On Scene First Aid and Emergency Care for Burn Victims

IntroductionBurn injury is damage to the skin or other body parts caused by extreme heat, flame, or contact with heated objects or chemicals. The World Health Organization estimated that 322000 people die each year from fire related burns with >95% of these occurred in developing countries [1]. The mortality rates were much greater at both ends of the age spectrum. Thirty- eight percent of all burn deaths were due to multiple organ failure and only 4.1% were due to burn wound sepsis [2]. The biggest factor in burn mortality was inhalation injury with increased mortality to 26.3% in the 6.5% of burn patients admitted with inhalation injury [2].In United Kingdom (UK), burns accounted for 175,000 emergency department attendances and 13000 admissions, and a further 250,000 patient were managed in the community by general practitioners and allied professionals [3]. Although recent data from Burn Repository in USA showed significant improvement of overall burns mortality, there are still many areas that can be improved especially in the early stage of burns treatment to optimize chances of survival and outcome [2]. A survey in 1998 showed that up to 58% of UK ambulance services had no specific treatment policy for burn patients [4]. In Ireland and Australia, only 23% and 39% respectively, had employed the correct first aid burn management in studies conducted on their primary carers [5,6]. Equally, a review of the management of minor burns within the emergency departments of hospitals in Ontario, Canada, showed that 70% of responding physicians would not measure the extent of the burn area when making an assessment, whereas 45% failed to discuss analgesic requirements [7]. Based on these data, there is still much room to improve in the basic care of burn victims.Pathophysiology of burnsBurn from thermal source inflicts damage through various mechanisms, both locally and systemically, through direct injury and reactive physiology. The natural functions of skin are to act as a barrier to bacteria and prevention of water loss through its epidermal layer. The deeper, dermal layer provides mechanical strength and integrity through its abundant connective tissue composition, and nourishment to epidermal and dermal layers through myriad of vascular plexuses. The dermal layer is also the home to many dermal appendages such as sweat glands and hair follicles, which houses regenerative epidermal cells that are capable of replenishing injured skin. When such functions of skin are compromised, attending physician should institute treatments that will minimize the injury and compensate its deficits through adequate first aid and resuscitation. Early burns management is one of the most important determinant factor in reducing the potential morbidity and mortality of burn victims. In USA, approximately 75% of severe burn deaths occur on scene or during initial transport [8].The pathophysiology of thermal burn injury is related to the initial distribution of heat within the skin with its severity dependent upon the temperature of the source of insult and the duration of contact [9]. On a cellular level, the initial response to thermal injury involves direct heat-induced protein denaturation and cell death. This is followed by inflammation and ischemia-induced injury, which resulted in burn of varying skin depth. Because skin is a good insulator, most burns generally involve only the epidermis or part of the dermis. Only with prolonged exposure do burn encompasses the entire dermis or extend beneath the dermis into subcutaneous tissue such as fat, muscle, and bone. However, similar extent of burn can also occur with short exposure to an object of high temperature. For instance, a thermal blistering injury can occur after 5 minutes of exposure to water at 48.9 °C (120 °F) or after just 1 second of exposure to water at 68 °C (155°F).The depth of burn is a dynamic process, as popularly described by Jackson [10]. …

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