Adult Burns & Scalds: An overview of the evidence, best practice and prevention programs in Western Australia

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1 Adult Burns & Scalds: An overview of the evidence, best practice and prevention programs in Western Australia Compiled by: Alison Kay, Injury Control Council of WA Inc. Disclaimer The content of this Overview is made up of research and information that was available to the Injury Control Council of WA (ICCWA) at the time of preparation. Although care has been taken to ensure the accuracy of the information provided, ICCWA takes no responsibility for any errors, omissions or changes to information that may occur. This document is solely an overview, and is not intended to be a comprehensive document regarding adult burns and scalds. It may unintentionally exclude information on WA burns statistics, prevention programs or initiatives and legislation. ICCWA acknowledges that there may be contributors to the prevention of adult burns and scalds outside of the organisations and programs listed.

2 Inclusions External causes of burn injuries are classified as thermal or non-thermal. Thermal burns include exposure to hot fluids, fire, hot objects and are generally unintentional. Non-thermal burns can be caused by explosives, electric current, corrosive chemicals, friction, extreme cold, and complications of medical or surgical care. (1) Both types of burns in persons aged 15 years and older will be classified as unintentional adult burns. Self-harm, interpersonal and domestic violence causing burn injuries will not be included in this analysis. The International Classification of Disease, version 10 (ICD-10-AM) 1 codes that are used to capture these burns are X00-X19. (2) (3) For a full description of each code, see Appendix A. Background The Model of Care for Burn Injury in Western Australia (WA) was completed in 2009 by the Injury and Trauma Health Network in response to the major burden for burn injuries in WA. The Model of care made recommendations for several injury prevention initiatives, including: the development of targeted programmes for the year old age group ; ongoing development of culturally secure Aboriginal and Torres Strait Islander (ATSI) resources for the prevention of Burn Injury ; and to implement WA Alcohol Plan strategies, including social marketing campaigns to policy targeting risky drinking behaviours. It was also recognised that although WA had a slightly higher rate of burnrelated hospitalisation than the national rate, it may be explained by the proportion of people living in non-metropolitan areas, as well as a large industry sector where burn injury is common. Research conducted by the Burn Injury Research Unit in Western Australia found that from there was an overall decline in burn injury hospitalisations, however children under 5 years, males aged 20-24, and older adults remained at higher risk of burn related hospitalisations.(4) For this same time period, for adults aged over 60, 31% of all burn-related hospitalisations occurred in rural or remote areas, and 7% were Aboriginal, suggesting that these are also higher risk groups. (4) 1 ICD is the international standard diagnostic classification for general epidemiological data, health management purposes and clinical use. It is used to classify diseases and other health problems from morbidity and mortality datasets. 2

3 Epidemiology Hospitalisations State: In WA, from 1983 to 2008 burn-injury hospitalisation declined by an average of 2% each year. (4) The highest age-specific hospitalisation rate occurred in 0-4 year olds 2, followed by males aged (4) In 2010 alone, there were 849 hospitalisations in Western Australia from burns and scalds injuries for adults 15 years and older, consuming 4,416 bed days and costing an estimated $7,016,747. From , 70% of all burns-related hospitalisations occurred in males. Persons aged years old comprised 25.5% and 20.5% of all burns injuries, for males and females respectively. In adolescents aged 15-29, 76% of burn hospitalisations from were male, with men having hospitalisation rates 3 times that of females. (5) Regional Comparison: From 2006 to 2010, males in rural and remote health regions had significantly higher rates of burn-related hospitalisation than the State, while those in metropolitan areas had significantly lower rates than the State. Females in rural and remote health regions also had significantly higher rates of hospitalisation from burn injuries than those in the State, while those in metropolitan areas had significantly lower rates than the State. (5) The Kimberley health region had the highest age-standardised rates of hospitalisation for burns from than any other health region (119 persons per 100,000). (6) From , 43.2% of all burn injury hospitalisations in adolescents aged were admitted to rural and remote hospitals. For all ages, rural patients also suffered more severe, deeper burns, involving a great total body skin area, and had higher death rates from burns than urban areas. (6) (7) However, hospital data from have shown that while admissions for severe burns of total body surface area of 20% or greater have not changed significantly in urban and remote areas, in rural areas these hospitalisations have declined at a rate of 20% per year since (9) Aboriginality: Aboriginal people in Western Australia are at greater risk of experiencing burns injuries than non-aboriginal people, with hospitalisation rates over five times higher. From 1983 to 2008 the age-standardised rates of hospitalisation for burn injury in Aboriginal people declined by over 50%, however, Aboriginals accounted for around 15% of all burns hospitalisations in Western Australia from (6) (4) A greater proportion of burns in Aboriginal people were the result of interpersonal violence (7.5% in Aboriginal populations versus 1.2% in non-aboriginal populations), when compared to non-aboriginal persons 3. (6) (7) Emergency Department (ED) Presentations State: From there were 117,320 ED presentations in WA for burn-related injuries in adults. Of all ED attendances in WA, 62% were male. Further, those aged contributed the 2 This age group will be considered in the overview of Child Safety, but will not be included in the review of Adult burns and scalds. 3 Intentional self-harm burn injuries will not be included in this analysis, although the significant burden that is experienced from these injuries is an important consideration for the prevention of overall burn injuries. 3

