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

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.