Elsevier

Burns

Volume 28, Issue 2, March 2002, Pages 135-142
Burns

The UK pre-hospital management of burn patients: current practice and the need for a standard approach

https://doi.org/10.1016/S0305-4179(01)00083-3Get rights and content

Abstract

Introduction: In any system of burn care, first-aid, packaging and transportation of the burn injured patient from outside of hospital is a most important contribution to the successful management and outcome.

This study aimed to assess the current initial care of burn patients given by the statutory ambulance services and then compare this to a survey of opinions among the plastic surgery and burns consultants in the United Kingdom (UK).

Methods: In 1999, each of the UK ambulance services was contacted via a postal questionnaire. A similar survey was sent to all of the plastic surgery consultants within the UK (taken from the specialist register) therefore, canvassing the plastic surgeons who deal less commonly with burn patients as well as the burns units.

Results: A total of 58% of ambulance services said that they had no treatment policy for burns patients; 97% sent patients to their nearest A&E department; 84% of services employed cooling; 12 different types of dressing were used for burn patients; 74% of services used nalbuphine hydrochloride and 97% used entonox; 74% services gave oxygen to all burn patients; 90% cannulated patients, with or without fluid administration.

Plastic surgical opinion indicated that the most important aspects of basic first-aid should include: stopping the burning process; cooling (15 min (median)); airway, breathing and circulation assessment; clothing removal and dressings (clingfilm). Oxygen need not be given to all patients, but they should be kept warm and administered entonox and/or intravenous morphine. Most surgeons felt that patients should be taken to the nearest A&E and the majority of surgeons caring for this large group of patients did not have good and regular liaison with their local ambulance service.

Conclusions: There seems to be a wide variation in the basic approach to the first-aid and pre-hospital care of burns patients. A significant improvement in management for this large and important group of patients is achievable, if a standard approach across all ambulance services could be achieved.

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

References (39)

  • National Association of Emergency Medical Technicians. Pre-hospital trauma life support manual,...
  • National Burn Care Review. National burn care review discussion document. Dunn, KW,...
  • Australian and New Zealand Burn Association. Emergency management of severe burns course manual....
  • J.C Lawrence

    First-aid measures for the treatment of burns and scalds

    J. Wound. Care

    (1996)
  • Emergency Care A Textbook for Paramedics. London: Saunders,...
  • Marsden AK, First-aid. In: Settle JAD, editor. Principles and practice of burns management. London: Churchill...
  • Hodgetts T, McNeil I, Cooke M, The pre-hospital emergency management master. London: BMJ,...
  • Handbook of Immediate Care. London: Saunders,...
  • Malata CM, Fitzpatrick JC, Pruitt BA, Sharpe DT, Management of burns in trauma victims, with experiences from the UK...
  • Cited by (39)

    • Factors influencing the implementation of best practice in burn care in Western Australia

      2021, Burns
      Citation Excerpt :

      In addition to evidence in the available literature, WA clinicians also have access to a wide variety of educational resources and programmes which teach assessment and management of burn patients [6]. International reviews of emergency department initial assessment and management of burn patients have identified the occurrence of sub-optimal care, particularly in the areas of burn size assessment, first aid, intravenous fluid management, wound management and analgesia [7,8,9,10]. A 10-year retrospective review of paediatric burn patient deaths at Shriners Burn Hospital in Texas, demonstrated that in 71 children who died, sub-optimal initial airway maintenance, fluid resuscitation and/or prevention of burn wound infection were deemed the main contributing factor in 50% of the deaths [11].

    View all citing articles on Scopus
    View full text