From research to policy and practice in the prevention of burn injury in New South Wales

Burns are devastating injuries, and have been identified as a priority for prevention by the World Health Organization. Fire-related burn injuries are responsible for the majority of burn-related deaths and scalds are the major cause of morbidity. This thesis examines the impact of public policy and community practice on the prevention of hot tap water scalds and residential fire-related injuries, and of research evidence on community knowledge of the optimal application of first aid to a burn. These issues are explored in the New South Wales context using a variety of methodologies. To identify the optimal case selection criteria to identify burns cases from ICD-10 coded data, a methodological review of commonly used criteria was conducted. Two population-based epidemiological studies were undertaken to evaluate the impact of the introduction of the hot tap water regulations and smoke alarm legislation. Semi-structured surveys of plumbers, plumbing students and regulators were conducted to investigate resulting changes in practice. To evaluate the community impact of the smoke alarm legislation and first aid knowledge, data from a state-wide population-based CATI survey was used. Results indicate that that routinely used case selection criteria potentially under-numerate burn injury cases by a quarter. Following the introduction of temperature regulations hospitalisation rates have decreased, although hot tap water scalds remain a significant cause of morbidity and mortality. The plumbing industry surveys highlight that there are deficiencies in knowledge about the benefit of the heated water temperature regulation and a perceived lack of support in the general population. The strengthening of the smoke alarm legislation demonstrates a positive effect on both rate of hospitalisations and smoke alarm ownership although high risk groups remain. Finally, the survey of knowledge of burns first aid indicates that only a minority of the population know the optimal time for cooling a burn injury and other appropriate first aid steps, highlighting a failure of diffusion of new research findings. In conclusion, this thesis demonstrates that although burn injuries remain an important public health issue in NSW, prevention strategies to reduce burn injuries have had a positive impact; and highlights areas where further prevention efforts can be focused to maximise these gains