4 greatest proportion of all ED attendances. The highest age specific rates occurred in males aged years, and females aged 80+ years. (9) Aboriginality: From there were 9,759 ED attendances by Aboriginal people for burn injuries. State-wide, Aboriginal people were 3.6 times more likely to present to ED than non-aboriginals, comprising 12% of all presentations. However, in metropolitan areas of WA the rate of ED attendances in Aboriginal people was 8.6 times greater than non-aboriginal people and only 1.5 times greater in country areas. (10) Deaths From there were a total of 68 deaths in WA from burns injuries, of which over 60% were male. (8) Further breakdown by region or Aboriginality is not possible due to the small number of deaths. Workplace Claims From there were 679 lost time injuries claims made to WorkSafe WA as a result of burn injuries that occurred in the workplace. In there were 9,741days lost by workers from burn injuries, at an estimated cost of $6,857, (9) Causation and Risk Factors Causes: The most frequent causes of burns hospitalisations in Western Australia from were contact with hot drinks/food/fats/cooking oils, contact with hot fluids and exposure to ignition of highly flammable material. (6) More than half of cases occurred in the home and 36% of injuries were associated with cooking. Burns prevention programs regarding burns in the home may be warranted as they pose the greatest burden to all age groups. (6) Of all admissions with a place of injury occurrence code, 13% were sustained in trade, service or industrial areas. (10) Data from WorkSafe WA showed that in 2009/10 the industries with the greatest number of claims for burns and scalds were manufacturing, accommodation and food services, and construction. Further, most work-related burns injuries were caused by heat, electricity and other environmental factors, followed by chemicals and other substances. (9) Older Adults: A WA study found that burn injuries in adults over 60 years were predominantly caused by flame (30%), scald (27%) and contact (13%), with most flame burns a result of controlled fires, such as in fireplaces and on the stove. Further, most of these injuries occurred in the home. (10) Adolescents: Males are over represented in this age group and this is thought to be associated with increased risk-taking behaviours, occupational hazards and societal genders roles. (11) Most burns in this age group that were admitted to hospital were the result of flame (45%), followed by scald (21%). Of all flame burns, 23% were caused by controlled fire (including fireplaces, stoves and campfires), followed by ignition of inflammable substances. (11) In this age group, 27% of all burn 4 Preliminary data only is available for 2011 at this time, and actual claims may be underrepresented. 5 Costs include claims for compensation (weekly payments and treatments), as well as non-compensation payments (legal costs, transport, etc.). 4

