The following principles are the basis of prehospital care for burn patients: (1) stop the burning process, (2) establish the airway, (3) initiate fluid resuscitation, (4) relieve pain, (5) protect the burn wound, and (6) transport the patient to an appropriate facility.
On-site assessment of a burned patient is divided into primary and secondary surveys. In the primary survey, immediate life-threatening conditions are quickly identified and treated. Initial management of the burned patient should be the same as for any other trauma patient, with emphasis on airway, breathing, circulation, and cervical spine immobilization. During the secondary survey, a thorough head-to-toe evaluation is carried out.
The patient must be removed from the burning process and burning clothing must be immediately removed and the remainder of the clothing removed after the airway, breathing, and circulation (ABCs) are secured. All rings, watches, jewelry, and belts should be removed, as they can retain heat and produce a tourniquet-like effect on the extremity causing ischemia. A 100% oxygen mask should be applied. Thought should be given to an airway that has potential to swell rapidly, even though initial assessment may be acceptable. Prophylactic intubation should be considered in burns about the face sustained in a closed-space fire. Intravenous fluids are started with isotonic crystalloid: usually Ringer's lactate solution. The patient should be covered with clean sheets to protect the wound. Early cooling can reduce the depth of burn and reduce pain, but uncontrolled cooling will result in hypothermia. Analgesia can be given upon direction of the on-line medical control physician. The patient should be transported to the nearest hospital capable of caring for a burn patient, or, if none is available, the nearest hospital for stabilization.
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