burns 38 (2012) 1174–1180

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Pre-hospital emergency burn management in Shanghai:

Analysis of 1868 burn patients

Shi-zhao Ji, Peng-fei Luo 1, Zheng-dong Kong 1, Xing-feng Zheng, Guo-feng Huang,
Guang-yi Wang, Shi-hui Zhu, Shi-chu Xiao **, Zhao-fan Xia *
Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, People’s Republic of China

article info abstract

Article history: Background: There are few studies reporting the level of pre-hospital emergency manage-
Accepted 17 March 2012 ment of burn patients and related influencing factors in China. This study is a summary of
our investigation on emergency education and people’s awareness about pre-hospital
Keywords: emergency management of burn patients in Shanghai, China, and analyses key factors
Burns influencing pre-hospital emergency management of burn patients.
Epidemiology Methods: The survey was conducted by questionnaire in burn patients who sought initial
Scalds clinical visits at the Burn Center of Changhai Hospital (Shanghai, China) between November
Pre-hospital emergency 2009 and December 2010, including demographic data, burn conditions, pre-hospital emer-
management gency management and education about emergency burn management. Data were statisti-
Prevention cally treated by SPSS software.
Results: Altogether 1868 effective questionnaire forms were collected; 33.9% of these burn
patients received cooling treatment before admission and 32.2% of them used ‘folk reme-
dies’ or antibiotics to treat the wound surface. Only 12.2% of these burn patients had
received education about the knowledge of emergency management, mainly through public
media (38.2%), relatives and friends (24.6%), Internet (15.8%), workplace (11.4%) and schools
(10.1%). The result of logistic regression analysis showed that emergency education, espe-
cially via Internet and workplace, played an important role in pre-hospital emergency
management, and that different channels of emergency education affected different age
groups of people: network and unit education mainly affected young adults, while relatives
and friends mainly affected elderly people. In addition, educational level was an important
factor favourably affecting ‘cooling therapy’.
Conclusions: The level of emergency burn management and related education is relatively
low in China at present, and it is therefore necessary to intensify education about pre-
hospital emergency management to raise the level of emergency burn management. At the
same time, more attention should be paid to age- and population-specific education. Finally,
universal emergency education should be included in the national basic education as a long-
term strategy.
# 2012 Elsevier Ltd and ISBI. All rights reserved.

* Corresponding author. Tel.: +86 21 81873471; fax: +86 21 65589829.

