Dissemination of evidence-based burn first-aid is critical for improving clinical outcomes for patients with acute burn injuries. The overarching goal of this research is the successful and sustainable translation of 20 min of cool running water (20CRW), administered within 3 hours of a burn, as a first-aid treatment for acute thermal injuries within emergency departments (EDs) and emergency medical services (EMSs). Despite the well-established benefits of 20CRW, this treatment is not included in relevant USA burn first-aid guidelines and has not been adopted in clinical settings as a standard first-aid treatment.

This protocol outlines an investigation using an effectiveness-implementation hybrid type III design to evaluate the effectiveness of 20CRW implementation into ED and EMS settings in Sacramento, California. The principal aim of this research is to implement 20CRW as a first-aid treatment for acute thermal burn injuries within participating ED and EMS settings. We will assess adherence to 20CRW guidelines and provision following implementation into routine clinical practice. In addition, we will evaluate the clinical effectiveness of 20CRW in improving patient outcomes, and the acceptability of 20CRW as a burn first-aid treatment, considering both clinician and burn survivor perspectives. This research will generate critical evidence on the implementation and clinical impact of 20CRW in US emergency care settings. It will also evaluate whether the co-designed implementation strategies effectively support adoption of 20CRW within the US ED and EMS settings.

Institutional Review Board (IRB) approval has been awarded for this research (IRB ID: 18834-5) from the University of California Davis Office of Research Ethics Committee. Results of this investigation will be disseminated across participating hospital and EMS organisations, presented at national and international conferences and published in open access peer-reviewed journals.

Large-for-gestational-age (LGA) and macrosomic births pose significant maternal and neonatal health risks, particularly in low- and middle-income countries (LMICs), where access to care are often limited. Despite well-established associations between LGA, macrosomia, and various risk factors, the relative contributions of these factors remain underexplored in LMICs. This study aims to identify risks factors for LGA and macrosomia in LMICs, with an emphasis on modifiable ones, and quantify their population attributable fractions (PAFs).

A systematic review will be conducted across the following databases: MEDLINE, Scopus and ProQuest Central and regional databases (Africa Index Medicus, Index Medicus for South Asia and Latin America and Caribbean literature of health sciences). Eligible studies will include observational studies, reviews and interventional research conducted between 2000 and 2025 that report on prevalence or association of risk factors for large-for-gestational-age (LGA) and/or macrosomia births in low- and middle-income countries (LMICs). Data extraction will encompass study characteristics, prevalence/incidence estimates, risk factor distributions and measures of association. Quality assessment will be performed by two independent reviewers using the Newcastle-Ottawa Scale for observational cohort, case–control and cross-sectional studies. While Cochrane Risk of Bias Tool will be used for randomised controlled trials and a Measurement Tool to Assess Quality of Systematic Reviews 2 (AMSTAR-2) for systematic reviews and meta-analyses. Meta-analyses using a random-effects model, which accounts for population heterogeneity, will synthesise risk estimates for factors examined in three or more studies from LMICs, up-to-date meta-analysis including all relevant studies identified through our search. Population attributable fractions for individual and combined risk factors will be calculated.

This systematic review will use only previously published information. Ethical approval is therefore not required. The results will be submitted for publication in a peer-reviewed journal and the findings will be presented at international conferences to engage relevant stakeholders including policymakers and public health organisations in LMICs with the aim of informing the development of targeted interventions to reduce the burden of LGA and macrosomia births in the region.