomized controlled trial)).pt.

2136945

25

22 not (23 or 24) [OPINION PIECES REMOVED]

1824

26

25 use ppez

826

27

burn/ or electric burn/ or hand burn/ or scald/

102867

28

Burn?.tw,kw.

132441

29

(thermal adj2 injur*).tw,kw.

13283

30

or/27-29 [BURNS]

166253

31

"bandages and dressings"/ or exp bandage/ or burn dressing/ or exp wound dressing/

60107

32

(bandage? or dressing?).tw,kw.

69271

33

or/31-32 [DRESSINGS]

101208

34

(((plastic or cling or saran) adj2 wrap?) or cellophane).tw,kw.

2948

35

(burnaid* or burn-aid* or burnshield* or burn-shield* or hydrogel? or hydro-gel? or hydrocolloid* or hydro-colloid* or hyaluronic? or hyaluronate?).tw,kw.

126476

36

(gauze? or film? or foam? or adhesive? or adherent? or non-adhesive? or non-adherent? or occlusive? or spray-on? or spray?).tw,kw.

711062

37

(gel? or ointment? or cream?).tw,kw.

730924

38

(honey? or mud? or aloe or banana? or alginate? or vaseline? or zinc? or silver?).tw,kw.

472418

39

or/34-38 [DRESSINGS OF INTEREST]

1936124

40

first aid/ or rescue personnel/

24106

41

(first aid* or first respon* or EMT or emergency medical technician* or EMT or emergency medical service or EMS or paramedic* or para-medic* or ambulance* or wilderness or out-of-hospital or prehospital or pre-hospital or pre-hospitalization or prehospitalization or pre-hospitalisation or prehospitalisation or (before adj2 hospital) or (before adj2 hospitalization) or (before adj2 hospitalization)).tw,kw.

329405

42

exp wound healing/

277073

43

(wound? adj3 (treat* or care or manag* or heal*)).tw,kw.

202579

44

(burn? adj3 (treat* or care or manag* or heal*)).tw,kw.

27774

45

or/40-44 [FIRST AID]

729728

46

30 and 33 and 39 and 45

2883

47

exp animal experimentation/ or exp animal model/ or exp animal experiment/ or nonhuman/ or exp vertebrate/

48953575

48

exp human/ or exp human experimentation/ or exp human experiment/

39030204

49

46 not (47 not 48) [ANIMAL-ONLY REMOVED]

2400

50

editorial.pt.

1144560

51

49 not 50 [OPINION PIECES REMOVED]

2397

52

conference abstract.pt.

3662200

53

51 not 52 [CONFERENCE ABSTRACTS REMOVED]

2191

54

53 use oemezd

912

55

Burns/ or Burns, Chemical/

82264

56

Burn?.tw,kw.

132441

57

(thermal adj2 injur*).tw,kw.

13283

58

or/55-57 [BURNS]

161186

59

exp Bandages/

41222

60

(bandage? or dressing?).tw,kf.

68760

61

or/59-60 [DRESSINGS]

91809

62

(((plastic or cling or saran) adj2 wrap?) or cellophane).tw,kw.

2948

63

(burnaid* or burn-aid* or burnshield* or burn-shield* or hydrogel? or hydro-gel? or hydrocolloid* or hydro-colloid* or hyaluronic? or hyaluronate?).tw,kw.

126476

64

(gauze? or film? or foam? or adhesive? or adherent? or non-adhesive? or non-adherent? or occlusive? or spray-on? or spray?).tw,kw.

711062

65

(gel? or ointment? or cream?).tw,kw.

730924

66

(honey? or mud? or aloe or banana? or alginate? or vaseline? or zinc? or silver?).tw,kw.

472418

67

or/62-66 [DRESSINGS OF INTEREST]

1936124

68

First Aid/ or exp Emergency Responders/

36305

69

(first aid* or first respon* or EMT or emergency medical technician* or EMT or emergency medical service or EMS or paramedic* or para-medic* or ambulance* or wilderness or out-of-hospital or prehospital or pre-hospital or pre-hospitalization or prehospitalization or pre-hospitalisation or prehospitalisation or (before adj2 hospital) or (before adj2 hospitalization) or (before adj2 hospitalization)).tw,kw.

