Winston de Mello - Prehospital management of burns

Winston chats to us about burns and the treatment of these in the prehospital environment 

 

Top 3 tips: 

1. Take a SAFE approach 

1. Stop the burning process 

1. Cool the burn but not the patient 

 

Biography: 

 

Dr de Mello undertook his medical training at Guy’s Hospital and Southampton. He served in the RAMC as a Regular and Reservist from 1976 to 2013 ending his military career as Colonel TA BATLS from 2007-2013. His NHS employment as an Anaesthetist and Pain Medicine Physician was at Mid Yorkshire and Manchester University Hospital. His clinical interests include pelvic pain, burns, pre-hospital care and trauma. He is a Founding Member of the Pre-Hospital Care Faculty at the Royal College of Surgeons Edinburgh and the College of Remote & Offshore Medicine at Malta. He retired in 2020 and is Trustee at the Vulval Pain Society UK and Chair of the Pre-hospital SIG at the British Burns Association. 

 

 

Links and resources:

 

Clinical Pearls: 

• Take a SAFE approach: Shout for help, Approach with care, Free from danger and Evaluate the ABCs 
• Stop the burning process by getting the victim to drop to the floor and roll, remove clothing and jewelry 
• Provide supplemental oxygen after clearing the airway 
• Check both radial pulses 
• If a burn patient is hypotensive within a couple of hours of the injury look for another source of blood loss – check the mechanism of injury 

• Stop the burning process 
• Cool the burn for a minimum of 20 minutes using cool water for up to 3 hours post burn 
• Keep patient warm 
• Loosely cover the burn with clingfilm 
• Sit up (if permissible) especially in burns involving the head and neck to minimize the swelling 

• Clingfilm also provides analgesia 
• Beware circumferential burns 
• The normal oximeter cannot detect carbon monoxide – and will falsely give a high saturation reading 
• Fluid resuscitation in adults in pre-hospital burns can be simplified by adopting the   “small man, small burn small bag; big burn, big man big bag” – which simplifies to either a 500 ml or 1000 ml bag of Hartmann’s Solution intravenously/intraosseously per hour 
• TBSA calculation in the pre-hospital can be difficult and is usually overestimated 

• Electrical burns may need 24hour ECG monitoring in vulnerable patients 
• Chemical contamination needs copious irrigation with water ideally within 10 minutes of contact except for elemental sodium, potassium or lithium 
• Alkali burns are worse than acid