Cool Running Water as a First Aid Treatment for Burn Injuries

The application of 20 minutes of cool running water within 3 hours of a burn injury significantly improves patient burn-related outcomes. To facilitate the integration of 20 minutes of cool running water into clinical practice in the United States, this investigation aimed to determine barriers and facilitators to implementing 20 minutes of cool running water in out-of-hospital emergency medical services (EMS) and in-hospital emergency departments (EDs) and to codesign tailored strategies for its routine use in acute burn first aid.

Using a sequential mixed-methods design, we identified barriers and facilitators to 20 minutes of cool running water implementation and codesigned strategies to enhance its implementation. EMS and ED clinicians completed an online questionnaire assessing perceived barriers and facilitators, with responses coded using the Consolidated Framework for Implementation Research. Semistructured interviews with a convenience sample of participants further examined determinants and codesigned implementation strategies.

A total of 371 (210 EMS, 161 ED) clinicians participated in the questionnaire, and 22 (14 EMS, 8 ED) participated in interviews. Twelve key determinants were identified across 4 Consolidated Framework for Implementation Research domains. Implementation barriers included a lack of resources, challenges adapting 20 minutes of cool running water to local clinical settings, and the absence of external policies incorporating burn first aid cooling, whereas facilitators included high clinician motivation, strong professional networks, and a supportive clinical culture. Codesigned strategies to enhance 20 minutes of cool running water uptake included portable irrigation equipment, nursing-driven protocols, and policy updates.

Although clinicians appear motivated to implement 20 minutes of cool running water, infrastructure, workflow, and policy challenges hinder widespread adoption. Addressing these barriers through targeted codesigned 20 minutes of cool running water implementation strategies will facilitate integration into EMS and ED settings, improving burn care outcomes.