329405

70

Wound healing/

206816

71

(wound? adj3 (treat* or care or manag* or heal*)).tw,kw.

202579

72

(burn? adj3 (treat* or care or manag* or heal*)).tw,kw.

27774

73

or/68-72 [FIRST AID]

674108

74

58 and 61 and 67 and 73

2655

75

conference abstract.pt.

3662200

76

74 not 75 [CONFERENCE ABSTRACTS REMOVED]

2412

77

76 use cctr

352

78

76 use coch

48

79

76 use dare

17

80

76 use clhta

1

81

76 use cleed

15

82

76 use acp

0

83

76 use clcmr

0

84

26 or 54 or 77 or 78 or 79 or 80 or 81 or 82 or 83

2171

CINAHL

N.B. No limiters applied

Top of Form

#

Query

Results

S22

S21 NOT (PT commentary OR PT letter OR PT editorial)

405

S21

S20 NOT (MH "Animals+") NOT ((MH "Human") AND (MH "Animals+"))

417

S20

S4 and S7 and S13 and S19

427

S19

S14 or S15 or S16 or S17 or S18

82,120

S18

TI (burn# N2 (treat* or care or manag* or heal*)) or AB (burn# N2 (treat* or care or manag* or heal*))

4,468

S17

TI (wound# N2 (treat* or care or manag* or heal*)) or AB (wound# N2 (treat* or care or manag* or heal*))

21,988

S16

(MH "Wound Healing")

20,435

S15

TI (first aid* or "first respon*" or EMT or "emergency medical technician*" or EMT or "emergency medical service" or EMS or paramedic* or para-medic* or ambulance* or wilderness or out-of-hospital or prehospital or pre-hospital or pre-hospitalization or prehospitalization or pre-hospitalisation or prehospitalisation or (before adj2 hospital) or (before adj2 hospitalization) or (before adj2 hospitalization)) or AB (first aid* or "first respon*" or EMT or "emergency medical technician*" or EMT or "emergency medical service" or EMS or paramedic* or para-medic* or ambulance* or wilderness or out-of-hospital or prehospital or pre-hospital or pre-hospitalization or prehospitalization or pre-hospitalisation or prehospitalisation or (before adj2 hospital) or (before adj2 hospitalization) or (before adj2 hospitalization))

39,364

S14

(MH "First Aid") OR (MH "Emergency Medical Technicians")

13,100

S13

S8 or S9 or S10 or S11 or S12

56,803

S12

TI (honey# or mud# or aloe or banana# or alginate# or vaseline# or zinc# or silver#) or AB (honey# or mud# or aloe or banana# or alginate# or vaseline# or zinc# or silver#)

14,313

S11

TI (gel# or ointment# or cream#) or AB (gel# or ointment# or cream#)

14,837

S10

TI (gauze# or film# or foam# or adhesive# or adherent# or non-adhesive# or non-adherent# or occlusive# or spray-on# or spray#) or AB (gauze# or film# or foam# or adhesive# or adherent# or non-adhesive# or non-adherent# or occlusive# or spray-on# or spray#)

26,354

S9

TI (burnaid* or burn-aid* or burnshield* or burn-shield* or hydrogel# or hydro-gel# or hydrocolloid* or hydro-colloid* or hyaluronic# or hyaluronate#) or AB (burnaid* or burn-aid* or burnshield* or burn-shield* or hydrogel# or hydro-gel# or hydrocolloid* or hydro-colloid* or hyaluronic# or hyaluronate#)

3,969

S8

TI (((plastic or cling or saran) N1 wrap#) or cellophane) or AB (((plastic or cling or saran) N1 wrap#) or cellophane)

91

S7

S5 or S6

17,557

S6

TI (bandage# or dressing#) or AB (bandage# or dressing#)

10,174

S5

(MH "Bandages and Dressings+")

12,953

S4

S1 or S2 or S3

21,593

S3

TI (thermal N1 injur*) or AB (thermal N1 injur*)

1,086

S2

TI (burn#) or AB (burn#)

17,657

S1

(MH "Burns") OR (MH "Burns, Chemical")

14,931

Bottom of Form

Table 1. Grey Literature Search of Google Chrome PDF Documents and Hand Search.

