Why Burn first aid is as important as any advanced life support treatment and why US EMS stinks at burn first aid.

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CCCSD

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I have NEVER been taught to use any salves, creams, etc. it’s not in the protocol anywhere I can find for EMT/P.
 

Tigger

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I have NEVER been taught to use any salves, creams, etc. it’s not in the protocol anywhere I can find for EMT/P.
Just because something is not in EMS guidelines does not mean it isn’t best practice. Guidelines take a long time to change compared to consensus.
 

VFlutter

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Just because something is not in EMS guidelines does not mean it isn’t best practice. Guidelines take a long time to change compared to consensus.
I thought mayonnaise was standard of care 🤷‍♂️
 

CCCSD

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Just because something is not in EMS guidelines does not mean it isn’t best practice. Guidelines take a long time to change compared to consensus.
So that means...don’t cool with water and apply aloe Vera? Maybe that’s WHY the guidelines haven’t changed for EMS.
 
OP
M

Melbourne MICA

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Just because something is not in EMS guidelines does not mean it isn’t best practice. Guidelines take a long time to change compared to consensus.
After all the put downs and insults I'm going to persevere anyway and stick my nose in here because this issue matters to me and I have many years of work invested in it Tigger so go ahead like the rest and tell me where to go, tell me my delivery sucks again, I should learn to put out fires before I dare to have an opinion or use any other kind of invective if you or others feel so inclined.

I couldn't disagree more with your comment above because it makes no sense and its at the heart of this issue.

What system or approach does your local service use to determine what is "best practice" if not by exploring the evidence base? Local "expert" opinion? That's a pretty common approach but what if the next burn centre along or local "expert" happens to have a different way of doing things? All the approaches can't be right in a clinical sense and burn first aid is a treatment so any approach must be adjudged for its clinical efficacy. You can only determine that through clinical studies, trials, other sources of information and analysis of existing practices.

So onto the consensus models you mention. These have been popular in the case of burn first aid because in the past the evidence base was considered poor but at the end of the day these are also just collective opinions, the lowest level of evidence in the hierarchy. As an example consider this. You would likely know the ABA, CDC, NASEMSO, the AHA and around 50% of US states in the US all publish burn first aid recommendations. Each in their own way expert organisations. What you may not know is each and every one of their recommendations is different. How can they all be different? Which one is right? I am currently in the process of asking them that very question.

There have been studies on water cooling in burns as far back as Rose in 1936. But in the last 10 years there has been an abundance of studies using differing methodologies to easily move away from consensus models. I uploaded 10 of those studies in my first thread. All support a 20 minute cooling model and simple dressing approach. So why haven't all those bodies above adopted this model when their counterparts OS all all pretty much moving in that direction? And why hasn't US EMS?

You said you just follow your local guidelines as did others and leave it at that. Fair enough. We all do. I'm simply asking, why if you know they might be wrong or a second string option because you are privy to new information or have discovered flaws in the current approach? Why can't paramedics themselves check and be a voice for change? You say best practice may not reflect current guidelines but then what the hell are services doing incorporating substandard models in their CPG's? We all care about our patients first and foremost. They should get the best care possible based on the latest research.

If people are prepared to look at the information I have provided - 20 papers - there is plenty to go on and plenty to support my original premise that US EMS burn first aid practices stink - a general comparison like many services around the globe - not the paramedics who follow their CPG's. As I said at the outset - you guys don't set the guidelines.

I don't agree guidelines take a long time to change, not if a service uses a proper model of CPG formulation that incorporates full examination of the literature and other sources of information and CPG analysis tools like the AGREE II instrument.

Organisations should be challenged. Practices should be challenged. I see no reason why not. Its as simple as pointing out the facts if you ask me. Worked for me.
 
