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

Status
Not open for further replies.
OP
OP
M

Melbourne MICA

Forum Captain
392
13
18
I took ABLS today.

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

I assume by "coming" you meant cooling with tepid water. I think bandages + clingwrap is overkill if that's what you meant as well. Whats become clear from studies is the duration of cooling is significant and an independent factor impacting recovery and complications . It is the clinical sweet spot in terms of healing. It is not an arbitrary figure. Studies by Bartlett and Cuttle in 2008/2009 and more recently studies by Wood (2016), 2 studies by Harish (2018/19, one by Griffin (2019/20) among others have confirmed the clinical veracity of this duration.

The dressing element of burn first aid still provides only a functional role not a purely clinical one at this point and clingfilm is effective in this capacity. This is because we don't have a medicated or similar dressing that can be employed to serve all the necessary pre-hospital functions i.e. protecting the wound from further damage, providing an analgesic effect and seriously impacting colonisation and subsequent infection risk in the injury. There are cost issues as well and this is why we don't see a routine use of hospital dressing varieties like acticote , foam dressings etc. in pre-hospital.

So from a practical and functional point of point of view, clingfilm is cheap, easy to store and apply and nicely covers the burn. The role of all other over-wraps at this point is to contribute to warming alone which is the other edge of the sword with cooling. We want a single block of cooling of 20 mins -that's it. Then its warming+++ and the other paramedic interventions I mentioned. This is why the chronology of care is so vital to changing the dynamic. We want to maximize the time needed and available for warming at the same time exploiting the clinical benefits of the water cooling.

We have to get the public on the job straight after the event occurs doing the cooling before we arrive. Thereafter the wound needs to be "quarantined" as I put it. The burn is sterilised by the heat source initially so once the dressing goes on after cooling is done it doesn't come off for any reason until the burns team in ED starts debridement etc. This is all part of the new "standard model" of burn first aid I have been peddling - my agenda. I had hoped I could encourage the comrades here to maybe broach the idea with their services but managed to just piss people off with my clumsy approach. Hope this all makes sense. Like I said - we don't get many burns patients but the cost reductions and impact of Rx are huge.
 

CCCSD

Forum Deputy Chief
1,677
1,022
113
Nothing like someone from another country trying to enlighten us about how they know better. Fix your screwed up system first.
 
OP
OP
M

Melbourne MICA

Forum Captain
392
13
18
Nothing like someone from another country trying to enlighten us about how they know better. Fix your screwed up system first.

What screwed up system would that be? Perhaps you mean our screwed up universal health care system Medicare that we've had since 1975 that provides free medical care for every man, woman and child in the country. Or our PBS - prescription products scheme that means people with chronic illnesses, disabilities, new medical problems, cancer, MS, arthritis -and so many more can afford to pay for medications. In some cases meds normally costing thousands cost as much as a Big Mac because they are on the PBS schedule to which many new meds are added every year. And last time I looked we are not bankrupt because of it. What does health care and prescription meds cost you and how good is your system really? Last time I checked the US was number 16 on the worlds health care systems.

And what is it that you say I'm saying I know better? Your population is already enlightened anyway - you don't need me - 40% of you think Earth is less than 10,000 yrs old and Adam and Eve were real people. Not my facts. Your facts. And a healthy slab of your population also voted for Donald Trump did they not? And he's been a roaring success hasn't he? If you're going to hang it on me just because I come from another country it says more about you than me really doesn't it?
 

Scott33

Forum Asst. Chief
544
35
28
Now you are just trolling for the sake of it.

I was going to keep out of this thread, but you are generalizing about not only the US EMS system, but yours too. First off, your healthcare isn't free. Not even close. There may be components of it which are not billed at the point of use, but Victoria (for example) use both government-funded and private insurance to fund healthcare. This was also true for my sister when she lived in WA for 8 years. I seem to remember that her ambulance insurance was separate to her hospital insurance. Double dipping? So much for free healthcare. Maybe it was because she was a "bloody foreigner"...a term you may be familiar with in inclusive Australia.

But as to your initial post, which started off poorly and declined from there. One thing you may want to take from this thread is that whether you are stand-up comedian, a religious nut, a politician, or EMS forum member, you should always know your audience. Did you really think that your post - directed towards a predominantly US-based community, and which does little more than slag them off and attempt to highlight how good you have it - would achieve anything other than to be met with contempt it deserved? Are you really surprised that people are closing ranks, particularly now that you have descended into political and religious diatribe? I can only guess that you may be new to evidence-based research if this is how you chose to present your findings.

Still, many people who are neither practicing nor living in the US, frequently feel the need to throw their weight around on US-based EMS forums, seemingly just to highlight how their systems are the envy of the world. Of course they are not, and believing so is quite an insular position to take. I've been reading the same nonsense for years, and as a British expat, have noticed that the "EMS in the US sucks" posts are only outnumbered by the PMs in my inbox with the usual "Hey, I'm from [pick a country]...How can I immigrate to work on the ambulances in the US?".

The questions remain however, if EMS systems in countries such as your own - as well as the often-quoted UK - are such Meccas of healthcare, why is there still serious problems with retention? Why are the likes of bullying, harassment, and assault so commonplace as to almost be expected from both senior staff and patients alike? Why are suicide rates on the increase amongst ambulance staff, particularly compared to the crappy old US? Come to think of it, I may have already answered that last question.

Forget the burn stuff, from where I am sitting you have bigger fish to fry before you go taking the piss out of other country's EMS system.
 
Last edited:
Status
Not open for further replies.
Top