5 injuries were sustained in the home or a residential institution, and 25% were sustained in trade, service or industrial areas. More males were burned in the latter location (28%) than females (12%) and more females were burned in the home (40%) than males (23%). (11) Risk Factors In the home: Risk factors include hot drinks, hot tap water, ovens, stoves, kettles, irons, heaters, open fires, matches, lighters, chemicals and electrical outlets. (7) (6) Cigarette and alcohol use: Smoking, consuming alcohol and using drugs all contribute to significantly higher rates of burn injuries. Cigarettes were found to be responsible for 28% of all fires causing deaths, while alcohol was associated with 23% of minor burns and 44% of fire deaths. (6) Open fires: Campfires, bonfires and barbeques for cooking, heating and lighting resulted in increased risk of burns injuries, particularly for children. (6) Campfire burns in particular have been associated in several studies with alcohol intoxication. (11) Socioeconomic status: Review of the international published literature has indicated that low socioeconomic status is associated with increased risk of burn injury. Factors include ethnicity (being non-caucasian), low income, large family size, single parents, illiteracy, low maternal education, unemployment, job loss, poor living conditions, not owning a home, not having a telephone and overcrowding. (6) Increased age: Factors such as impaired ability to managed activities of daily living, living alone and living in older homes with limited or no burn safety modifications contribute to an increased risk of burns injury in adults over 60 years. (10) Best Practice Best Practice guidelines were identified and developed in the Model of Care for Burn Injury in Western Australia (2009) for primary, secondary and tertiary prevention of burn injury 6. A modified Injury Prevention Framework to be applied to injury and trauma was developed by the Injury Prevention Working Group. The key components are: Primary prevention 1. Promotive: Well population, to include education, policy, legislation, advocacy, partnerships, media, community engagement, workforce development and resources. a. Legislation i. Safe water temperature: This legislation was passed Australia-wide in 1997, and requires all water heaters to have a safe pre-set temperature, with a maximum of 50 C in residences, and 45 C in childhood centres, schools, hospitals and aged care facilities. ii. Smoke alarm legislation: In 1996 the Building Code of Australia was amended to require all new residences to have hard-wired smoke detectors. 6 Secondary and tertiary prevention will not be included in this overview, as the injury has already occurred. However these activities can have a large impact on the outcome of the burn for an individual and are therefore emphasised in the WA Burn Injury Model of Care (2009). 5

6 2. Preventative 7 : Identified risk population (geographical location, age, gender, environment and ethnicity); identify specific actions in the promotive /strategic areas. Secondary prevention 1. Curative: Acute care of injured individual; Education, information, intervention, home assessment, discharge planning, workforce development and resource development. Tertiary prevention 1. Rehabilitative: Rehabilitative aspect of injury treatment; Education, information, community support, care plan, partnerships, referral processes, workforce development. Considerations for Prevention Risk factors such as elements in the home, cigarette and alcohol use and the use of fires for cooking, heating and lighting are factors that are relatively amenable to change through health promotion initiatives. Therefore, they are better targets for prevention strategies than socioeconomic status. (6) (7) Studies in the USA found that programs promoting smoke alarms have had modest impact on smoke alarm ownership; however, they were not shown to be effective in reducing burn-related injury. (12) This is likely due to the fact that most burn injuries were the result of contact with hot fluids and cooking oils, which are not prevented by smoke alarms. However, homes with smoke alarms typically have a 40-50% decrease in death rates compared to homes without smoke alarms. (13) Alcohol use has been identified as a factor strongly associated with both burn injuries and deaths. Strategies aimed at reducing the prevalence of heavy, occasional drinking behaviour are likely to reduce the burden of alcohol-related burn injuries. (6) There has been a decrease of burn injury hospitalisations in adults in WA from 1983 to 2008; however the reason for this is not clear. It may be a combination of legislative changes, burn prevention and safety education, improved work place safety and a shift to increased outpatient care, but further research and program evaluation is needed in order to identify successful agents of change. (4) 7 A list of burn injury prevention activities in WA will be included in the section titled Prevention Activities. 6