** Corresponding author. Tel.: +86 21 81873474; fax: +86 21 65589829.
E-mail addresses: xiazhaofandr@gmail.com (Z.-f. Xia), huangzhuoxiao@sohu.com (S.-c. Xiao).
1
These authors contributed equally to the article with the first author.
0305-4179/$36.00 # 2012 Elsevier Ltd and ISBI. All rights reserved.
http://dx.doi.org/10.1016/j.burns.2012.03.010
 burns 38 (2012) 1174–1180
Burn injuries remain one of the main causes of disability and
death [1], and at the same time they are injuries that can most
likely be prevented. The incidence and mortality of burn
injuries have been brought under effective control in devel-
oped or high-income countries, while about 90% of deaths
caused by burn injuries in the world are from developing
countries. Therefore, how to improve burn and fire prevention
systems has become a main problem in developing countries
[2].
As far as primary prevention of fires and burns is
concerned, the main method at present is to improve the
safety of materials and equipment to establish a safe
surrounding environment [3]. However, as this method is
closely associated with economic development and involves
improvement in infrastructure, it is difficult for developing
countries to completely adopt methods of developed coun-
tries at present [4,5]. Timely and rational pre-hospital
emergency management plays an important role in alleviat-
ing tissue damage and improving the prognosis, and cooling
therapy is considered the simplest and most effective way of
emergency burn management [6,7]. However, there are few
data concerning research in this aspect in China. The degree
of awareness about emergency burn management and the
level of pre-hospital emergency burn management remain
unclear in China. In this study, we evaluated pre-hospital
emergency management of burn injuries and related educa-
tion in China, and analysed key factors affecting pre-hospital
emergency management of burn injuries in China, in an
attempt to provide a foundation for decision making in
improving and raising secondary prevention of fires and
burns.
1. Methods
The Burn Center of Changhai Hospital affiliated to the Second
Military Medical University (Shanghai, China) was founded in
1958, and now is one of the largest burn centres in China, and
the Emergency Burn & Wound Center in Shanghai, mainly
responsible for the treatment of burn injuries in Shanghai and
its surrounding areas including Zhejiang, Jiangsu and Anhui
provinces.
In this study, we made an investigation by questionnaire
in burn patients when he/she sought clinical visits first time
at the Burn Center of Changhai Hospital between November
2009 and December 2010. Other than the baseline char-
acteristics of the burn patients (age, gender, cause, area,
depth, location, place and educational level), which were
collected by the doctors during the consultations, five
multiple-choice questions about pre-hospital emergency
burn management were answered by the patients them-
selves with choosing one answer: whether or not the patient
had been isolated from the source of injury, whether or not
they had received cooling treatment and how long it lasted,
whether or not they used external agents and what kind
of external agents was used, whether or not they were
sent to hospitals within 24 h and whether or not and from
which channel the patients had received education. For
children and old patients who lost the ability of living
independently, questionnaire was conducted through their
1175
caregivers. Patients who suffered from electric shock
injuries and hypothermal injuries and those who were
complicated with inhalation injuries, pulmonary blast
injuries, gas poisoning and other compound injures were
excluded from the study. The admitting physician adminis-
tered the questionnaire to patients. By virtue of the trust
relationship between the doctor and the patient, the
number of items on the questionnaire was relatively small,
and the items did not involve personal privacy, no reliability
questions were designed in the questionnaire and the
validity was mainly controlled by the opinions from the
experts.
Data were analysed using SPSS16.0 software, and all data
were expressed as frequency and percentage (n, %). Unordered
categories were compared by Pearson’s Chi-square test, and
ordered categories were compared by Mann–Whitney U test.
Influencing factors were screened by logistic regression
analysis (stepwise forward method, with entry level = 0.05
and removal level = 0.10; unordered multi-classification vari-
ables were defined as dummy variables; P values were
calculated using Wald test). P values <0.05 were considered
statistically significant.
2. Results
2.1. Burn epidemiological data
Altogether 1868 effective questionnaire forms were collect-
ed. The male/female ratio was 1.9:1. Most of these burn
patients were children (0–14 years), and adolescents/adults
(15–60 years). The main causes of burn were hot liquids and
flames. Most of the burn cases were small and moderate
area superficial second-degree burns mainly involving the
four extremities and the trunk. Most of the burn accidents
happened in homes and working places. Education of most
patients and caregivers was mainly at the junior middle
school level. The details are shown in Table 1.
2.2. Pre-hospital emergency management
Most of the patients were immediately isolated from the
source of burn and sent to hospitals for consultation within
24 h, and only 33.9% of them were treated by ‘cooling
therapy’, and the duration of cooling therapy was less than
10 min in 88%. With respect to wound treatment, most
patients did not use any drug or wound dressing; 32.2%
patients improperly used disinfectants and antibiotics
externally or ‘folk remedies’ including toothpaste, soy sauce,
eggs, table salt or cooking oil (Table 2). Any external agent,
which may cause secondary infection, bacterial imbalance
or resistance or misjudgement of burn depth, was consid-
ered to be improper when used before hospital consultation,
including some kitchen supplies (e.g. soy sauce, sugar,
vinegar, salt, eggs, and oil), disinfectants and antibiotics
(oral and intravenous antibiotics) and some others such as
toothpaste or tea. Some specialised burn creams (e.g. silver-
contained ointment) produced by the pharmacy company
for treatment of burns were considered to be rational as well
as clean gauze.
1176 burns 38 (2012) 1174–1180

Table 1 – Baseline characteristics of burn patients.

Sex Burn area
Female 645 (34.5%) <10%TBSAa 1051 (56.3%)
Male 1223 (65.5%) 10–30%TBSAa 483 (25.8%)
>30%TBSAa 334 (17.9%)
Age Burn depth
Children (0–14 yr) 703 (37.6%) Superficial 2nd-degree 1170 (62.6%)
Adolescents and adults (15–59 yr) 898 (48.1%) Deep 2nd-degree 425 (22.8%)
The elderly (60 yr) 267 (14.3%) 3rd-degree 273 (14.6%)
Educational level Place
Primary school 342 (18.3%) Home 1228 (65.7%)
Middle school 1013 (54.2%) Workplace 396 (21.2%)
College 513 (27.5%) Outdoor 244 (13.1%)
Cause Locationb
Hot fluids 1011 (54.1%) Head and neck 445 (23.8%)
Flames 435 (23.3%) Upper extremities 902 (48.3%)
Hot solids 238 (12.7%) Lower extremities 870 (46.6%)
Chemical 100 (5.4%) Trunk 658 (35.2%)
Electrical spark 84 (4.5%) Hips and perineum 344 (18.4%)
a
Total body surface area.
b
Some patients have more than one location involved.

