Burns management:

Several factors need to be considered along with management of the primary survey and deficits:

• Crew safety will be an important aspect. Along with the threat of fire and smoke, further elements such as poisonous gases and structural instability of the affected area will need to be identified. If the scene is unsafe, await Fire and Rescue Service to manage and extricate any patients
• If there is burning materials still on the patient, remove the source of the burn if possible and safe to do so. If there are dry chemicals, try and get the patient to brush them off. Again, if it unsafe utilise the Fire and Rescue Service
• Airway burns can cause significant compromise, identify any telling features such as soot around the mouth and nose, oedema, hoarseness, etc. Consider early intubation if available/possible of advanced clinical support
• Lung injury/irritation may occur through smoke inhalation. Further deficits may be caused through hypoxia or carbon monoxide poisoning. Consider a good O2 saturation reading may be false due to carboxyhaemoglobin
• Circumferential burns can cause significant swelling and compromise whether around the torso or limbs. Consider further issues as tissues begin to swell through the damage. Consider removal of rings, watches, etc, which may cause constriction during tissue swelling
• Review burns surface area, time to hospital, and fluid therapy. Different Ambulance Services have different guidelines as to the use of fluid therapy in burns patients
• Irrigation of burns with copious amounts of water for a maximum of 20 minutes can help limit overall tissue damage. If a chemical burn is involved, irrigation can be done for up to an hour. Consider use of Fire Service resources if not a time critical patient
• Where the patient has deficits on their primary survey, an early extrication and transport to hospital with management on route will be needed
• Consider specialist/advanced support where available/possible