7 Scope of Current Activities, WA Organisation Program Description Fire and Emergency Services Authority of WA (FESA) Simulated House Burns (2006) Don t be a Fool! Change your Smoke Alarm Batteries on April 1 st campaign (launched 2006) Reducing Roadside Fires Caused by Cigarettes (2004/05) Bushfire Arson Reduction activities (2004/05) Fire Safety in Your Home DVD: Community engagement publications for Aboriginal and CaLD communities (2011) Fire Safety in your home. Protect your family, protect your life booklet Good fire; Bad fire presentation Juvenile and Family Fire Awareness (JAFFA) Program Burned 3 condemned houses for media promotion to highlight the dangers of home fires during winter. The project was aired on a national current affairs program, and participants were also invited to see firsthand the effects of fire dangers. Highlights the importance of replacing smoke alarm batteries annually, having a home escape plan and testing smoke alarms with moving into a new house. FESA worked with local governments to manage the roadside mulch moisture content during periods of high fire danger. They also created a Discarded Cigarette Report Card, in which volunteers could report people discarding cigarettes from their cars, and then bush fire prevention awareness letters were sent to vehicle owners to improve awareness of the risks of bush fires. Uses staff and volunteers from FESA, the Fire and Rescue Service, bush fire brigades, local governments, Department of Education and Training, Catholic Education and WA Police to increase community awareness of arson, encourage suspicious behaviour to be reported. Activities included doorknocking, school visits and shopping centre displays in targeted areas. Produced in 12 languages, to raise awareness of home fire safety by addressing the 8 major home fire risks through scenarios acted by CaLD community members. Addresses the major causes of house fires in communities with a high Aboriginal population. The booklet was developed through consultation with Aboriginal community groups and the Derbal Yerrigan Health Service to ensure that the language, content, look and feel of the publication were suited to Aboriginal people. School presentations based on the Fire Safety in your home booklet. The Juvenile and Family Fire Awareness Program is a free, confidential education and 7

8 Kidsafe WA Department of Health / Drug and Alcohol Office South Metropolitan Area Health Service Julian Burton Burns Trust Home Safety Demonstration Home Alcohol. Think Again campaign The Western Australian Drug and Alcohol Strategy (WADAS) Prevent Alcohol and Riskrelated Trauma (PARTY) Fire lighters program Commercial Kitchens Campaign Radiator Community Service Announcement support program for children between the ages of 6-16 that have been involved in fire lighting. The program was started in 1989 by a small group of firefighters in response to an increasing demand for support from parents, schools and agencies. The firefighters involved in the program all volunteer their own time to assist families. A centre to showcase a safe home environment to prevent injury in the home with emphasis on appliances and safe products to prevent burn injuries. Targeted primarily to children, but also educational tool for adults. Campaign run by the Drug and Alcohol Office WA in reduce the incidence of alcohol-related consequences, including all forms of injury, such as burns. Provides the broad direction for addressing problems related to alcohol and other drug use in WA, with the aim of preventing and reducing alcohol-related harm through social marketing to decrease support for risky drinking and provide policy and environmental settings that discourage risky drinking. Target groups include young males (17-30) and people in northern and central regions of regional WA, who are more likely to drink to levels of intoxication. Targets year olds in high risk- and alcohol-related injury prevention. Program is supported by the Adult Burn Injury Unit. Targets year olds by providing awareness education on the consequences for people with burn injury. Also conducted in schools, and therefore mostly targets children, but overlaps with some adults. Campaign to reduce workplace burn injury in businesses whose purpose is food and beverage service, including restaurants, cafes and take-away shops. Businesses will also be provided with free burns first aid kit. In conjunction with the Royal Adelaide Hospital and Channel 9, a community service announcement was created to educate drivers on how to avoid burns from overheated car radiators. Announcement was aired in South Australia, however similar driving conditions exist in Western Australia and there may be scope to use the same 8

9 Household fat fires community announcement announcement targeting the WA population. In conjunction with the Royal Adelaide Hospital and Channel 9, a community service announcement was created to educate the population on how to respond to kitchen fires caused by burning oil/fat. Announcement was aired in South Australia, however there may be scope to use the same announcement targeting the WA population. (25) Legislation National Plumbing and Draining Code AS Brief Temperatures of hot water for all new buildings shall not exceed 45 C in schools, early childhood centres, nursing homes or similar facilities and 50 C in all other buildings. All new homes are required to have smoke alarms fitted. AS 3786 AS Fitting of electrical safety switches into all homes since Priority Areas These have been identified through previous literature and Burn Injury Model of Care (2009). Gender: The hospitalisation rate for males from burn injury in WA was double the rate for females. This difference has been prevalent since 1988/89. (6) Age: WA data from suggests that males in their late teens and early 20 s (15-24 years), as well as older adults, are at the greatest risk of burn injury. Increased risk of burn injury in older adults may well be associated with impaired senses, cognition and mobility. However, in older adults burn-related mortality is associated with advancing age, inhalation injury and presence of comorbidities. (17) (6) Due to the increasing ageing population in Australia and other developed countries, this presents a significant public health issue. (10) Geographic location: Non-metropolitan areas experience higher rates of burn injury hospitalisation in Western Australia, which is consistent with other countries. In WA, the highest hospitalisation rates were experienced by the Kimberley, Goldfields, Pilbara and the Wheatbelt health regions. (6) Ethnicity: While there was a significant decline in Aboriginal burn injury hospitalisations over the past few decades, Aboriginal people still experience significantly higher rates compared to non- Aboriginal people. Effective prevention programs should also include culturally appropriate interventions for Aboriginal and Culturally and Linguistically Diverse (CaLD) groups. An opportunity exists to target males aged 15-24, as well as to expand programs into Aboriginal populations. It is also crucial to implement program evaluation of injury prevention programs, as this is a current area of weakness. (6) From there was an increase in contact burns among both male and female adolescents. This may be a result in work-place related burns, which is supported by the literature. (11) 9

