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A Thermal Event

Their future in your hands.

Burn injury remains the most traumatic of survivable injuries. When of sufficient severity, it can have a profound effect on every body system, even the most minor burn injury can change the individual’s appearance with inevitable social and psychological consequences.

All Burn Patients are Trauma Patients

– Patrick M Bourke

Functional losses with restricted scarring and contractures over joints have work and lifestyle consequences which can be career limiting with all the financial concerns that follow. As such, anything that can prevent burn injury in the first place or prevent the injury developing into something worse than it need be, must be the primary concern of emergency medical and rescue responders caring for the victim at the beginning of their care journey. This applies from the scene of injury through to final discharge from the burn care service, which for many patients may extend into expensive long term management programs that may extend from weeks to months, or in many cases, years.

Serious burn injuries are devastating events that leave patients with long term physical and psychological challenges, recognised by emergency medical and rescue responders (both civilian and military) worldwide as one of the most horrific and challenging injuries known to emergency medical and rescue services around the world.

Serious Burn Injuries are for Life

– Anon

Burn injuries may be extremely complex in their presentation and are by their very nature disturbing to assess and treat. Not only because they affect the largest organ of the human body which at ~16% of the average adult’s body weight, proportionally constitutes a massive traumatic injury when a substantial proportion of it is injured, human skin communicates our well being in so many ways, as it performs daily protecting the human body from the challenges of everyday life.

The outcome of the burn injured patient will be influenced by the patients age and the severity of the burn injury which is dictated by the primary source of injury: thermal, chemical, mechanical, electrical or radiation. These primary sources can be further sub-divided into ten sub-sources: thermal dry, thermal wet, chemical acid, chemical alkali, chemical hydrocarbon, mechanical friction/blast, electrical AC, electrical DC, solar and manmade radiation. As each source has a different destructive action on the human body, the time in contact with the source, location of the burn injury on the patient’s body (critical areas, circumferential etc.) any medical and mental conditions, additionally the location of the patient at the time of injury, any other non-burn injuries, time to cooling, any suspected history of inhalation injury (carbon monoxide – CO, Hydrogen Cyanide – HCN), all of this plus the effectiveness (or not) of the initial response and treatment by the responding Emergency Medical and Rescue personnel, are all important.

Many of the adverse consequences that follow a burn injury can be reduced by a clear understanding of the problem, and effective pre-hospital management. When emergency responders arrive at the scene of severe burn injury, there can be many distractions. During initial assessment they will be faced with the sights and smells of severe burn injury, plus the pain being suffered by the patient, coupled with the extreme reactions of bystanders and relatives, this can cause sufficient distraction such that co-existing injuries can be missed and vitally important information to be overlooked by the emergency medical and rescue responders. The application of a correct trauma response remains vital, with modifications for the burn injury that intersect with the routine trauma assessment to accommodate the specific requirements of the injuries being considered.

If it is a chemical incident, is it acid or alkali, or is it one of the special case chemicals that require specific action? Were correct irrigation/brush procedures performed or was an antidote employed? (If so, is it recognised and approved by the nationally recognised overseeing advisory body, is it in date, was it designed for this application), always bring all antidote information with you to the receiving ED.

Emergency Medical and Rescue Responders are the receiving Emergency Department (ED) detectives on scene, they must use their eyes and ears to record as much information as possible (3 x history – scene, patient and pre-cooling) in the time available on scene, as they now become part of an extended burn care team. They are the first on scene and must understand the need for an in-depth scene, patient and pre-cooling history, a clear understanding of the various categories of burn injury and what to do and not do in each category whilst at the same time assessing, estimating and treating the burn injured patient.

In other words, they must define the true mechanism of injury and understand the additional information that must be sought, recorded and handed on, as well as any specific action or inaction appropriate to a specific circumstance.

Many burn injuries require advanced surgical intervention, the timing and extent of which is often influenced and affected by the Pre-Hospital care provided by emergency medical and rescue personnel.

Inevitably burn injury carries with it a higher risk of death than many other forms of injury. The rate of such loss of life has reduced in recent times but remains a constant feature of burn care. This is not only from the inevitable consequences of burn injury, but also from the fact that that there is a high complication rate, especially infection among burn victims with the potential for misadventure at every stage of the burn care pathway. Critically within the first 48 hours.If there is not a clear clinical understanding of what this means for the burn patient, and the care pathway they are about to follow, due to a lack of training or inexperience, then the burn patient faces the prospect of a less than favourable outcome; Possibly resulting in a more severely restricted lifestyle than might have been the case, which may in turn impact on their ability to self-manage, work and earn a living for their future life.