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Emergency prehospital care of burn injuries: thermal, electrical and chemical burns

13 January 2011
Features
02 January 2011
Volume 3 · Issue 1

Abstract

The prehospital approach to severly burnt patients still remains challenging for prehospital carers. The adequate approach for thermal, electrical and chemical burns, with special focus on paediatric burnt patients, still needs to be further clarified and some controversies remain. This article addresses the preclinical algorithm for burn treatment and discusses contoversial aspects. After the burning process is stopped, the prehospital carer has to deal with cooling the surface, maintaining a balanced body temperature to avoid hypothermia, identify life-threatening injuries, assess the burn size and severity, and provide adequate dressings. Furthermore, airway management in case of inhalation injury, fluid replacement and analgesia/ sedation must be approached before transportation to a specialized centre. In this article, available formulas for fluid replacement and a guide for paramedics, as well as certain criteria for direct delivery to a burn centre, are discussed. Special aspects of the pathophysiology and primary care of electrical and chemical burns, which particularly require measures of self protection, are evaluated. Basic recommendations of paediatric burn treatment are also addressed. All aspects are integrated into the algorithmic approach in order to make the prehospital carer feel sufficiently prepared.

The number of severely burnt patients in industrial countries is declining due to augmented safety systems and technical modifications (Allison, 2002). Against this background, a national survey in 1998 revealed 58% of UK ambulance services had no specific treatment policy for burns patients (Allison, 2002). Thus, prehospital carers often feel insufficiently prepared for caring of burnt patients, particularly children, which may be explained by a lack of teaching and simple, evidence based guidelines (Allison, 2002).

Approximately 60% of all patients suffering from burn injuries may be treated as outpatients having burnt less than 10% total body surface area (TBSA). For the corresponding 30–40% burnt patients, the primary care paramedic and physician have to provide initial care and identify correctly whether these patients have to be admitted to a specialized burn centre or to a general hospital.

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Algorithms
Burns
Emergency care
Preclinical