Burns Care: Improving outcomes at sea

This month, we’re taking a look at the latest research into burns, and just how vitally important the management and treatment of burns is in the pre-hospital environment.

This report is a proposal that looks at ways we can provide a casualty centred approach to improve pre-hospital care and the quality of life outcomes for burn survivors. It is focused on the Fire and Rescue Service response, but there are some valuable points that we should consider in the way we treat burns, and how we teach others to manage a patient with burns. 

Onboard, this knowledge needs to be shared with those who might be first on scene, who should know what to do and be able to start treatment for a burn, even before the medic arrives.

The importance of treating burns in the first 3 hours has been highlighted in the report, along with the realisation that cooling a burn is unlikely to happen once the patient is handed over to an ambulance or when they arrive at hospital. Paramedics don’t carry much water and there isn’t the time, or resources (in terms of people or facility) to cool a burn in a hospital. 

This means that the immediate actions can have a huge impact on the long term recovery of the patient, and the quality of their life in the future.

Surviving a burn injury can be a long, painful and challenging process, physically and psychologically. Even small burns can be life changing and prevent someone from resuming their previous lifestyle and work. We need to do better.

Some of the key points that we have taken from the proposal are:

• Post burn cooling is a vital part of burn care.

• Cooling should be for at least 20 minutes.

• Water should be no less than 12 degrees centigrade and actually as close to body temperature as possible. Anything under body temperature will have the right effect.

• Ideally the water should be running at a flow rate of 1 - 1.5 litres per minute.

• The sooner the cooling can take place, the better the outcome for the patient, but it must be in the first 3 hours after injury.

• Early cooling significantly improves healing time and the likelihood of achieving a scar-free outcome.

• For younger or older people, burn injuries should be treated as serious/life threatening until proven otherwise.

• Ambulance crews and EDs do not have the facility or manpower available to cool burns. So the cooling must happen at, or close to, the point of injury in terms of time.

• Poor ambulance response times in many countries may mean that they are only able to attend outside the 3 hours optimum time for burn cooling. This makes it even more important that those on scene start the treatment immediately.

• Cooling the burn can lead to hypothermia, which in turn promotes wound progression. So we must cool the burn in a safe, controlled manner to maximise the benefit while keeping the patient warm. 

• We must warm the patient to avoid a life threatening deterioration. Remember that we can cool with water between 12 degrees and body temperature which will help prevent hypothermia.

• Cooling with clean, potable water is best, but any water will help. Infections can be dealt with later. If the only water available is sea or river water, it can be used; but ideally send a sample of it to the hospital with the patient.

• It’s important to handover a full history of the injury, preferably in writing, and particularly if the injury is due to a fire. This can greatly assist ongoing clinical decisions and treatment options.

• Managing multiple burn injury patients at the same time should be considered in mass casualty planning.

• Mental wellbeing is important for the patient, but also for others present, especially where there is a personal stake in the incident, such as knowing the victim. We need to identify any opportunities to offer psychosocial support for all involved.

A quick training session with your crew might just give them the confidence to start treatment immediately if dealing with a burn injury. After all, they can make a real difference short and long term for the patient by starting the cooling process and caring for the patient sooner rather than later.  

We hope you find this information useful? Having access to the very latest advice has changed our approach to managing burn injuries and the way we teach it. If you’d like regular updates on the latest for burns and burn injuries, we recommend following the amazing Krissie Stiles on LinkedIn.