Burn care: before the burn center

Excerpt

Many burn care papers and textbooks begin with presentation of the patient to the Emergency Department. Maudet and coworkers from Switzerland depart in an important way from this pattern by providing a 10 year review of pre-hospital Helicopter Emergency Medical Service (HEMS) management of burn patients in a homogeneous practice serving one of two Burn Centers in Switzerland [1]. Notably, in this with system, every EMS service automatically refers to the Burn Center. Thus, these authors have a good sample of the pattern for initial hospital management and prehospital care. Sophisticated pain protocols utilize fentanyl and ketamine. There is remarkable consistency in evaluation of burn size. Resuscitation complications are not identified. Consideration of this elegant work begins an important conversation in which I will present a North American perspective. My observations reflect experience with the extensive area of the North Central United States served by a network of small safety net hospitals providing care for a wide variety of problems and having inconsistent burn experience. …