Search

# Results

# Result Screened

# New, Potentially Relevant Records

# Included After Review

“superficial burn AND First Aid AND Dressing”*

387,000

53

44

0

Hand Search

10

10

10

5

TOTAL

387,010

63

54

5

*Restricted to PDF documents

Table 2. Grey Literature and Hand Search Results.

References

Document Type

Intervention/Outcomes Evaluated

Results

Notes

Edwards 2013 6

General review article of burn assessment and management

‘There is little evidence for the superiority of one dressing over another (Wasaik et al, 2008). Improved healing and reduced pain has been well-documented with moist wound healing, this environment also promotes autolytic debridement of dead tissue, and aids the migration of epithelial cell (Fallabella, 1998).’

Provides a table of dressing selection principles.

Lloyd 2012 5

A general review article of burn prevention, assessment and management

Lotion, honey, aloe, antibiotic ointment

“Superficial burns can be treated with topical application of lotion, honey, aloe vera, or antibiotic ointment.” “Burn wounds heal best in moist—not wet—environments that promote reepithelialization and prevent cellular dehydration.”

Recommendation made that “minor thermal burns should be treated immediately with cool running water.

Varley 2015 1

British Burn Association Position Statement

Position statement ‘based on evidence from a formal systematic literature review’.

Supporting references for statement included:

Cuttle L, Kempf M, Kravchuk O, Phillipa GE, Mill J, Wang, X-W. & Kimble RM. The optimal temperature of first aid treatment for partial thickness burn injuries. Wound Repair Regen. 2008;16(5):626-34.

Bartlett N, Yuan J, Holland AJ, Harvey JG, Martin HC, La Hei ER, Arbuckle S, Godfrey C. Optimal duration of cooling for an acute scald contact burn injury in a porcine model. J Burn Care Res. 2008;29:828-34.

Cuttle L, Kempf M, Liu P-Y, Kravchuk O & Kimble RM. The optimal duration and delay of first aid treatments for deep partial thickness burn injuries. Burns. 2010; 36; 673-679.

“Cover the cooled burn with cling film, or where this is not available, a clean cloth or non-adherent dressing.”

Varley 2016 571

Cross-sectional survey.

Results of a cross-sectional survey of UK health organizations involved in first aid prevention and education.

Results from the review concluded: cool the burn with running tap water, remove clothing and jewelry and cover the burn with cling film or a clean non-adhesive dressing.

Guidelines or protocols were provided by 21/34 organizations.

ClingfilmTM (US trade name Saran WrapTM) was recommended for covering the burn wound in 14 guidelines. Five guidelines specifically mentioned using it lengthways to the limb to reduce the risk of constriction following tissue swelling post burn. The remaining guidelines either did not specify a particular method of covering, or recommended a sterile, nonadhesive dressing.

Task Force Insights

1. Why this topic was reviewed.

Home incidents, mass trauma, and disasters such as explosions and fires can cause a variety of serious injuries, including burns (CDC 2019). These can include thermal burns, which are caused by contact with flames, hot liquids, hot surfaces, and other sources of high temperatures, as well as chemical burns and electrical burns. Regardless of the etiology, burns are potentially devastating injuries with numerous consequences ranging from physical, functional, and occupational to cosmetic and psychosocial damage {Kattan 2016 2}. Proper and immediate care can reduce suffering and can be lifesaving, and it is therefore vital that first aid providers understand how to evaluate and manage minor burns in the first aid setting as well as the indications for referral to the emergency department {Lloyd 2012 25}.

Burns are usually classified by depth. In this scoping review, a superficial burn (previously known as first-degree burn) involves only the epidermis, which remains intact. These burns are erythematous, painful, and dry {Lloyd 2012 26; Yastı 2015 79}.

First aid providers are often faced with situations where they must decide what advice to offer an individual following a thermal burn {Singletary 2015 S574, Zideman 2015 278}. However, despite the myriad of treatment recommendations for superficial burns, there is still limited data as to which type of dressing is most effective after cooling a superficial burn, especially in the first aid environment {Singletary 2015 S299; Zideman 2015 e229}.