2.3. Emergency education
Most patients (87.8%) had not received any education about
emergency burn management. Those who had received
related education reported that they mainly learnt the
knowledge of emergency burn management via the channels
of traditional media (38.2%) including newspapers, magazines
and posters; relatives and friends (24.6%); Internet (15.8%);
workplace (11.4%); and schools (10.1%).
To explore the influence of emergency education on pre-
hospital emergency burn management, the patients or
caregivers of children and elderly patients were divided into
two groups (education group and non-education group)
according to whether they had received emergency knowl-
edge. There were no significant differences in the baseline
characteristics (including demographic data, cause, location,
area, depth and place) between the two groups (data not
shown). Therefore, differences in pre-hospital emergency
burn management were compared between the two groups.
The results showed that patients in the education group were
better than those in the non-education group with respect to
prompt cooling treatment, duration of cooling treatment,
rational use of external covers (burn cream and clean gauze)
and hospital consultation within 24 h (Table 3).

2.4. Association between pre-hospital emergency

Table 2 – Pre-hospital emergency management. management and depth of burn injury
Immediate isolation from the source of injury
No 135 (7.2%) Analysis of the association between post-burn emergency
Yes 1733 (92.8%) management and the depth of burn injury showed that the
Cooling treatment distribution of burn depth was significantly different between
No 1234 (66.1%) the two groups divided by whether or not they have adopted
Yes 634 (33.9%) correct emergency management, such as whether or not
Duration of cooling treatment
isolated from the source of injury immediately, whether or not
<10 min 558 (88.0%)
10–20 min 49 (7.7%)
adopted prompt cooling treatment and whether or not used
>20 min 27 (4.3%) proper external agents. The depth of burn injury was
Agents for external use superficial second degree in most patients who adopted
No external material used 989 (52.9%) correct emergency burn management, while the depth of
Folk remediesa 338 (18.1%) burn injury was deep second degree or third degree in most
Burn creamb and clean gauze 277 (14.9%)
patients who did not adopt emergency burn management
Disinfectants and antibioticsc 232 (12.4%)
correctly (Table 4).
Others 32 (1.7%)
Hospital consultation within 24 h
No 437 (23.4%) 2.5. Factors affecting pre-hospital emergency burn
Yes 1431 (76.6%) management
a
Folk remedies includes tooth-paste, soy sauce, eggs, table salt
and cooking oil. Using ‘immediate isolation from the source of injury’, ‘prompt
b
Burn cream represents some specialized burn creams produced cooling treatment’, ‘rational use of external agents’ and
by the pharmacy company for the family standing, e.g. silver- ‘hospital consultation within 24 h’ as the effect indicators
contained ointment.
c
for evaluating the level of pre-hospital emergency burn
Antibiotics includes oral and intravenous antibiotics except
management, seven candidate factors that may affect the
antibiotic ointment.
level of pre-hospital emergency burn management were
 burns 38 (2012) 1174–1180 1177

Table 3 – Comparison of pre-hospital emergency management between the education group (EG) and non education group
(NEG).
Pre-hospital emergency management NEG (n = 1640) EG (n = 228) P valuea
Immediate isolation from the source of injury 1520 (92.7%) 213 (93.4%) 0.687
Cooling treatment 503 (30.7%) 131 (57.5%) <0.001
Duration of cooling treatment <0.001
<10 min 447 (27.3%) 111 (48.7%)
10–20 min 38 (2.3%) 11 (4.8%)
>20 min 18 (1.1%) 9 (3.9%)
Rational use of external agentsb 1085 (66.2%) 181 (79.4%) <0.001
Hospital consultation within 24 h 1231 (75.1%) 200 (87.7%) <0.001
a
P values of EG vs. NEG were calculated using Pearson’s Chi-square test, except the duration of cooling treatment, for which Mann–Whitney U
test was used.
b
Rational use of external agents was defined as using burn cream and clean gauze.

