Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury
First Aid
United States Department of Defense
The first consideration is removal of the source of thermal injury from the patient. Burning clothing should be extinguished and removed, and the patient should be removed from a burning vehicle or building. In electric injury, the patient should be removed from the point or points of contact, with the rescuing personnel taking care to avoid contact with the power source. Chemical agents should be washed immediately from the skin sur ace by copious water lavage. First aid should be reduced to a minimum, and nothing must be done that could prejudice subsequent treatment. All constricting articles, such as rings, bracelets, wristwatches, belts, and boots must be removed, but the patient is not undressed unless the injury has been caused by a chemical agent, in which case all contaminated clothing must be removed. The patient should be covered with a clean sheet and a blanket, if appropriate, to maintain body temperature and prevent gross contamination during transport to a treatment facility. If available, burn dressings can be used for such initial wound coverage.
Patency of the airway should be assured, hemorrhage should be controlled, and fractures should be splinted. If at all possible an intravenous pathway should be established in an unburned area and in an upper extremity vein if there are associated abdominal wounds. Resuscitation may be safely begun with electrolyte solution alone, and should be continued before and during movement to an installation where definitive medical care is available. An intravenous cannula is preferable in all situations since large volumes of fluid are required for patients with extensive burns, and patient restlessness, transportation, or edema may dislodge an intravenous needle. Patients with injuries from white phosphorus should have the burns dressed with saline-soaked dressings to prevent reignition of the phosphorus by contact with the air.
Pain is seldom a major problem in patients with severe burns, but patients with extensive partial thickness burns may have considerable discomfort, which can be relieved by appropriate doses of morphine or meperidine administered intravenously. Subcutaneous or intramuscular injections of analgesics will not be mobilized during the period of edema formation and will be ineffective in pain control. A patient who has received multiple subcutaneous or intramuscular doses of an analgesic may later mobilize them simultaneously and develop severe respiratory depression which must be treated promptly.
On the day of injury, after hemorrhage is controlled, ventilatory stability achieved, and urinary output established, one should promptly move the extensively burned patient to a definitive treatment facility. Intravenous fluid administration should be maintained throughout transportation and, if any question exists as to adequacy of the airway, a tracheostomy should be performed or, preferably, an endotracheal tube placed and secured.