Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience.

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Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_D1D050051F62
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience.
Périodique
Scandinavian journal of trauma, resuscitation and emergency medicine
Auteur(s)
Maudet L., Pasquier M., Pantet O., Albrecht R., Carron P.N.
ISSN
1757-7241 (Electronic)
ISSN-L
1757-7241
Statut éditorial
Publié
Date de publication
20/08/2020
Peer-reviewed
Oui
Volume
28
Numéro
1
Pages
84
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
Emergency medical services regularly encounter severe burns. As standards of care are relatively well-established regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS).
All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively.
We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were - 5.3, 4.4 and - 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively.
We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.
Mots-clé
Burn injury, Burn size, Emergency medical services, Fluid therapy, Pain management, Prehospital
Pubmed
Web of science
Open Access
Oui
Création de la notice
03/09/2020 10:47
Dernière modification de la notice
14/10/2020 5:23
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