Table 4 – Association between pre-hospital burn emergency management and depth of burn injury.
Immediate isolation Cooling treatment Rational use of Hospital
from the source of external agents consultation within
injury 24 h

No Yes No Yes No Yes No Yes

Superficial 2nd-degree 71 (52.6%) 1099 (63.4%) 749 (60.7%) 421 (66.4%) 337 (56.0%) 833 (65.8%) 283 (64.8%) 887 (62.0%)
Deep 2nd-degree 37 (27.4%) 388 (22.4%) 302 (24.5%) 123 (19.4%) 146 (24.3%) 279 (22.0%) 101 (23.1%) 324 (22.6%)
3rd-degree 27 (20.0%) 246 (14.2%) 183 (14.8%) 90 (14.2%) 119 (19.8%) 154 (12.2%) 53 (12.1%) 220 (15.4%)
P valuea 0.010 0.035 <0.001 0.187
a
P values were calculated using Mann–Whitney U test.

analysed in the logistic regression model, including age, burn

area, burn location, cause, place, educational level and 2.6. Analysis of effective channels of education about pre-
emergency management education (receiving or not). The hospital emergency management
results showed that emergency education was an important
factor affecting the level of pre-hospital emergency burn To screen out effective factors influencing pre-hospital
management, especially with respect to cooling treatment. emergency management, age, burn area, location, cause,
Age, education, cause and place of burn injuries also had place and education channels (not receiving emergency
different effects (Table 5). knowledge, traditional media, relatives and friends, Internet

Table 5 – Factors affecting the level of pre-hospital emergency burn management.

Effect indicator Risk factora Odd ratio (95% CI) Wald x 2 P value
Immediate isolation from the source of injury
Age 0.63 (0.43, 0.92) 5.83 0.016
Cooling treatment
Chemicalsb 1.88 (1.22, 2.90) 8.26 0.004
Electrical sparksc 0.26 (0.14, 0.51) 15.92 <0.001
Outdoorc 0.58 (0.42, 0.80) 10.83 0.001
Education 1.38 (1.19, 1.61) 18.16 <0.001
Emergency management educationd 2.99 (2.24, 3.99) 54.73 <0.001
Rational use of external agents
Burn area 0.85 (0.75, 0.96) 6.68 0.010
Chemicalsb 1.24 (0.78, 1.99) 0.82 0.366
Electrical sparksb 0.46 (0.29, 0.73) 11.04 0.001
Emergency management educationd 1.95 (1.39, 2.74) 14.85 <0.001
Hospital consultation within 24 h
Chemicalsb 1.76 (1.01, 3.07) 3.96 0.047
Electrical sparksb 2.37 (1.24, 4.55) 6.75 0.009
Emergency management educationd 2.34 (1.55, 3.53) 16.30 <0.001
a
Emergency education, age, burn area, location, cause, place and educational level of the patients or caregivers were used as the candidate
factors and analysed by logistic regression model (stepwise forward method with entry level = 0.05 and removal level = 0.10).
b
‘‘Cause’’ was defined as a dummy variable with ‘‘hot fluids’’ as reference category.
c
‘‘Place’’ was defined as a dummy variable with ‘‘home’’ as reference category.
d ‘‘
Emergency management education’’ was defined as dummy variable with ‘‘not receiving any education’’ as reference category.
1178 burns 38 (2012) 1174–1180

