Initial Treatment and transport for Burn Injuries
This means that pre-hospital care needs to be timely and excellent in order to get the burn patient to a burn center to receive the care they need.
The first step in burn management is to remove the individual from the source of the burning. Of course, in order to do this safely, it must be done so that the rescuing individual doesn’t become a victim as well. Burning clothing must be removed, including watches and jewelry. If available, pour water on the burned area, taking care not to cool the individual to hypothermia. Emergency personnel should monitor the person’s core temperature as the burn is being cooled. Don’t use ice packs or ice as this can damage the tissue.
If the burn is chemical, rinse off any chemical liquid or brush off any chemical powder. Wear gloves so as to avoid getting the chemical on yourself. It is not a good idea to neutralize the chemical using another chemical as this can generate heat which can further damage tissue. If the burn is electrical, shut off the electrical source before removing the person from the site.
When a burned patient is looked over for the first time after sustaining a burn, there should be a “primary survey” and a “secondary survey”. The primary survey involves doing a once-over to check for anything that can be life-threatening. The secondary survey is a head-to-toe observation of all areas of the body for other injuries, including non-burn related injuries.
The primary survey should look into whether or not there has been a lung or airway exposure through inhalation of hot gases. Patients should be given 100 percent humidified oxygen by mask even if it isn’t yet clear there has been an airway exposure. If a patient is showing progressive hoarseness, this is a sign that airway obstruction is occurring. This is when a ventilator tube should be placed down the victim’s trachea, before the swelling becomes too severe.
The chest should be observed to make sure it is expanding with each breath.
In the secondary survey, the patient may need to be placed in a cervical collar or backboard to protect this area from non-burn related injuries. The emergency medical technician should establish an IV access as soon as possible before swelling interferes with getting an IV in. An IV solution is given at 500 ml per hour for those over the age of 14 because a great deal of fluid from the blood vessels will leave these areas to go to the burned areas and the patient can go into shock.
Cover up the patient with clean dressings or a clean sheet to keep the burn away from the environment while the patient is being transported. Place a blanket over the clean sheet. The IV access should otherwise be all that is needed; it can help with pain management as well as fluid resuscitation. The pain medication should be given in small amounts and never orally or by intramuscular injection.
At the Initial Hospital
Unless the burn happens close to a burn center, the patient will be transported to the nearest facility that can handle the situation. The evaluation is a lot like the pre-hospital evaluation with the exception that there are more resources to assess the patient with. X-rays can be done to make sure there aren’t any broken bones. If a good airway has not been established in the pre-hospital phase, it should be done at this time. A thorough history, including the time of the incidence, the nature of the incidence, and past medical history can be obtained while arrangements are made for transport to a burn center.
An examination of all the major pulses should take place at the initial facility, especially if the burns are circumferential around the trunk or limbs. If pulses are absent, even with the use of a Doppler ultrasound, a procedure called an “escharotomy” should be performed to prevent burned tissue from constricting and limiting blood flow in the area.
The burned area should be evaluated for depth and extent. Any blisters greater than an inch in diameter can be deflated with antimicrobial ointment added to the affected area. The wounds can then be dressed for further transportation. A second IV site should be established as soon as possible so that if one site fails, another IV can take over. Ringer’s lactate solution is the preferred solution for the burned patient. There are formulas for how much fluid to give based on the amount of body surface area involved. Basically, there should be a steady and adequate urine output as measured by a Foley catheter. A nasogastric tube should be passed from nose to stomach in order to relieve the stomach of excess gas.
Transportation to a Burn Center
At the initiating facility, the patient should have IV access, a Foley catheter, a nasogastric tube, and a stable body temperature between 38 and 39 degrees Celsius. Narcotic pain relief should be stopped. Options for transport depend on the patient’s condition as well as on the distance to be travelled.
Options for transport include a full medical intensive care unit transport vehicle, an airplane or helicopter, a private plane with the proper staff in attendance, a commercial airliner, or ambulance transport. Staff can include people with a minimum of six month’s burn experience. A good transport team consists of at least one registered nurse, a physician and a respiratory therapist. They should be trained in CPR, advanced cardiac life support, or pediatric advanced life support, and be deemed clinically competent.
There should be means to ventilate the patient as well as a portable heart monitor. IV infusion pumps should be available to regulate the amount of fluid the patient is given. Extra battery packs should be available in case the transport time is long.
A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.