Effect of prehospital topical application of water and other agents on outcome in burn injured patients: A prospective study

Introduction: Topical agents applied to the burn wound as first aid measures have been noted to impact outcomes. The application of cool running water is effective when administered for at least 20 min within 3 h of burn as recommended by the Australian and New Zealand Burn Association. However, the American Burn Association recommends running water for 5 min, and only in minor burns. In Nigeria, there are no guidelines for duration of water application. Other agents are often applied in the prehospital setting despite education against such practices. This study was carried out to determine the practice of prehospital first aid and its impact on outcome of burn injuries. Method: This was a prospective observational study of all burn injured patients admitted to our burn unit between February 2013 and March 2020. Result: A total of 335 burn injury patients were included in this study, with a median age of 22 years. Males constituted 54.3 % of the patients. Flame injuries accounted for 60 % of cases, and median TBSA was 20.5 %. Majority of the patients received first aid (80.2 %), with 78.9 % receiving first aid within 30 min of injury. Water was applied for first aid in 53.2 % of patients. Application of water for a period of 5 min was associated with reduced rate of infection(P = 0.023), hospital length of stay (P = 0.012, and mortality(P = 0.001) compared with water application for 10 min, 20 min or just to extinguish flame. The use of running tap and water from a clean container were associated with reduced rate of infection (P = 0.041) and reduced mortality rate (P = 0.006) compared with other sources of water. Other agents applied were raw pap (a local custard) over the wound, honey, and raw egg, amongst others. These other agents were used either singly or in combination for a combined total of 205 times in 126 patients. These other topical agents had no statistically significant impact on outcome compared with those who did not receive these agents as first aid. Conclusion: The application of water for approximately 5 min and the use of running tap water or water from a clean container were associated with improved burn injury outcomes. The use of non-water agents had no statistically significant impact on the outcome measures.