Table 6 – Logistic regression analysis of effective methods of education about pre-hospital emergency management.
Effect indicator Risk factora Odd ratio (95% CI) Wald x 2 P value
All patients
Cooling treatment
Traditional mediab 1.91 (1.22, 2.98) 8.09 0.004
Relatives and friendsb 2.99 (1.72, 5.19) 15.17 <0.001
Internet educationb 5.46 (2.58, 11.57) 19.66 <0.001
Workplace educationb 5.41 (2.25, 13.00) 14.21 <0.001
School educationb 3.78 (1.58, 9.03) 8.94 0.003
Rational use of external agents
Internet educationb 3.78 (1.33, 10.77) 6.20 0.013
Workplace educationb 4.04 (1.20, 13.65) 5.05 0.025
Hospital consultation within 24 h
Traditional mediab 2.80 (1.39, 5.64) 8.30 0.004
Internet educationb 3.73 (1.14, 12.26) 4.71 0.030
Adolescents and adults (15–59)
Cooling treatment
Relatives and friendsb 1.77 (0.88, 3.54) 2.58 0.108
Internet educationb 8.40 (3.14, 22.50) 17.95 <0.001
Workplace educationb 9.51 (2.62, 34.60) 11.69 0.001
School educationb 5.64 (1.76, 18.00) 8.51 0.004
Rational use of external agents
Internet educationb 3.89 (1.16, 13.01) 4.85 0.028
Workplace educationb 8.33 (1.09, 63.39) 4.19 0.041
Hospital consultation within 24 h
Internet educationb 8.86 (1.20, 65.66) 4.55 0.033
The elderly (I60)
Cooling treatment
Traditional mediab 5.27 (2.35, 11.79) 16.30 <0.001
Relatives and friendsb 8.57 (2.95, 24.87) 15.63 <0.001
Rational use of external agents
Traditional mediab 4.20 (1.45, 12.18) 6.96 0.008
Relatives and friendsb 4.79 (1.10, 20.89) 4.34 0.037
Hospital consultation within 24 h
Traditional mediab 6.20 (1.45, 26.42) 6.08 0.014
Relatives and friendsb 8.45 (1.12, 63.96) 4.27 0.039
a
Education channels, age, burn area, location, cause, place and educational level of the patients or caregivers were used as candidate factors
for all patients; education channels, burn area, location, cause, place and educational level of the patients or caregivers were used as candidate
factors for adolescents and adults group and the elderly group. These candidate factors were analysed by logistic regression model (stepwise
forward method with entry level = 0.05 and removal level = 0.10). Only the results of education channels are listed in the table, and the other
results were not shown in the table.
b
‘‘Education channels’’ was defined as a dummy variable with ‘‘not receiving emergency education’’ as reference category.