OP
M

Melbourne MICA

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Make sure to follow it up with a 100ml bolus of mustard over the next 6 hours.
You guys shouldn't laugh - I can point you in the direction of YouTube videos stating categorically that such approaches are great for burns. Like toothpaste, turmeric powder, vinegar, potato peels, egg whites and even more heat applied to the burn - a chef reckoned that was the way to go.
 

mgr22

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OP, here's why your thread took the direction it did:

"Being disappointed at the response to my original post on this topic and quite willing to say I have an agenda I've decided to throw some sand around to get some attention."

That was the first sentence of your first post. It was a nonstarter for me.
 
OP
M

Melbourne MICA

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OP, here's why your thread took the direction it did:

"Being disappointed at the response to my original post on this topic and quite willing to say I have an agenda I've decided to throw some sand around to get some attention."

That was the first sentence of your first post. It was a nonstarter for me.
Clearly all the things I have said warrant insults, abuse, accusations, put downs, condescension and otherwise deciding there and then I am some kind of second rate smartarse, scumbag idiot that deserves a mob put down. Its obvious from the years of contributions I have made here I was deserving of such vilification. I wonder how many here have actually read all that I have written and taken into account all I have offered? 20 documents, some of which I paid for uploaded free of charge and not asking anything in return.
 

FiremanMike

EMS Coordinator
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OP: writes a post insulting everyone's inferior intelligence to him in relation to a patient cohort that makes up less than 1% of our overall patient population.

Everyone: Dude, back off a bit..

OP: ah yeah, makes sense that everyone would insult me instead of acknowledging my superior intelligence, I think I'll keep writing walls of text demonstrating how inferior you are at burn care..

Everyone: Seriously, dial it down 2 notches so we can discuss..

OP: Alas, everyone still wants to insult me instead of admitting they are inferior


Pretty much sums up this entire thread..
 

DrParasite

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Who called you an idiot? who said you were stupid? in fact, who even said you were wrong??? I haven't seen any abuse, insults, or or putdowns (ok, maybe a little condescension).

The only consistent thing that was said was that your delivery sucks. And then some people were mocking you because of all the home remedies out there. and your tone is off putting to some. In fact, one poster asked for specifics:

It didn't tell me any of the following:

- What I'm doing wrong
- What I should be doing
- How to implement it
- Consideration of variables for availability of burn hospital care, transport times, level of service, etc...

If you can explain what I'm doing now, how and why it's wrong, and what I should be doing, and then tell me the limitations of that, I'm eager to hear it.

Do we do a 20 water cooling if we are 10 minutes from a burn center? Do we do it of we are 1 hour from a local trauma center with no burn capability, which will have to transfer another hour by flight another to a burns center? Does this apply to only thermal burns? How does the availability of active warming change things? (Yes, we have active warming.)

If you can present THIS information, I am open to listening. I'll even give you the first one:

My protocol is to apply dry sterile dressing and wrap in plastic wrap.
Yes, all this might be covered in one of your 20 papers (and I will admin, I didn't read any of them), but those are all valid questions in my opinion, ones I haven't seen you answer in this thread.

the only one who seems to be offended here is you, and, quite honestly, I am not seeing why you are so indignantly offended.
 

FiremanMike

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the only one who seems to be offended here is you, and, quite honestly, I am not seeing why you are so indignantly offended.
Because he’s been working on this for many years and apparently no one is listening to him..

Which brings us to the real issue at hand, OP..

If you’ve been working on something so diligently for so long and no one wants to pick up your idea and run with it, you need to do some serious soul searching and re-evaluate your research methodology, your data points, or your delivery (or possibly all of the above).
 
OP
M

Melbourne MICA

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Yes, all this might be covered in one of your 20 papers (and I will admin, I didn't read any of them), but those are all valid questions in my opinion, ones I haven't seen you answer in this thread.

Because he’s been working on this for many years and apparently no one is listening to him..
I hope you all enjoy the documents I uploaded. There's a fair bit of half decent information if you're interested.
 