10 Flammable nightclothes: While there are regulations in Australia regarding the fabrics of children s nightwear, there are currently no regulations for adults. From in Australia nearly all deaths resulting from clothing fires occurred in those aged 65+ years. (18) Stakeholder Consultation What really matters to your organisation? 1. Legislation and standards for burns prevention Several stakeholders stated that legislation and product standards were key factors in reducing the incidence of burns and scalds in the community. In particular, the importance of safe designs of equipment, including kitchen appliances such as stoves, was highlighted. Within a workplace environment, stakeholders stated the importance of mandatory education and training provided to staff working in industries with an increased risk of burn injuries, as well as improved supervision and more consistent enforcement of workplace policies and procedures. This was emphasised as a shift from a reactive to proactive approach to injury prevention. There was some dissent amongst stakeholders regarding legislation versus individual behavioural change. Some members of the group expressed concern that too much legislation could have a negative effect on injury prevention, while others stated that behavioural change was too difficult to achieve, took too long before results would be seen and could be short-lived. 2. Culture change Culture change in the workplace and community were cited by several stakeholders as important elements. The concept of a capable community, building capacity within the community to rely on individual s strengths to become a safe and thriving community, was seen by the group as having a positive effect on injury prevention as a whole. Addressing the culture around alcohol use and abuse was another key factor that a majority of stakeholders felt would have a positive effect on injury prevention. Within the workplace, some stakeholders stated that a change in workplace culture that was more focused on the individual was important. 3. Community Engagement Development of a solid community engagement strategy was stated by stakeholders as having a positive impact on increasing the profile of burn injuries and ensuring that people were aware of the consequences that their actions could have. Several stakeholders emphasised the importance of networking, bringing community members together and the formation of an injury prevention community. 4. Education Education and awareness raising targeting high risk populations, such as the elderly and young men, were both stated as important. Education starting with young children, such as in primary schools, was mentioned as a way of engraining the importance of injury prevention from an early age. 10

11 5. Data and information Stakeholders emphasised the importance of having access to accurate and timely data in order to inform evidence-based interventions and strategies to reduce the incidence of burn injuries, as well as direct funding. One suggested mechanism for gathering better data is through increased mandatory reporting schemes. To Keep: Which programs/initiatives/policies are working well that we need to keep doing? 1. Data collection Mandatory reporting systems that are currently in place, as well as a product surveillance system (market surveillance system) were stated by stakeholders as policies that should be continued. 2. Legislation Current legislation was also stated by several stakeholders as being successful to date. Specific legislation mentioned was non-flammable night wear, short cords on kettles and reducing water temperatures for hot water systems. To fix: Which need to be modified in order to work well or should be stopped, as they are not working? 1. Data collection Expanding on the current reporting system to ensure that robust quantitative data is collected was mentioned by several stakeholders as having potential to improve burn injury prevention. This may include linkages between health and non-health data, such as workplace absenteeism following an injury. The current workplace reporting scheme requires injuries that result in 10+ days of workplace absenteeism to be reported, whereby stakeholders stated that it may be more useful to collect data on all reported injuries regardless of the number of days absent from work. Further, respondents highlighted that more qualitative data is also necessary. 2. Education and awareness raising Several stakeholders identified a need for increased education in burn and scald injury prevention. Areas in particular need of increased awareness included risk of burns on treadmills, as no known awareness campaigns have occurred, and exhaust burns. Respondents also felt that there was a greater role for media, including social media, to play in the promotion of community programs, such as the Juvenile and Family Fire Awareness (JAFFA) and Fire Inside Out programs. It was also mentioned that safety messages need to evolve to appropriately reflect one s stage of life. For example, targeting new mothers or parents at various stages in their child s development, or elderly people as they begin to lose grip strength was suggested. 11

