Professor Roy Kimble: Prevention is better than cure. From CICM ASM PROGRAM 2019.

1. Prevention is Better than Cure
Professor Roy Kimble
Centre for Children’s Health Research and Queensland Children’s Hospital,
Brisbane, Queensland, Australia
http://www.coolburns.com.au
CICM 2019 ASM
June 2019
Trauma
A Crash Course
Goddess Hygieia
College of Physicians Edinburgh

2. Trauma is the leading cause of child death
& disability in Australia

3. Paediatric Trauma at QCH
• Verified as a 1st Level 1 Paediatric Trauma Centre
• Will admit 850-900 children with trauma (>24hrs)
• 70-90 Trauma Respond activations per year
• Red Blanket System initiated in 2017

4. Classic Model of Injury Prevention
• Primary prevention: preventing new injuries
• Secondary prevention: reducing the severity of injuries
• Tertiary prevention: decreasing the frequency and
severity of disability after an injury

5. Mechanism of Injury: QCH 2019

6. Children Admitted to PICU with Severe Trauma
Published Jan 2019
doi.org/10.1371/journal.pone.021
• 7 year study
• 542 children
• 42% ISS>15
• Mortality 11%
• Very few penetrating
injuries
Overwhelming Majority of Mortality:
• Drowning (0-4yrs)
• Hanging (10-15)
• Intentional Injury (0-4yrs)
• Massive Head Injuries (with or without multitrauma)

7. Blunt v Penetrating Injuries
March/April 2019 QCH: Blunt Injuries 131
Penetrating Injuries 0
Jan 2017-June 2019: 40 Penetrating Injuries
• 24 Eye Injuries
• 4 Knife Stabbings
• 3 Gunshot Wounds

8. Physician & Champion of Injury Prevention
1926-1985
Host Agent/
Vehicle
Physical
Environment
Social
Environment
Before
During
After
Haddon Matrix
Dr William Haddon Jnr.

9. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
1 Prevent the creation of the hazard
in the first place
-Banning the manufacture and sale
of inherently unsafe products

10. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
2 Reduce the amount of energy
contained in the hazard
-Speed reduction

11. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
3 Prevent the release of the hazard Child-resistant medicine containers

12. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
4 Modify rate or spatial distribution of
the hazard from its source
Use of seat-belts and child restraints

13. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
5 Separate people in time or space
from the hazard and its release
Bicycle and pedestrian pathways

14. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
6 Separate people from the hazard
by interposing a material barrier
Window bars, pools fencing,
covering wells

15. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
7 Modify the relevant basic qualities
of the hazard
Softer playground surfaces

16. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
8 Make the person more resistant to
damage
Good nutrition for children

17. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
9 Counter the damage already done
by the hazard
First aid treatment for scalds – “cool
running water”

18. First Aid Recommendations
Cuttle, Kimble et al (2010) Burns. 36:673-9
Cuttle, Kimble (2010) Wound Prac Res 18: 4-13
Cuttle, Kimble et al (2009): Burns 35:768-75
Cuttle, Kimble et al (2009). J Burn Care Res. 30:1028-34
Rajan, Harvey, Holland et al (2009) J Burn Care Res. 30:729-34
Bartlett, Holland, Harvey et al (2008) J Burn Care Res. 29:828-34
Cuttle, Kimble et al (2008) Wound Repair Regen. 16:626-34.
Cuttle, Kimble et al (2008) Burns. 34:1176-82.
Yuan, Holland, Harvey, (2007) J Burn Care Res. 28:514-20
• Cold running water 2-15°C
• 20 minutes duration, with delay up to 3 hrs
• Alternative treatments (inc. ice) only
relieve pain
A/Prof Leila Cuttle

19. • Reduced burn depth
– Cuttle et al 2009, Nguyen et al 2002, Harish et al 2018
• Accelerated re-epithelialisation
– Cuttle et al 2009, Brown et al 2014, Harish et al 2018
• Decreased likelihood of grafting and Intensive Care Unit
admission
– Skinner et al 2002, Nguyen et al 2002, Wood et al 2016, Harish et al 2018
• Shorter length of stay (LOS) in hospital
– Skinner and Peat 2002, Tung et al 2005, Wood et al 2016
Clinical Benefits of Cool Running Water

20. • Study type: Cross-sectional analysis
• Data source: Queensland Paediatric Burns Registry
• Time period: July 2013 - June 2016
• Inclusion criteria: Age ≤16 years, thermal burns
• Exclusion criterion: Unknown first aid
• Sample size: 2484 patients
First Aid in Queensland Children

21. Full-Thickness Depth

22. Hospital Admission

23. Theatre Intervention

24. Skin Grafting

25. Treatment Timeline
Scene of
injury
Three hours
post-burn
Adequate
71%
Inadequate
29%
Adequate
31%
Inadequate
69%

26. Safdarjung Hospital, Delhi 2018 18% (any water)
Queensland Children’s Hospital 2005 12%
2012 51%
2018 71% (91% any water)
Optimum First Aid:

27. Haddon’s Ten Countermeasures
with Examples of Child Injury Prevention
10 Stabilize, repair and rehabilitate
the injured person
Burn grafting, reconstructive surgery
and physical therapy

28. The Swedish Model
•Good surveillance data
•A commitment to research
•Regulations & legislation for safer environments
•Broad-based safety education campaigns involving
partnerships of different agencies
•Committed leadership on safety issues.
Bergman AB, Rivara FP. Sweden’s experience in reducing
childhood injuries. Pediatrics, 1991, 88:69–74.

29. Financial Savings from Selected Injury Prevention Interventions
Smoke alarms 65
Child restraints 29
Bicycle helmets 29
Prevention counselling by paediatricians 10
Poison control services 7
Road safety improvements 3
Expenditure of $1 each on: Savings (US$)
Miller TR, Levy DT. Cost outcome analysis in injury prevention and control: eighty-four recent estimates for
the United States. Medical Care. 2000, 38:570–3