In 2015, the International Liaison Committee on Resuscitation (ILCOR) Consensus on First Aid Science with Treatment Recommendations (CoSTR) yielded no recommendation relative to the usage of wet dressings compared with dry dressings for thermal burns in the first aid setting {Singletary 2015 S300; Zideman 2015 e229}. There were no studies comparing plastic wrap, considered a dry dressing, with a wet dressing which met the inclusion criteria {Singletary 2015 S292; Zideman 2015 e229}. The 2015 CoSTR did acknowledge that further research was needed on the use of burn dressings in the prehospital setting. Specifically, it is unknown what type of dressing is optimal for use by first aid providers.

Therefore, the topic was chosen for review by the First Aid Task Force originally in 2015 and again for 2020 because of the ongoing risk of thermal injuries and the need to evaluate which dressing type is most effective and available in the first aid setting for the treatment of superficial thermal burns.

2. Narrative summary of evidence identified

Our extensive database search strategy yielded many publications; however, a subsequent review resulted in the selection of no published manuscripts which compared the unique effects or demonstrated efficacy of burn dressings applied in the first aid setting by first aid providers for superficial thermal burns. We did identify other types of interventions applied to thermal burns, but these did not meet the inclusion criteria for this PICO and did not involve a direct comparison between dressings. Many of the studies involved dressings that were applied to partial thickness or full thickness burns following admission to the emergency department or upon transfer to a burn unit. There was literature that discussed the risks and management of continued burning and heat entrapment with the use of hydrogel dressings. Lastly, there were a significant number of articles on the benefits of honey in the use of acute wound management, including burns.

The grey search literature yielded 21 informational (basic care for thermal, chemical, and electrical injuries) documents, 15 guidelines and position statements, and 8 additional manuscripts. All 44 documents addressed burns from superficial to full-thickness in some capacity. Only four documents {Edwards 2013 7; Lloyd 2012 25; Varley 2015, Varley 2016 571} provided any primary or secondary references relative to any type intervention (ie., not just dressings) possibly applied to a superficial burn in the first aid setting. Nine documents were excluded as they made reference to thermal injury care (any depth) following admission to the emergency department or upon transfer to a burn unit or upon arrival at home for follow-up care.

The grey literature search yielded several different therapeutic interventions used in the first aid setting; some include multiple interventions such as dry dressings with topical aloe vera (National Association of State EMS Officials ND 3) or a dry dressing with topical antibiotic ointment (Boy Scouts of America ND 22). In some cases, the information was not clear as to which was applied first, or under what conditions. The most commonly discussed (but not necessarily referenced) intervention in the first aid setting included the application of a dry dressing (n=16; 29.6%) normally after cooling the superficial burn with water. Further common interventions included cling wrap (n=10; 18.5%), cotton sheet (n=4; 7.4%), aloe vera (n=3, 5.5%), antibiotic ointment, dressing non-descriptive, petroleum in combination with gauze dry gauze and other alternatives ( n=2; 3.7%), and honey, paraffin gauze, and burn gel (n=1; 1.8%). The majority of the intervention recommendations originated in the United States (n=20; 46.5%), Australia (n=8; 18.6%), and United Kingdom (n=6; 13.9%). Other represented Countries included Africa, Canada, New Zealand, India, Turkey.

The joint 2015 American Red Cross-American Heart Association first aid guidelines update recommended that “… after cooling of a burn, it may be reasonable to loosely cover the burn with a sterile, dry dressing (Class IIb, LOE C-LD)” {Singletary 2015 S580}. Additionally, it was recommended that “… it may be reasonable to avoid natural remedies, such as honey or potato peel dressings (Class IIb, LOE C-LD). However, in remote or wilderness settings where commercially made topical antibiotics are not available, it may be reasonable to consider applying honey topically as an antimicrobial agent (Class IIb, LOE C-LD)” {Singletary 2015 S580}.

3. Narrative Reporting of the task force discussions

Task force discussions underscored concern for the consequences of failure to properly treat a superficial burn in the first aid setting, and the need for an effective treatment strategy. Failure to properly recognize thermal burn can result in a delay or absence of referral for definitive initial and follow-up evaluation and medical care; or in some cases inappropriate release to activity (eg, work, driving, school, sport), which has the potential to exacerbate poor outcomes.