12 To start: What should we be doing in the future? 1. Multi-disciplinary approach to prevention When asked that they would like to see done in the future, many stakeholders responded that all injury prevention, including burns and scalds prevention, required a multidisciplinary approach. It was highlighted that many organisations currently have an opportunity to engage the community in injury prevention, although they may not have the capacity to do so. Utilising these existing channels for communication was emphasised. For example, working with general practitioners (GPs) to implement age paced parenting information systems, whereby the GP would be prompted by a computer reminder to inform parents of potential injuries that could occur in their child s stage of life was one suggestion. Other suggested partnerships for burn injury prevention include the Telethon Institute for Child Health Research (TICHR), existing publications or utilising an injured community member or sports star as a spokesperson. It was also suggested by stakeholders that working with non-health experts could prove beneficial to burn injury prevention. Experts suggested include behavioural change and community development experts. 2. Increase the number of people trained in first aid (secondary prevention) Several stakeholders emphasised the importance of extending the number of people who are first aid trained to address injuries such as burns and scalds. In particular, linking first aid training to obtaining one s driver s license was stated as having a potentially positive impact on the severity of burns and scalds. For a list of all workshop attendees, see Appendix B. 12

13 Appendix A: ICD-10 Codes Burns and Scalds (X00-X19) Code Description Inclusion/Exclusion X00 Exposure to uncontrolled fire in building or structure. Includes: Conflagration in building or structure. Excludes: Exposure to ignition or melting of nightwear; ignition or melting of other clothing and apparel; exposure to other specified smoke, fire and flames. Excludes: Arson X01 X02 Exposure to uncontrolled fire, not in building or structure Exposure to controlled fire in building or structure Includes: Exposure to forest fire. Includes: Exposure to fire in fireplace or stove. X03 Exposure to controlled fire, not in building or structure Includes: Exposure to bon fire, camp-fire, trashfire. X04 Exposure to ignition of highly flammable material Excludes: Ignition or melting of nightwear, or other clothing and apparel. X05 X06 X08 Exposure to ignition or melting of nightwear Exposure to ignition or melting of other clothing and apparel Exposure to other specified smoke, fire and flames Includes: Exposure to bed fire from cigarette, other burning material, unspecified burning material, sofa fire, other furniture fire. X10 Contact with hot drinks, food, fats and cooking oils. X11 Contact with hot tap water Includes: Contact with boiling tap-water, and boiling water NOS. Excludes: Contact with water heated on stove. X12 Contact with other hot fluids Includes: Contact with water heated on stove. Excludes: Hot liquid metals. X13 Contact with steam and Excludes: exposure to excessive natural heat, fire and flames. 13

14 other hot vapours X14 X15 X16 X17 X18 X19 Contact with hot air and other hot gases Contact with hot household appliances Contact with hot heating appliances, radiators and pipes Contact with hot engines, machinery and tools Contact with other hot metals Contact with other heat and hot substances Excludes: Contact with heating appliances; powered household appliances; exposure to controlled fire in building due to household appliance; and exposure to household appliances electrical current. Excludes: Contact with powered appliances; exposure to controlled fire in building or structure due to appliance or industrial appliances electrical current. Excludes: Contact with hot heating appliances, radiators and pipes or hot household appliances. Includes: Contact with liquid metal. Excludes: Contact with objects that are not normally hot, e.g., an object made hot by a house fire. Appendix B: Adult burns and scalds workshop attendees Organisation Name Australian Competition and Consumer Commission Stephen Kinnersly Burn Injury Research Unit, University of Western Australia Burns Service of WA Burns Service of WA Burns Service of WA Burns Service of WA Burns Service of WA Burns Service of WA Burns Service of WA Department of Health Department of Health Fire and Emergency Services Authority of Western Australia (FESA) Department of Health, Health Networks Janine Duke Alwena Willis Dale Edgar Suzanne Rec Fiona Wood Joy Fong Lisa Martin Tania McWilliams Erica Davison Laura Bond Ruth Noonan Karina Moore 14

