Consensus on the prehospital approach to burns patient management

Abstract

Burns patients form a large group of trauma patients cared for by rst-aiders, ambulance staff, nurses and doctors before reaching specialist care in hospital. Guidance for these important carers is often poor or confused and this engenders anxiety and detracts from optimal patient care. This paper outlines nine key steps in the initial management of burn patients in the prehospital environment based on current available evidence and a consensus of specialists of all disciplines caring for burns patients. The basis of care should be that simple things should always be performed well.

Keywords

burns rst-aid prehospital

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References

Allison K. 2002. The UK prehospital management of burn patients: current practice and the need for a standard approach. Burns 28: 135-142.

American College of Surgeons . 1997. Injuries due to burns and cold. In: Advanced trauma life support for doctors (ATLS). Chicago, 273-288.

Ashworth HL , Cubison TC , Gilbert PM , Sim KM. 2001. Treatment before transfer: the patient with burns. Emerg Med J 18: 349-351.

Australian and New Zealand Burn Association . 1996. Emergency management of severe burns course manual.

Baack BR , Smoot EC, III , Kucan JO , Riseman L , Noak JF. 1991. Helicopter transport of the patient with acute burns. J Burn Care Rehabil 12: 229-233.

Chambers JA , Guly HR. 1994. Prehospital intravenous nalbuphine administered by paramedics. Resuscitation 27: 153-158.

Childs C. 1994. Temperature regulation in burned patients. J Intens Care 131-134.

Clayton MC , Solem LD. 1995. No ice, no butter. Advice on management of burns for primarycare physicians. Postgrad Med 97: 151-160, 165-165.

Coats TJ , Edwards C , Newton R , Staun E. 2002. The effect of gel burns dressings on skin temperature. Emerg Med J 19: 224-225.

10.

Cole RP , Shakespeare PG , Chissell HG , Jones SG. 1991. Thermographic assessment of burns using a nonpermeable membrane as wound covering. Burns 17: 117-122.

11.

Collis N , Smith G , Fenton OM. 1999. Accuracy of burn size estimation and subsequent fluid resus citation prior to arrival at the Yorkshire Regional Burns Unit. A three year retrospective study. Burns 25: 345-351.

12.

Cooke MW , Morrell R , Wilson S et al. 1999. Does criteria based dispatch of 999 calls adequately detect the critically ill and injured? Prehospital Immediate Care 3: 191-195.

13.

Cummings G , O’Keefe G. 2000. Scene disposition and mode of transport following rural trauma: a prospective cohort study comparing patient costs. J Emerg Med 18: 349-354.

14.

Dalton AM. 1995. Prehospital intravenous fluid replacement in trauma: an outmoded concept? J Roy Soc Med 88: 213-216.

15.

Demling RH , Mazess RB , Wolberg W. 1979. The effect of immediate and delayed cold immersion on burn edema formation and resorption. J Trauma 19: 56-60.

16.

De Wing MD , Curry T , Stephenson E , Palmieri T , Greenhalgh DG. 2000. Cost-effective use of helicopters for the transportation of patients with burn injuries. J Burn Care Rehabil 21: 535-540.

17.

First aid manual. The authorised manual of St John Ambulance, St Andrew’s Ambulance Association and the British Red Cross. London: Dorling Kindersley, 1997.

18.

GreavesI , Porter K eds. 1999. Scene approach, assessment and safety. In: Prehospital medicine: the principles and practice of immediate care. London: Arnold, 273-279.

19.

Greaves I HTPK ed. 1997a. Basic life support. In: Emergency care: a textbook for paramedics. London: WB Saunders, 17-26.

20.

Greaves I HTPK ed. 1997b. Burns. In: Emergency care: a textbook for paramedics. London: WB Saunders,270-278.

21.

Hammond JS , Ward CG. 1987. Transfers from emergency room to burn center: errors in burn size estimate. J Trauma 27: 1161-1165.

22.

Henry S , Scalea TM. 1999. Resuscitation in the new millennium. Surg Clin N Am 79: 1259-1267, viii-viii.

23.

Hodgetts T , McNeil I , Cooke M. 1995. The prehospital emergency management master. London: BMJ.

24.

Hodson AH. 1992. Treating burns by initial cooling. J Roy Soc Med 85: 121-121.

25.

IHCD . 1991. Ambulance service basic training. Bristol: IHCD.

26.

IHCD . 1994. Ambulance service paramedic training. 3. Bristol: IHCD.

27.

Jandera V , Hudson DA , de Wet PM , Innes PM , Rode H. 2000.Coolingthe burn wound: evaluation of different modalites. Burns 26: 265-270.

28.

Jelenko C, III , Jennings WD Jr , O’Kelley WR III , Byrd HC. 1971. Threshold burning effects on distant microcirculation. I. Preliminary observations. Arch Surg 102: 617-625.

29.

Jelenko C III , Jennings WD Jr , O’Kelley WR III , Byrd HC. 1973. Threshold burning effects on distant microcirculation. II. The relationship of area burnt to microvascular size. Arch Surg 106: 317-319.

