The immediate management of

a burn injury

Peter Lindle, Consultant Paramedic, Major

Trauma

p.lindle@nhs.net

@PeterLindle

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http://emj.bmj.com/content/emermed/21/1/112.full.pdf

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http://79.170.40.160/britishburnassociation.org/wp-content/uploads/2017/06/BBA_First_Aid_Position_Statement_final_25.8.15.pdf

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1. SAFE approach

2. Stop the burning process

3. Cool the burn

4. Dressings

5. AcBC

6. Assess burn severity

7. Cannulation and IV fluids

8. Analgesia

9. Transport5

1. SAFE approach

• Shout or call for help

• Assess the scene for danger

• Free from danger?

• Evaluate the casualty

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2. Stop the burning process

• Stop, extinguish, remove patient

from source, brush off dry

chemicals

• Remove jewellery, burnt clothing

(unless stuck), bring with patient

• If chemical burn, ID chemical,

may need extended irrigation or

neutralising agent

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3. Cool the burn wound

• Irrigate with water for 20 mins,

effective up to 3 hours post

injury, en route if possible

• Do not use ice or ice water

• Cool the burn, not the patient

• Chemical burns may require

extended irrigation

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4. Dressings

• To control pain and keep the

wound clean

• Clingfilm, used in sheets, not

wrapped circumferentially

• Wet dressings for chemical

burns, beware those that react

with water

• Wrap patient in blankets

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5. AcBC

• Airway with c-spine

immobilisation

• Breathing

• Circulation

• Assess and manage co-existing

injury

• Give oxygen unless wound very

small and/or no suspicion of

inhalation injury10

Signs of inhalation injury

• Burns to nose, mouth, face

• Singed hair

• Carbonaceous sputum

• Hoarseness, laryngeal stridor,

cough

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6. Assessment of severity

• Estimate the size of burn

• Wallace Rule of Nines

• Patient’s palmar surface

including adducted fingers

• Consider obesity and larger

tissue area when estimating

burn size

• Assessment of depth

unnecessary

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Document

• How the patient was burned

• Time of injury, length of

exposure to source

• Temperature of source

• First aid?

• Time and volume of infusions

• Any suspicion of NAI?

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Cannulation and IV fluids

• Do not delay on scene time, x2

attempts en route

• <15% no fluid

• >15% <25% and travel time >30

mins= 1 litre

• >25%= 1 litre

• Normal saline, warmed if

possible

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8. Analgesia

• Cool and cover the burn area

• Titrated opiate with anti-emetic

• Entonox if nothing else

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9. Transport

• Minimise on scene time

• Liaise with Trauma Desk?

• Triage to specialist centre?

• Air transport/ modified primary or

secondary retrieval?

• ATMIST standby call and

handover

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Trauma Desk/ Specialist Services Desk

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Trauma triage

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Burn triage?

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Case study

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