15 Injury Control Council of Western Australia (ICCWA) Injury Control Council of Western Australia (ICCWA) Safety in Workplaces WorkSafe WA WorkSafe WA Facilitator Emily Anderson Deb Costello Gavin Waugh Nigel Martin Angela Stanley Rebecca Cotton Bibliography 1. Peter Hughes Burn Foundation. Types of Burns. [Online] [Cited: January 12, 2012.] 2. T Ballestas, J Xiao S McEvoy Peter Somerford. The Epidemiology of Injury in Western Australia, Perth : Department of Health WA, ICD-10-CM Codes. [Online] [Cited: January 12, 2012.] 4. A 26-Year Population-Based Study of burn Injury Hospital Admissions in Western Australia. Janine Duke, Fiona Wood, James Semmens, katrina Spilsbury, Dale W. Edgar, Delia Hendrie, Suzanne Rea. 3, 2011, Journal of Burn Care & Research, Vol. 32, pp Epidemiology Branch in collaboration with the Cooperative Research Centre for Spatial Information. Comparative report on Exposure to smoke, fire, flames, hot substances related hospitalisations by external causes in health Regions areas for persons aged years. Perth : Epidemiology Branch, Epidemiology Branch (PHI) in collaboration with the Cooperative Research Centre for Spatial Information (CRC-SI). Comparative report on fire, burns and scalds related hospitalisations in Health Regions areas for persons aged years. Perth : Department of Health WA, Department of Health, Western Australia. Burn Injury Model of Care. Perth : Health Networks Branch, Department of Health, Rimajova, G Arena S Cardova A Gavin P Palamara M. Injury in Western Australia: A review of best practice, stakeholder activity, legislation and recommendations for selected injury areas. Perth : Injury Research Centre, School of Population Health, University of Western Australia, Urban compared with rural and remote burn hospitalisations in Western Australia. Janine Duke, Suzanne Rea, James Semmens, Fiona Wood. 4, Perth : Burns, 2012, Vol Epidemiology Branch (PHI) in collaboration with the Cooperative Research Centre for Spatial Information. Health status report on Burns ED attendances for the State for persons aged years. Perth : Department of Health WA,

16 11. Epidemiology Branch (PHI) in collaboration with the Cooperative Research Centre for Spatial Information (CRC-SI). health status report on Burns ED attendances for the State for persons aged years. Perth : Department of Health WA, Epidemiology Branch, Department of Health in collaboration with the Cooperative Research Centre for Spatial Information. Comparison of fire, burns and scalds mortality rates for Aboriginals and non-aboriginal people who live in the State for persons aged years. Perth : Epidemiology Branch, Government of Western Australia, Department of Commerce. Western Australia lost time injuries and diseases: Burns and poisoning. Perth : Department of Commerce, Government of Western Australia, Rates of hospitalisations and mortality of older adults admitted with burn injuries in Western Australia from 1983 to Janine Duke, Fiona Wood, James Semmens, Katrina Spilsbury, Alwena Willis, Delia Hendrie, Suzanne Rea. s1, 2011, Australasian Journal on Ageing, Vol. 31, pp An assessment of burn injury hospitalisations of adolescents and young adults in Western Australia, J. Duke, F. Wood, J. Semmens, D.W. Edgar, K. Spilsbury, S. Rea. 2012, Journal for the International Society of Burn Injuries, Vol. 38, pp Interventions for promoting smoke alarm ownership and function. C DiGuiseppi, CW Goss and JPT Higgins. 2, 2010, Cochrane Database of Systematic Reviews, Vol Nebraska Injury Prevention Advisory Committee. Nebraska Injury Prevention State Plan. Lincoln : Nebraska Health and Human Services System, Julian Burton Burns Trust. National Prevention. [Online] [Cited: January 12, 2012.] Nebraska Health and Human Services System. Nebraska 2010 Health Goals & Objectives. Lincoln : s.n., Australian Competition & Consumer Commission. Flammable clothing. [Online] Australian Competition & Consumer Commission, [Cited: June 3, 2012.] 16