30.

Jelenko C III , Jennings WD Jr , O’Kelley WR III , Byrd HC. 1974. Threshold burning effects on distant microcirculation: presence of a passively transfer-rable, nondialyzable arteriolar constrictor substance in blood of burned patients. Am Surg 40: 388-391.

31.

Judkins KC. 1999.Thermal injury. In: Greaves I , Porter K eds. Prehospital medicine: the principles and practice of immediate care. London: Arnold, 375-387.

32.

Kendall JM , Reeves BC , Latter VS. 2001. Multicentre randomised controlled trial of nasal diamorphine for analgesia in children and teenagers with clinical fractures. BMJ 322: 261-265.

33.

King TC , Price PB. 1963. Surface cooling following extensive burns. JAMA 183: 677-677.

34.

Kinsella J , Booth MG. 1991. Pain relief in burns: James Laing memorial essay. Burns 17: 391-395.

35.

Kravitz H. 1970. First-aid therapy for burns - cool it: need to instruct laymen. Clin Pediatr (Phila) 9: 695-697.

36.

Kravitz H. 1974. Letter: cooling as first aid for burns. Pediatrics 53: 766-766.

37.

Latarjet J. 1990. Immediate cooling with water: emergency treatment of burns. Pediatrie (Bucur.) 45: 237-239.

38.

Lawrence JC. 1987. British Burn Association recommended first aid for burns and scalds. Burns Incl Therm Inj 13: 153-153.

39.

Lawrence JC. 1996. First-aid measures for the treatment of burns and scalds. J Wound Care 5: 319-322.

40.

Marichy J , Chahir N , Peres-Tassart C , Abeguile R. 2002. Prehospital management of burns. Pathol Biol (Paris) 50: 74-81.

41.

McGugan EA , Paterson B , Nichol N , Klaassen B. 2000. Re: accuracy of burn size estimation and subsequent fluid resuscitation prior to arrival at the Yorkshire Regional Burns Unit. A three year retrospective study. Burns 26: 415-416.

42.

Myers C. 1997. Fluid resuscitation. Eur J Emerg Med 4: 224-232.

43.

Nakae H , Wada H. 2002. Characteristics of burn patients transported by ambulance to treatment facilities in Akita Prefecture, Japan. Burns 28: 73-79.

44.

National Association of Emergency Medical Technicians . 1994. Prehospital trauma life support manual.

45.

National Burn Care Review. 2000. National burn care review. http://www.baps.co.uk/documents/nbcr.pdf. Last accessed on 6 August 2003.

46.

Nguyen NL , Gun RT , Sparnon AL , Ryan P. 2002. The importance of initial management: a case series of childhood burns in Vietnam. Burns 28: 167-172.

47.

Nguyen NL , Gun RT , Sparnon AL , Ryan P. 2002. The importance of immediate cooling - a case series of childhood burns in Vietnam. Burns 28: 173-176.

48.

Novak J , Tury P. 1991. Inter-hospital transportation of burned patients. Magy Traumatol Orthop Helyreallito Seb 34: 43-48.

49.

Ofeigsson OJ. 1965. Water cooling: first aid treatment of scalds and burns. Surgery 57: 391-391.

50.

O’Rourke G , Hanley K , Dowling J , Murphy A , Bury G. 1999. The use of basic life support kits in general practice. Ir Med J 92: 399-400.

51.

Palmer JH , Sutherland AB. 1987. Problems associated with transfer of patients to a regional burns unit. Injury 18: 250-257.

52.

Phillips GD. 1980. First aid in disasters. Med J Aust 2: 420-424.

53.

Queen D , Evans JH , Gaylor JD , Courtney JM , Reid WH. 1987. Burn wound dressings - a review. Burns Incl Therm Inj 13: 218-228.

54.

Raine TJ , Heggers JP , Robson MC , London MD , Johns L. 1981. Cooling the burn wound to maintain micro-circulation. J Trauma 21: 394-397.

55.

Sawada Y , Urushidate S , Yotsuyanagi T , Ishita K. 1997. Is prolonged and excessive cooling of a scalded wound effective? Burns 23: 55-58.

56.

Slater H , O’Mara MS , Goldfarb IW. 2002. Helicopter transportation of burn patients. Burns 28: 70-72.

57.

Treharne LJ , Kay AR. 2001. The initial management of acute burns. J R Army Med Corps 147: 198-205.

58.

Vartak AM , Keswani MH , Patil AR , Savitri S , Fernandes SB. 1991. Cellophane - a dressing for split-thickness skin graft donor sites. Burns 17: 239-242.

59.

Warden GD. 1992. Burn shock resuscitation. World J Surg 16: 16-23.

60.

Wilson JA , Kendall JM , Cornelius P. 1997. Intranasal diamorphine for paediatric analgesia: assessment of safety and efficacy. J Accid Emerg Med 14: 70-72.