RocketMedic
Californian, Lost in Texas
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Their rationale is solid though. Would you rather get sprayed with tap water for 20 minutes or get a fancy cooling blanket?
Burns management
- Thread starter Melbourne MICA
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EpiEMS
Forum Deputy Chief
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Also, it's easier to transport somebody with that blanket on...
I don't have that much water in my ambulance.
Melbourne MICA
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Sorry guys but I thought I had painted a pretty compelling picture but wonder if you have even read any of my posts in full. Hydrogels were not purpose designed for burns. And the idea is bystanders/family will water cool the patient before EMS arrive. And its not getting sprayed with water for 20 mins like standing in front of a fie hose. Its a shower, a garden hose sprayed gently over your burnt arm or back. So you don't cool in the truck because the hypothermia issue largely arises from over cooling - continuous cooling by paramedics because the burn feels hot. 20 mins water cooling stops burn progression and contributes to much better outcomes. This is fact. We don't want continuous cooling any more. The 20 mins is a tailored and specific treatment element. EMS should focus on their tasks - IV's, analgesia, warming, fluid loading pain relief etc.
And there is no rationale for hydrogels backed by evidence just supposition and marketing. The shiny bag with the fix - that can and does dry out - the warmer the environs, the faster they dry out. And when they do you have to take them off and replace them - defeats the purpose of covering the burn. They can and do heat up on the burn when covered as per manufacturers instructions to stop them sliding off the patient who won't be lying there quietly that's for sure. Did you know they melt on bitumen burns? They sting the eyes and the gooey mess makes IV and ETT placement a nightmare. On kids they are a nightmare for hypothermia and peripheral vessel shutdown on limbs caused in part by the way EMS apply them - you cant help but overlap the dressing onto non-burned areas. Thus if you leave them on there is a much larger surface area that is being cooled - in kids there is no room to move, hence the hypothermia risk. Water evaporates rapidly ( the main reason it cools so effectively). And you can't separate the functions of hydrogels, an illogical and stupid practice some EMS employ. I.e. you can't just use them as a dressing or to cool. And there is absolutely no evidence that you can put on a hydrogel for just 20 minutes e.g. and it will cool effectively, then take it off because you just expose the wound again and cause more pain as the air hits the burn. There is a crazy EMS video on YouTube with a paramedic who does exactly that and he doesn't even realize when he takes off the dressing that it is the air exposure causing the pain. By implication you can cover the burn with anything and this will reduce the pain and this is exactly what happens. This misunderstanding is part of the mistaken belief about the pain relieving benefits of hydrogels. You don't need a $50 dressing to do the job. Cool with gently applied water at room temperature and cover with clingfilm, It doesn't get much simpler.
And there is no rationale for hydrogels backed by evidence just supposition and marketing. The shiny bag with the fix - that can and does dry out - the warmer the environs, the faster they dry out. And when they do you have to take them off and replace them - defeats the purpose of covering the burn. They can and do heat up on the burn when covered as per manufacturers instructions to stop them sliding off the patient who won't be lying there quietly that's for sure. Did you know they melt on bitumen burns? They sting the eyes and the gooey mess makes IV and ETT placement a nightmare. On kids they are a nightmare for hypothermia and peripheral vessel shutdown on limbs caused in part by the way EMS apply them - you cant help but overlap the dressing onto non-burned areas. Thus if you leave them on there is a much larger surface area that is being cooled - in kids there is no room to move, hence the hypothermia risk. Water evaporates rapidly ( the main reason it cools so effectively). And you can't separate the functions of hydrogels, an illogical and stupid practice some EMS employ. I.e. you can't just use them as a dressing or to cool. And there is absolutely no evidence that you can put on a hydrogel for just 20 minutes e.g. and it will cool effectively, then take it off because you just expose the wound again and cause more pain as the air hits the burn. There is a crazy EMS video on YouTube with a paramedic who does exactly that and he doesn't even realize when he takes off the dressing that it is the air exposure causing the pain. By implication you can cover the burn with anything and this will reduce the pain and this is exactly what happens. This misunderstanding is part of the mistaken belief about the pain relieving benefits of hydrogels. You don't need a $50 dressing to do the job. Cool with gently applied water at room temperature and cover with clingfilm, It doesn't get much simpler.