Burning Issues

   For fluid replacement guidance, the Parkland system can be used. This considers the TBSA as well as the patient's weight: Volume equals the TBSA percentage multiplied by the weight in kilograms. Links to specific burn tools and fluid replacement can be found in Table 3.^13-15,17

   Depending on the extent and severity of the patient's burns, it may not be possible to obtain traditional peripheral intravenous access. In these cases, intraosseous access and infusion is an option for the prehospital setting. Consult your local protocols regarding use of this procedure.^2,3,5,6,16

   When pain management is indicated, initiate it in the prehospital setting. Consider factors such as the patient's age and location and the extent and severity of the burn. While medications and routes of administration may vary from system to system, morphine, fentanyl and Dilaudid are all effective in managing burn-injury pain. Be aggressive in managing the pain a burn victim experiences.^{2,3,5,6,10,11}

   Chemical burns present a particular challenge because it may not always be clear what chemical was involved. If chemicals are encountered or suspicious or unknown substances involved, trained personnel should assist. Contaminated clothing should be removed and placed into appropriate bags for the decontamination team to manage. If a powder is present on the patient, brush it off before performing any rinsing or irrigation (unless the decon team requests irrigation first). When brushing chemicals off a patient, wear eye and respiratory protection to avoid inadvertent ingestion. Applying the same protection to the patient may assist in avoiding additional exposure.^{2,3,5,6,11,12}

   A key component of prehospital treatment is determining patient destinations. If a patient has both trauma and burns, the most appropriate facility may be the local trauma center, which can then transfer the patient to a burn center when indicated. Where trauma and burn centers are not immediately available, providers may need to transport to a local hospital for initial resuscitation efforts. Once resources such as air transport are available, the patient may need to be transferred to a higher level of tertiary care. Examples of guidelines regarding burns and burn center criteria can be found in Table 4. Providers should be familiar with the burn capabilities of their local facilities.^2,3,5,6

CONCLUSION

   Burns can range from relatively simple to lethal, but their severity may not be immediately apparent in the prehospital setting. Prehospital providers should thoroughly assess burn victims and anticipate both their immediate and long-term needs. By having a thorough understanding of the pathophysiology of burns, providers can support their patients' chances of recovery and good outcomes while reducing morbidity and mortality.

References

1. American Burn Association, www.ameriburn.org.

2. Chapleau W, Burba A, Pons P, Page D. The Paramedic. Boston: McGraw-Hill, 2008.

3. Hubble M, Hubble J. Principles of Advanced Trauma Care. Albany: Delmar Thompson, 2002.

4. Naradzay J, Alson R. Burns, Thermal, www.emedicine.com/emerg/topic72.htm.

5. Bledsoe B, Porter R, Shade B. Paramedic Emergency Care. Upper Saddle River, NJ: Brady Prentice Hall, 1997.

6. Campbell J. Basic Trauma Life Support for Paramedics and Advanced EMS Providers. Englewood Cliffs, NJ: Brady, 1995.

7. U.S. Department of Health and Human Services, Radiation Event Medical Management. Burn Triage and Treatment: Thermal Injuries, www.remm.nlm.gov/burns.htm.

8. Oliver R. Burns, Resuscitation and Early Management. www.emedicine.com/plastic/topic159.htm.

9. MobileHome. Parkland Formula for Treating Burn Victims, www.josephsunny.com/medsoft/iparkland.html.

10. Medline Plus. Burns, www.nlm.nih.gov/medlineplus/burns.html.

11. BurnSurgery.org. Section III: Burn Wound: Histological Assessment (Zones of Injury), www.burnsurgery.org/Modules/BurnWound%201/sect_III.htm.

12. Emergency Medicine Health. Chemical Burns, www.emedicinehealth.com/chemical_burns/article_em.htm.

13. Wedro B. Burn Percentage in Adults: Rule of Nines, www.emedicinehealth.com/burn_percentage_in_adults_rule_of_nines/article_em.htm.

14. OrganizedWisdom. Parkland Formula for Burns, http://organizedwisdom.com/Parkland_Formula_for_Burns.