Knowledge of First Aid Treatment of Burns: A Comparative Study of Parents and Non-parent Adults

A burn is an injury to the skin or other tissue mainly caused by heat or exposure to radiation, radioactivity, electricity, friction, or contact with chemicals. Burns are a global public health problem, resulting in approximately 180,000 deaths per year, out of which 96,000 are children.¹ According to the World Health Organization, the highest occurrences of deaths related to burn injuries have mostly been reported in Africa and southeast Asia, which make up almost two-thirds of the globe’s low- or middle-income communities.¹

A severe burn is an exceptionally devastating thing to experience; it imposes a great burden on the medical sector and can be mentally, socially, and economically overwhelming for the injured patient. These patients require long hospital stays and numerous reconstructive surgeries, minimizing the loss but leaving a lifelong scar.²

Children are said to be the most vulnerable group to burn injuries. Being less perceptive of their surroundings, they tend to run into dangerous situations without swift recovery from the crisis.^3-5 According to a 10-year survey in a developed country, 69% of children under the age of 5 years had been brought to the emergency room with burn injuries. ⁶ According to data collected in Bangladesh, Colombia, Egypt and Pakistan, 17% of pediatric burns result in temporary disability, and 18% of these young patients will have a permanent disability.¹

Being the leading cause of morbidity and long-term disability, burn injuries pose a great burden upon the society. The majority of these tragic outcomes are preventable by prompt management of the injuries. Over the past 30 to 40 years, some degree of fruitful effort has been made in the developed world to minimize this burden and reduce burn rates.⁷ However, most of the global population lacks the knowledge of application of first aid at a domestic level in case of a burn emergency.⁸ For example, Figure 1 displays the results of applying toothpaste on a burn from hot oil sustained at home.⁹

First aid is any primary care provided to the patient by any nearby person available until proper medical aid has arrived. These measures are generally easy to perform and do not alter the further course of management. The aim is to minimize the risks and enhance healing outcomes, which include maintaining stable vasculature and reducing edema and pain.¹⁰

In most instances, the injured are first approached by their parents or other family members or friends. Thus, for parents, it is particularly imperative for them to have proper understanding and knowledge of first aid to decrease the severity of these nonfatal burns. Inadequate awareness and procedure performance can adversely affect the recovery outcomes of the injury or may even exacerbate the situation.¹¹ Because the application of first aid to burns plays a pivotal role in the healing outcome and management options for the injury, the first aid provider’s knowledge should be accurate and applicable.¹²

Misconceptions and misguided home practices, like adults (especially parents) using toothpaste and burn creams as acute aid for pediatric burns, encumbers the health care system despite complications being preventable with proper acquisition and application of correct means of treatment. The aim of this study was to assess and compare the knowledge scores of parents of children under the age of 13 years versus those of non-parent adults regarding first aid treatment of burns. 

This was a cross-sectional descriptive survey conducted in the twin cities of Pakistan, Islamabad and Rawalpindi, from August 2020 through July 2021. The study population comprised parents of children under the age of 13 years and adults without children among the general public of the cities.

To keep a 95% confidence interval (CI), a 5% margin of error, and a prevalence of 50%, the minimal required sample size calculated for this study was 336. Out of a total of 410 respondents, 364 participants were included by convenient nonprobability sampling technique; responses that did not meet the inclusion and exclusion criteria were then excluded. All consenting people who were either parents of children under the age of 13 or non-parent adults (≥18 years of age) with or without a prior history of burn injury were included in the study. Respondents who had previously attended a workshop or course about first aid management of burns and anyone younger than 18 years of age were excluded.

A self-administered questionnaire derived from literature for collecting data was distributed online among the population of Rawalpindi and Islamabad by convenience sampling. The questionnaire was divided into 2 sections: a sociodemographic section and a section assessing knowledge of burn first aid treatment.  The first section of the questionnaire collected data regarding age, sex, socioeconomic status, education, and prior history of exposure to burn injury (self or family member). The second section contained questions on various first aid measures commonly used following a burn injury through which each individual’s knowledge was assessed. Each correct answer was scored as 1 point, and the individual knowledge score was calculated from a total of 14. The participants’ confidence level regarding the knowledge was also charted using a Likert scale of 1 through 5 (1 = not confident; 5 = very confident). The questionnaire was distributed online among study participants belonging to different socioeconomic backgrounds. Written consent was obtained from all the participants after explaining the study objectives. Confidentiality of participants' information was maintained properly where the participant had the choice to refuse and withdraw from the interview. The study was approved by the Ethical Review Board of Rawalpindi Medical University.

Data were collected from 410 participants, out of whom 364 responses were entered and analyzed using SPSS v23 (IBM Corp). For categorical variables, frequencies and proportions were calculated; for continuous variables, means and standard deviations were calculated. The descriptive analysis of data was presented in the form of tables and graphs. Respondents with missing data were omitted from specific analyses where the missing values occurred. Statistical analysis was done using the chi-square test, t test, and one-way analysis of variance (ANOVA). CIs were set at 95%, and P values were considered statistically significant if ≤0.05.

The study population subject to analysis amounted to 364; of these, 47% were male (n = 171) and 53% were female (n = 193). Two-thirds of the respondents were parents while one-third did not have children. Table 1 summarizes the demographics of the study participants.

The most common source of knowledge regarding burn care was television and social media (44.8%). A total of 120 respondents (33%) had a history of previous exposure to burns. Approximately 41.8% of the respondents had children under 13 years of age. The relevant statistics are displayed in Figure 2.

The participants’ knowledge was scored based on correct answers to a total of 14 questions regarding first aid management of burns. The mean score of the study population was 4.18 out of a total of 14 possible points. The maximum score achieved was 10 points by only 1 of 364 participants (0.3%). 