Peak

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What I have seen here and in the OPs other thread of essentially the same topic is a theme of obsession, grandeur, thoughts of persecution, and lack of insight. I think that there are some concerns here, but burn management problem isn't the most pressing one.
 

FiremanMike

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I was curious and bored so I looked up our stats.

We are a single station urban department that takes ~7500 EMS runs per year.

In the last 4 years, we have been dispatched on 27 "burn" runs

Of those, based on documentation, I would consider 3 of those runs to be significant.

Of those "significant burns" (>10% BSA), I would say 1 of them could have potentially benefited from the idea of 20 minutes of flushing. I say potentially benefited because I'm not convinced that delaying transport for 20 minutes to flush is a good idea when you're only 12 minutes from a burn center.
 
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OP
M

Melbourne MICA

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I was curious and bored so I looked up our stats.

We are a single station urban department that takes ~7500 EMS runs per year.

In the last 4 years, we have been dispatched on 27 "burn" runs

Of those, based on documentation, I would consider 3 of those runs to be significant.

Of those "significant burns" (>10% BSA), I would say 1 of them could have potentially benefited from the idea of 20 minutes of flushing. I say potentially benefited because I'm not convinced that delaying transport for 20 minutes to flush is a good idea when you're only 12 minutes from a burn center.
Clinically, cooling with running water for 20 minutes is so beneficial that in isolated thermal burns - so no multi trauma, RSI for airway required etc. the time frame to ED is not the primary consideration. And 8 minutes won't change anything anyway and its likely cooling in the ED is problematic from a practical standpoint besides.

But there is more to it. The perception EMS does the cooling needs to change. In a number of countries, emergency call takers now coach the caller to apply the cooling before EMS arrives. For many people, applying water is an almost instinctive approach anyway. As an alternative if 10 minutes has been completed, a further 10 can be done at scene with the assistance of the EMS crew. This is part of the what will be a prominent element of a new standard model of burn first aid.

The cooling really is a significant treatment. Water cooling for 20 minutes significantly reduces pain and progression of the burn. It reduces the inflammatory response and oedema formation, need for grafting, debridement and excision, time in hospital, time in ICU, accelerates re-epithelialisation and reduces scar formation whilst improving cosmetic outcomes, time to recovery and yes mortality as well. It is way more complex in effect than is actually understood. The paper by Wright from 2015 on mechanisms of cooling in burns suggests it affects gene expression. I looked up gene expression and didn't get past the first paragraph.

But the biggest battle has been to nudge the public away from all the home remedies and internet driven myths, so this has been the focus of education efforts all over the world . If the public are compliant to the best evidence based approach - that's 20 minutes of gentle cooling with clean running water, then when EMS arrive the focus is assessment, dressing the burn, analgesia, fluid management and crucially warming. Burn patients with temps <35 deg C cannot be operated on until core temp is raised, hence my remark about no active warming systems on ambulance being a problem, especially in paralysed airway burns patients.

Thus the public contribution becomes an important part of the standard model. The days of EMS pouring saline over the burn in the back of the truck have to go. If readers are skeptical then please read the material I have uploaded. In terms of clinical outcomes, water cooling of burns is probably one of the most effective forms of management done by EMS across the board.

When you consider the average cost of admitted serious burns patients is around $70,000 (a PTCA costs around $23,000 USD) and costs exceeding $1,000,000 USD are not uncommon its easy to see why that tiny <1% of EMS patients is a pretty important part of health care cost considerations.

So our role is pivotal for the patient and the health care system. BTW I appreciate your response.
 

akflightmedic

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What I have seen here and in the OPs other thread of essentially the same topic is a theme of obsession, grandeur, thoughts of persecution, and lack of insight. I think that there are some concerns here, but burn management problem isn't the most pressing one.
Trump left Twitter for EMTLife..????
 

NPO

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I took ABLS today.

They recommend coming with tepid water then wrapping with dry sterile bandages, and wrapping with plastic wrap.
 
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