It was recognized that immediate and effective cooling of the burn is still the primary intervention with proven efficacy and should be performed first, once the patient is removed from the thermal source. As cooling times may encompass the entire first aid treatment timeframe, further interventions may not occur. Active cooling should take place as soon as possible with most first aid organizations recommending that this cooling should be undertaken for at least 20 minutes using cool/cold but nonfreezing water.

The Task Force acknowledged that the literature search highlighted that no dressing was evaluated uniquely in the first aid setting for superficial thermal burns; rather the literature focused on dressings as part of on-going burn medical care. In addition, the published literature focused predominantly on partial and full-thickness burns. The Task Force also recognized the literature which had been previously identified highlighted the potential risks from heat entrapment and continued burning with hydrogel dressings. While this was not the focus of this review it has been recognized before and should be part of first aid training. A future systemic review may be warranted.

Further Task force discussions focused on the efficacy, accessibility and feasibility of the application of cling film as a dressing in the first aid setting after immediate cooling of the burn. While discussion was not unique to burns, some believe that cling film is an ideal temporary dressing for a burn (not for facial thermal injuries) as it protects the wound, reduces heat and evaporation, reduces pain, and also allows the wound to be visualized for a more accurate evaluation by the burn team later {Hettiaratchy 2004 1557}. Concern was raised about the sterility of the cling wrap and its storage in a first aid kit, as well as how many layers are required. However, Liao {Liao 2014 443} found that the potential for plastic wrap to act as a fomite when used as an acute burn wound dressing is extremely low.

Lastly, Task force discussions focused on the efficacy, accessibility, and feasibility that the use of honey may serve as a topical therapy in the first aid setting after immediate cooling of the burn. Lloyd {Lloyd 2012 25} states, “Superficial burns can be treated with topical application of lotion, honey, aloe vera, or antibiotic ointment”. It is postulated that the lipid component of these treatments accelerates the repair of damaged skin and reduces drying, however, limited information on how to apply the honey (with or without a dressing) exists or whether honey prepared as a medicinal compound versus commercially available as a food product is more effective. Concern was raised about storage in a first aid kit, application, the need for consideration of an expiration date.

There may be benefit from a systematic review of the risks of the use of hydrogel dressings in the first aid setting. Whilst not directly part of this scoping review, the evidence found could warrant a systematic review of alternative therapies following active cooling for superficial thermal burns, such as honey and aloe vera.

Knowledge Gaps

This scoping review highlights significant gaps in the research related to superficial burn care by a first aid provider for both adults and pediatrics.

It is unknown whether a first aid provider can properly determine the depth of thermal burn in a first aid setting in order to be able to render appropriate care in the first aid setting.

It is unknown what first aid intervention is most appropriate in the first aid setting for managing a thermal burn with an unknown depth.

There is an urgent need for identification of superficial thermal interventions compared with other interventions, not just dressings, and whether first aid providers have the ability to use these.

There is a need for more thorough explanations of the application of alternative thermal injury interventions (ie, application of honey or aloe vera, with or without dressing and bandage) and whether first aid providers have the ability to use these.

References

Boy Scout of America (BSA). Wilderness first aid curriculum and doctrine guideline. https://fortdrum.isportsman.net/files/Documents%2Fbsa-wilderness-first-aid-curriculum.pdf Accessed December 23, 2019

Centers for Disease Control and Prevention. Burns.

https://www.cdc.gov/masstrauma... Accessed December 22, 2019.

Edwards V. Key aspects of burn wound management. Wounds UK. 2013;9(3-suppl):6-9.

Heinrich JJ, Brand DA, Cuono CB. The role of topical treatment as a determinant of infection in outpatient burns. J Burn Care Rehabil. 1989;9:253-257.

Hettiaratchy S, Papini R. Initial management of a major burn: I—overview. BMJ. 2004;328(7455): 1555–1557. doi: 10.1136/bmj.328.7455.1555

Kattan AE, AlShomer F, Alhujayri AK, Addar A, Aljerian A. Current knowledge of burn injury first aid practices and applied traditional remedies: a nationwide survey. Burns Trauma. 2016;4:37. eCollection 2016. doi: 10.1186/s41038-016-0063-7

Lloyd EC, Rodgers BC, Michener M, Williams MS. Outpatient burns: prevention and care. Am Fam Physician. 2012;85(1):25-32.

