Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Abstract

Background: Emergency medical services regularly encounter severe burns. As standards of care are relatively wellestablished regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). Methods: All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively. Results: We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were − 5.3, 4.4 and − 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively. Conclusions: We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.

Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis

“…This preparedness is typically based on an EMS provider’s previous experiences [ 24 ]. The more information related to the patient’s emergency conditions, the location of the incident, and the atmosphere of the scene that is received and transmitted to the EMS provider by the call center, the better equipped these individuals are to provide safe and timely services to the patients through proper scene management [ 25 , 26 ]. On the other hand, improved management of the incident scene and strict adherence to safety precautions when dealing with hazardous factors can also guarantee their own security and safety [ 27 ].…”

Puntos clave para el abordaje inicial del paciente quemado en el servicio de urgencias

“…Cubrir al paciente con apósitos limpios y secos para evitar la hipotermia corporal es el único cuidado necesario de las heridas antes de la atención hospitalaria. Algunos estudios refieren que los pacientes se podrían beneficiar de una analgesia temprana 21 .…”

Tratamento Da Dor Em Pacientes Vítimas De Queimaduras Agudas

“…Um estudo realizado por Wang em 2011 demonstrou down regulation de receptores de opióides e up regulation de receptores de N-metil D-aspartato (NMDA) em animais com queimaduras 17 . Por outro lado os opioides são aqueles que pela sua rápida ação são os mais disponíveis em nível pré-hospitalar 18 .…”

“…Mas com os AINEs o uso deve ser mais restringido e deve-se usar por períodos mais curtos 2,8 . A ketamina também está disponível para nível pré-hospitalar 18 e hospitalar. É um antagonista não competitivo do receptor NMDA, induzindo anestesia dissociativa e mantendo o reflexo da via aérea, pressão arterial e frequência cardíaca.…”