The UK pre-hospital management of burn patients: current practice and the need for a standard approach
Introduction
Unfortunately in the UK at present, there is no national, co-ordinated collection of data reporting burns incidence [1]. There have been localised demographic studies published in the UK, the largest coming from Birmingham, whilst specific burns have been investigated more widely.
The report on hospital in-patient enquiry (published annually until 1985) [2] estimated total annual admissions for burn and scald injuries. These numbered approximately 11,000, although this is now old data. Within this, there is no breakdown of cause, or severity of injury, apart from in 1983 in a special survey entitled “Domestic Thermal Injuries”, which looked at 1000 burns and scalds admitted to several burns units during 1979 [3]. North American data suggests that burn injury is the third leading cause of accidental death, exceeded only by motor vehicle accidents and falls [4].
Today it is estimated that burns are responsible for 175,000 attendances at A&E departments each year and 15,000 admissions [5]. There are around 20 burns units within the UK, but no definition of what such a unit is, or facilities and staff which it should contain. A large number of patients admitted to hospital are not seen by burns trained staff and despite the size of this problem the burns community is only just beginning to address the problem on a national basis via a National Burn Care Review.
Optimal management of burned patients requires good initial treatment with collection and transport of the patient from the site of injury to hospital by ambulance personnel. The observation of cold patients with poor analgesia and dressings when they arrive at hospital in the West Midlands, suggests that this area of patient care needs examination to reach consensus guidelines for ambulance staff both locally and nationally.
Section snippets
Method
Each of the UK ambulance services was contacted via a postal questionnaire and given approximately 2 months to reply; one reminder was sent to non-responders.
Eight simple questions related to the provision of burn care were asked:
- 1.
Does your service have a treatment policy for burns patients?
- 2.
Which hospital do you send the patients to?
- 3.
Do you have a local treatment/bypass policy with the hospitals in your area?
- 4.
What first-aid measures do your crews employ?
- 5.
What dressings do you use?
- 6.
Do your crews give
Ambulance survey
Thirty-one replies were received from a total of 39 questionnaires (79% response).
- 1.
Eighteen (58%) services said that they had no treatment policy, 10 (32%) services said that they had a treatment policy for burns patients and 6 (19%) services said that they followed IHCD/basic ambulance guidelines; there was some overlap in the last two responses as some services quoted the IHCD guidelines as their treatment policy.
- 2.
Thirty (97%) services sent patients to their nearest A&E department.
- 3.
Seven (23%)
Discussion
General practitioners, practice nurses, first-aiders and ambulance personnel manage the pre-hospital and primary care of patients with burns. This care can be variable as this ambulance survey shows. The education of ambulance personnel and other pre-hospital carers has increased since the advent of the ambulance paramedic at the start of the 1990’s. Ambulance personnel have access to the Pre-hospital Trauma Life Support course [4], but not all services subscribe to it. They also have access to
Conclusions
Burns in the UK are responsible for approximately 175,000 attendances at A&E departments, affecting 0.5% of the population per year. Pre-hospital care for this patient group in the UK varies widely. It is suggested that some new guidelines formulating a standard approach to burn care nationally may benefit these patients. Issues that need to be addressed are the simplification of the Basic and Paramedic texts as regards burns, a uniform policy of first-aid and the introduction of opiate
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