Considering the individual questions asked to assess the first aid knowledge of burns, the most common answers are quantified in Table 2, along with the correct answer statistics. The t test was applied to interpret the knowledge scores within the contexts of sex, marital status, parental status, and previous history of exposure to burns. The relationship between knowledge score and history of exposure to burns was significant (P = .007), whereas the other variables did not demonstrate any statistically significant differences (sex, P = .941; marital status, P = .766; parental status, P = .881).

One-way ANOVA was used to compare whether knowledge scores correlated with the respondents’ educational status, parental status (whether the respondents had children under 13 years of age), and level of confidence in delivering first aid; any differences turned out to be statistically insignificant (P = .139, .137, and .375, respectively). Chi-square analysis demonstrated that parental status was, however, significantly associated with respondent level of confidence in administering first aid  (P = .020).

This study focused on the level of knowledge of burn first aid treatment in both parent and non-parent adult populations. Out of the 364 participants, two-thirds were parents and 41% of the total respondents had children under 13 years of age. The mean knowledge score of the study population as calculated from the first aid questionnaire was 4.18 out of 14 possible points, with only 1 participant achieving the population’s maximum score of 10. These results suggest that most of the population under study has very inadequate knowledge about first aid for burns, which is similar to the conclusion drawn by Naumeri et al in their study conducted in Mayo Hospital in Lahore, Pakistan.¹³ However, this assessment cannot be generalized because of the small sample size and limited geographical coverage under study. 

After a burn injury, the standard of first aid immediately provided has shown to impact outcomes in terms of both morbidity and mortality.¹⁴ The protocol of using cool running water as the initial management of acute burns has been established by several studies.¹⁵ In the current study, only 22% of the participants selected cool running water as the best first aid item to be used while the most common answer was toothpaste (40.7%). This is in contrast to a study conducted in Palestine where 66% of the burn victims studied had been given cool running water as first aid.¹⁶

The current study’s results are comparable with those of a Jordanian study where appropriate first aid measures were reported in only 6.7% of burn victims.¹⁷ Knowledge about application of antibiotics (30%) and sterile dressings (33%) over the burned area was also inadequate in the current study population. In comparison, a study conducted in the United Kingdom showed that 92% of parents would protect the wound with appropriate dressing.¹⁸ This discrepancy indicates a greater need for awareness about first aid treatment of burns in developing countries. It is important to assess the factors that may influence this knowledge in a certain population so as to apply targeted intervention methods that help in improving public awareness on the matter.

Upon analyzing the knowledge scores within the contexts of sex, marital status, parental status, and previous history of exposure to burns, the authors of the present study found a significant relationship between knowledge of first aid treatment of burns and previous experience of burn injuries (P = .007). The same relationships were also discussed in a 2020 study conducted in Indonesia that considered both experience and educational status to be an important determinants of knowledge about first aid.¹¹ Another study from Saudi Arabia also showed that a history of burn injury had the greatest effect on knowledge of first aid.¹⁹ Although the last 2 questions in the present survey (Table 2) are not under the category of first aid management of burns, these questions were important to ask because they reflect the respondent’s knowledge of the first step to protecting oneself when caught in a burning building. 

In this study, no statistically significant association was found between knowledge scores and the sex, marital status, and education levels of the respondents. Similarly, a survey in Saudi Arabia was also not able to establish any appreciable relationship between the level of education and knowledge score.²⁰ However, Faqumala and Mukminin demonstrated that educational level is a significant factor in making appropriate first aid choices.²¹ The present study also indicates a significant association between knowledge score and the parental status of the participants.

Regardless of the education levels of a community, steps must be taken to improve the population’s awareness about appropriate first aid treatment for burn victims. The present study highlights the need for a more precise approach to assess the association between first aid knowledge and parental education levels so that awareness programs can be made more targeted.

Limitations of the study include a lack of detailed in-person interviews and a limited sample size. The study group mainly consisted of moderately educated subjects who seemed to lack proper understanding of some questions, which led to limited results. The poor knowledge scores may also reflect that the questions pertaining to immediate steps to take following a burn injury were in-depth and somewhat confusing to members of the general population who likely have only a superficial knowledge of first aid of burns. Furthermore, health-related awareness campaigns via media and social media platforms are limited among the Pakistani population, especially with respect to administering various types of first aid. Hence, the poor awareness scores are understandable. In addition, certain questions that were asked regarding the general management of burns could not be applied to all sorts of burns. 

In this survey, the achieved scores for knowledge of first aid treatment for burns were very poor among both the parent and non-parent groups in regard to the morbidity and mortality from burn injuries, especially in the pediatric group. Further, the impact of education and parental status of the study participants and the general understanding of the questionnaire on the achieved results also proved to be of some value. Regardless, these findings demonstrate that attention should be paid to increasing adult knowledge of proper first aid application; education of the general population in this field is needed, especially for parents. Various health platforms (including multimedia) and training courses, along with national programs, are needed to counter the prevalent misconceptions in society. This may help in delivering accurate knowledge regarding first aid management of burns. 

Affiliations: ¹Rawalpindi Medical University, Holy Family Hospital, Rawalpindi, Pakistan; ²Islamabad Medical and Dental College, Holy Family Hospital, Rawalpindi, Pakistan; ³Rawalpindi Medical University, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

Correspondence: Hamna Atique, MBBS, BSc; hamnaatique1997@gmail.com

Ethics: Institutional Review Board Approval was obtained for this study (S3-44-21)

Disclosures: The authors disclose no relevant financial or nonfinancial interests.