Liao AY, Andresen D, Martin HC Harvey JG, Holland AJ. The infection risk of plastic wrap as an acute burns dressing. Burns. 2014 May;40(3):443-5. doi: 10.1016/j.burns.2013.08.006. Epub 2013 Sep 6.

National Association of State EMS Officials. https://nasemso.org/wp-content... firefighter: burn injury guidelines for care. Accessed December 22, 2019.

Singletary EM, Zideman DA, De Buck EDJ, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE, Herrington RA, Pellegrino JL, Hood NA, Lojero-Wheatley LF, Markenson DS, Yang HJ; on behalf of the First Aid Chapter Collaborators. Part 9: first aid: 2015 International Consensus on First Aid Science With Treatment Recommendations. Circulation. 2015; 132(suppl 1):S269–S311. doi: 10.1161/CIR.0000000000000278

Singletary EM, Charlton NP, Epstein JL, Ferguson JD, Jensen JL, MacPherson AI, Pellegrino JL, Smith WR, Swain JM, Lojero-Wheatley LF, Zideman DA. Part 15: first aid: 2015 American Heart Association and American Red Cross Guidelines Update for First Aid. Circulation. 2015;132(suppl 2):S574–S589.

Varley A, Sarginson J, Young A. British Burn Association: First aid position statement. http://79.170.40.160/britishburnassociation.org/wp-content/uploads/2017/06/BBA_First_Aid_Position_Statement_final_25.8.15.pdf Reviewed 2015, Accessed December 23, 2019.

Varley A, Sarginson J, Young A. Evidence based first aid advice for paediatric burns in the United Kingdom. Burns. 2016;42(3)571-577.

Yastı AÇ, Şenel E, Saydam M, Özok G, Çoruh A, Yorgancı K. Guideline and treatment algorithm for burn injuries. Ulus Travma Acil Cerrahi Derg. 2015 Mar;21(2):79-89. doi: 10.5505/tjtes.2015.88261.

Zideman DA, Singletary EM, De Buck EDJ, Chang WT, Jensen JL, Swain JM, Woodin JA, Blanchard IE,

Herrington RA, Pellegrino JL, Hood NA, Lojero-Wheatley LF, Markenson DS, Yang HJ; on behalf of the

First Aid Chapter Collaborators. Part 9: First aid: 2015 International Consensus on Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Resuscitation. 2015; 95:e229-e265.

Zideman DA, Emmy D.J. De Buck, Eunice M. Singletary, Pascal Cassan, Athanasios F. Chalkiase, Thomas R. Evans, Christina M. Hafner, Anthony J. Handley, Daniel Meyran, Susanne Schunder-Tatzber, Philippe G. Vandekerckhove, European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First Aid. Resuscitation. 2015; 95:278–287.


Scoping Review

Discussion

GUEST
Cees van Romburgh (218 posts)
I’m missing some important references like the one of New Zealand Guidelines Group. Management of burns and scalds in primary care. Wellington (NZ): Accident Compensation Corporation ; 2007:1-116, and the publication of the Education Committee of the Australian and New Zealand Burn Association. Emergency Management of Severe Burns (EMSB) After cooling, it is indeed recommended to cover the burns clean and cover the victim warmly. Certainly clean plastic household foil can be used to cover the wound, applied in layers and is not circularly wrapped in an extremity due to a risk of seizing hazard in edema formation. Covering the wound reduces pain and can be used prior to further professional medical help. Furthermore, it is still important not to apply a cream or other topical means because it can harm the wound inspection at the ER and/or burns centre (of course only in the case of severe burns). Seems to me important enough to mention.
Reply
GUEST
David Zideman (218 posts)
Thank you for taking the time to comment on this scoping review. ILCOR undertakes scoping reviews to search for evidence from well-designed scientific studies that might prompt a full systematic review. Thank you also for the two additional references. The first is an evidence based guideline from 2007 the results of which, for the first aid management of superficial burns, does not differ from that found in this scoping review. The second reference is a course aimed at healthcare professionals and the management of severe burns, both of which fall outside the limitations of this scoping review.

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