and schools) were used as candidate factors for analysis in the
regression analysis model. The results showed that all these
education channels had positive protective effects, with the
effect of Internet and workplace being most obvious. Further
analysis on the basis of the age of the patients or caregivers
showed that the effective channels of emergency education
were different between young adults and elderly patients: the
former were mainly affected by workplace and Internet, while
the latter were mainly affected by relatives and friends and
traditional media (Table 6).
3. Discussion
The key point of burn injuries lies in prevention. A good
security and prevention system can reduce the occurrence of
burn injuries significantly, while timely and correct emergen-
cy management can alleviate the severity of burn injuries
effectively [8]. The primary prevention of fires and burns
focusses on ensuring safety of the surrounding environment
and reducing unsafe factors that may cause burn injures by
installing fire alarms and water sprinklers; setting safe water
and electrical equipment temperature; and using fire protec-
tion materials and equipment to minimise risk factors causing
burn injuries [4]. However, as these measures are built on the
prerequisite of improving the infrastructure and closely
associated with social and economic development, it is
difficult to spread them widely in developing countries at
present. For this reason, intensifying secondary prevention
and raising the level of emergency burn management have
become the focus of burn prevention in these countries.
In recent years, many studies have reported epidemiologi-
cal distributions of burn injuries including aetiology and risk
factors [9–13]. However, there are few studies reporting
emergency burn management, especially about related factors
affecting pre-hospital emergency management. The results of
our investigation showed that most burn patients knew the
essentials to escape from the source of burn injuries
immediately and to go to hospitals for medical consultation
within 24 h. However, there were still 23.4% burn patients who
 burns 38 (2012) 1174–1180
did not go to hospitals for help until wounds deteriorated or
infections occurred. Although about one-third of the patients
used cooling treatment on the spot, the duration of cooling
treatment was less than 10 min in most patients, and only
4.3% of the patients used cooling treatment for more than
20 min. About 32.2% of the patients used ‘folk remedies’ or
antibiotics to treat the wounds. These results are similar to
those reported in other developing countries such as Vietnam
[7], Ghana [14], Cambodia [15] and Turkey [16]. Post-burn
cooling treatment is recommended as the simplest and the
most effective means of secondary prevention of fires and
burns. Research has demonstrated that correct and effective
cooling treatment can alleviate burn-induced tissue damage,
reduce the hospitalisation rate and surgical skin grafting and
lower medical costs. In addition, research has shown that the
above ‘folk remedies’ could not protect burn wounds; rather
they may induce allergic reactions or even deepen burn
injuries [16–18]. Our investigation also showed that most
burns were superficial second degree in patients who were
immediately isolated from the source of injury, promptly used
cooling treatment and treated burn wounds rationally, while
most burns were deep second degree or third degree in those
who did not treat the wounds timely and rationally. Although
it suggests that timely and rational emergency burn manage-
ment may alleviate the depth of burn injury, the definite
causation relationship between them needs more effective
evidence such as a further randomised controlled study or a
prospective cohort study. In the present situation, the urgent
task is to raise people’s awareness about emergency burn
management and raise the public level of emergency burn
management so as to improve secondary prevention of fires
and burns.
To determine the key factors affecting emergency burn
management, we further investigated emergency education
in these burn patients and found that most patients did not
receive any education about emergency burn management,
and, in those who had received emergency education, the
knowledge about emergency management mainly came
from traditional media, relatives and friends and Internet,
and only about 20% of such education came from the
workplace and schools, indicating that the situation in
emergency education in China is worrying. Some studies [19]
had demonstrated that multi-media campaigns through
televisions, radios, books, magazines and posters could
achieve good outcomes in raising the level of emergency
management and reducing the hospitalisation rate of burn
patients within a short time. It was found in our study that
pre-hospital emergency management in burn patients who
had received emergency education was significantly better
than that in those who had not received emergency
education, but there was no significant difference in burn
depth between the two groups of patients (data not shown),
which probably suggests that education from traditional
media may have different influences on the level of
emergency management. We therefore suggest that multi-
media campaigns should be used as an accessory means to
raise the level of emergency management in the contempo-
rary period, and, at the same time, emergency education
should be included in school, unit and family education
systems as a fundamental strategy. In other words, universal
1179
emergency education should be taken as a long-term
strategy in national basic education.
The results of our further logistic regression analysis
revealed that emergency education is the most important
factor affecting pre-hospital emergency management, and
age, educational level, cause, place and area of burn injury are
also unneglectable factors affecting correct management of
burn injuries. The age is an unfavourable factor affecting
‘immediate isolation from the source of injury’ (odds ratio
(OR) = 0.63), especially in elderly patients who may not be able
to escape from the source of injury due to sensory numbness
from diabetes mellitus, hemiplegia and other underlying
diseases. Educational level is an important factor affecting
‘prompt cooling treatment’ (OR = 1.38), probably because
educated patients are more likely to use more scientific
methods instead of ‘folk remedies’. In addition, burns from
some special causes may affect emergency management in
varying ways. For instance, chemical burn is a favourable
factor affecting ‘cooling treatment’ (OR = 1.88) and ‘wound
surface management’ (OR = 1.24), while electrical spark burn
is an unfavourable factor affecting ‘cooling treatment’
(OR = 0.26) and ‘wound surface management’ (OR = 0.46),
probably because chemical burn may easily produce a reflex
of washing reaction that urges burn victims to remove the
chemical from the skin surface, while electrical spark burn is
easily mistaken as an electrical contact injury, where the
patient is rarely aware that skin burn from electrical sparks
also needs cooling treatment. In addition, chemical and
electrical spark burns are relatively complex and more likely
to produce phobia, which may urge patients to seek help from
hospitals in time. Outdoor burn is an unfavourable factor for
cooling treatment because of unavailability of water sources
(OR = 0.58). With respect to the channels from which emer-
gency knowledge is acquired, the effect of unit and network
education is the most obvious, especially on cooling treat-
ment. It was also found that most of the patients who obtained
emergency knowledge from Internet usually sought help from
Internet after they were injured by burns, suggesting that it is
important to intensify unit education and establish emergen-
cy network platforms. Age stratification analysis showed that
different age groups obtained emergency knowledge through
different channels: network and unit education is an impor-
tant and characteristic factor affecting pre-hospital emergen-
cy management in adolescents and young adults; relatives
and friends is an important factor affecting elderly patients, in
whom the influence of relatives and friends is even greater
than that of traditional media (ORrelatives and friends = 8.57 vs.
ORtraditional media = 5.27), suggesting that community health
service systems play an important role in spreading knowl-
edge in elderly people.
4. Conclusion
Pre-hospital emergency management and knowledge publici-
ty about emergency burn management remain at a relatively
low level in China, and therefore emergency education is
urgently needed at present. Network education and unit
education are two main channels affecting the overall level of
pre-hospital emergency management in the contemporary
1180 burns 38 (2012) 1174–1180
period. The channel of education should vary with age groups:
education via Internet and workplace should be the main
channels of education for young adults, while community
education should be intensified in elderly people.
Conflict of interest
There is no competing interests or conflicts in the present
paper.
Acknowledgements
This project was supported by the National Natural Science
Foundation of China (C30600646, 81071555, 81120108015).
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