The Emergency Management of Severe Burns

At the scene, first aid procedures are often life saving. Basic immediate care can be summarized under the following headings;

1) Personal safety

2) Stop burning process and immediate wound care

3) Care of the Airway and Breathing

4) Intravenous fluid therapy

5) Pain relief

6) Transfer to hospital

Personal safety

Do not risk injury to yourself by attempting to rescue a casualty from a fire until the fire has been dealt with effectively and the risk of re-ignition/explosion has been minimized.

Isolate car electrics which will inactivate electronic fuel pumps enabling effective fire-fighting and minimize the above risks. It may be impossible to extinguish a car fire until an electronic fuel pump has been inactivated.

Initial assessment

Remember, following a race incident involving fire, it is likely that there will be other injuries as well as burns, so bear in mind the possibility of cervical spine injuries etc.. and manage the situation accordingly.

Immediate life saving measures in burns

Immediate first aid

What NOT to do

Do NOT apply wet soaks or ice packs to large burned areas. They will not provide any pain relief for patients with full thickness burns and can cause profound hypothermia and intensify shock.

Use cold soaks only on partial thickness burns less than 10% of body surface area.

Do not break blisters or apply antiseptics.

Management of the airway

Clinical features of smoke inhalation/resp. thermal injury

Intravenous access

Signs of shock in burns victims

Intravenous fluid requirements in burns victims

Assessment of percentage of burn

The rule of nines

Head 9%

Trunk 18% front & 18% back

Arm 9%

Leg 18%

Pain relief in burns

Depth of burns

Traditionally described as 1st, 2nd or 3rd degree.

Now more descriptively described as superficial, partial thickness and full thickness burns.

Superficial burns

Partial thickness burns

Full thickness burns

Transfer to hospital

Immediate transfer of burned casualties to hospital is of paramount importance if complications are to be minimized.

Transfer to a specialised Burns Unit should be considered rather than to the nearest A & E unit in severe injury.

Indications for transfer to a Burns Unit


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