ABC of major trauma. Management of severe burns.
Authors: C Robertson, O Fenton
Journal: BMJ (1990)

At the scene of a fire first aid procedures are often life saving.Medical staff should use the following instructions for preparing a victim for evacuation to a hospital.Under the direction of the fire service and ensuring the safety of the rescuers the patient should be removed from the scene of injury to a place of safety and fresh air.Flames and heat track upwards, so the patient should be kept supine and _ rolled or covered with a heavy blanket, coat, or rug to extinguish any residual flames.Take care not to get burnt yourself, especially if dealing ie ~~~~~~~~with petrol burns or self immolation.If the clothing is still smouldering or hot apply large amounts of cold water.Clothing saturated with boiling liquids or steam should be removed rapidly, but do not remove burnt clothing that is adherent to the skin.Cover burnt areas with clean (sterile if available) towels or sheets and ensure that the patient is kept warm.Do not apply wet soaks or ice packs or use them during transit as this will not provide any pain relief for patients with full j , j zthickness burns and can cause profound hypothermia, especially in children.Evacuate the patient to the receiving hospital as quickly as possible.In patients with severe burns or those who have been exposed to smoke or fumes high flow oxygen through a facemask should be given during transit.Alert the receiving accident and emergency department by radio or telephone as to the number and ages of the patients and the severity of their burns, together with the estimated time of arrival. Reception and resuscitationNecessary information on incident * Its nature (house fire, blast, release of steam or hot gas, etc)The primary assessment, investigation, and treatment of a patient with * If possible, the nature of burning materials (furniture, polyurethane foam, polyvinyl severe burns should be a continuous and integrated process rather than a chloride, etc) stepwise progression.While assessment is being performed a member of * Was there any explosion?staff must obtain the necessary information about the incident from the * Was the patient in an enclosed space?ambulance crew and other emergency services.This should then be .For how long was the patient exposed to conveyed to the senior doctor in charge of the patient.smoke or fire?* The time elapsed from burn/injury/smoke inhalation to arrival in hospital. Management of the airwayRapidly examine the patient for clinical evidence of smoke inhalation and Clinical features indicating smoke thermal injury to the respiratory tract.In patients with one or more of the or thermal injury to respiratory tract features described in the box respiratory obstruction from pharyngeal or laryngeal oedema may develop rapidly.In such patients early endotracheal Altered consciousness intubation performed by an experienced doctor is essential.Mucosal Direct burns to face or oropharynx swelling of the oropharynx and epiglottis can be extremely rapid, and delay Hoarseness, stridor can render tracheostomy necessary.In patients in whom complete Soot in nostrils or sputum respiratory obstruction has already occurred or intubation is unsuccessful, Expiratory rhonchi or both, immediate cricothyrotomy or "mini" tracheostomy is required, Dysphagia followed by formal tracheostomy.It should be emphasised, however, that Dysphagia in patients with severe burns the tracheostomy site is an important site of infection.