Emergency pre-hospital care of burn injuries- A reference guide and review

Background: The pre-hospital approach to severely burnt patients remains challenging for pre-hospital carers. The adequate approach for thermal, electrical and chemical burns still needs to be further clarified and some controversies remain. Although various international burn associations have formulated standard guidelines, they are still not well known to public at large in our country. This review outlines the pre-clinical algorithm and key steps in the initial management of burn patients in the pre-hospital environment based on current available evidence and a consensus of specialists from all disciplines caring for burns patients.Methods: In this review, data gathering was done through medical education and emergency related-textbooks, databases including Pub Med, CINAHL, Embase, Pro Quest, and Science Direct. At first step, 68 article was found. Finally, 25 articles were selected based on purpose of study.Results: After the burning process is stopped, the pre-hospital carer has to deal with cooling the surface, maintaining a balanced body temperature to avoid hypothermia, identify life-threatening injuries, assess the burn size and severity, and provide adequate dressings. Furthermore, airway management in case of inhalation injury, fluid replacement and analgesia/sedation must be approached before transportation to a specialized center. In this review, available formulas for fluid replacement and a guide for paramedics, as well as certain criteria for direct delivery to a burn center, are described. Special aspects of the pathophysiology and primary care of electrical and chemical burns, which particularly require measures of self-protection, are investigated. All aspects are integrated into the algorithmic approach in order to make the prehospital carer feel sufficiently prepared.Conclusions: Considering the weaknesses and deficiencies in the emergency pre-hospital care of burn injuries in Iran, the findings of this study can help the primary management of thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn. Furthermore, using these results can effectively contribute to reducing the morbidity and mortality rate of burn patients.