FEATURE PARAMEDIC TRAINING
hospitalized and up to 10,000 die as a result of thermal injury or burn related infection. Morbidity and mortality rates from burn injury follow significant patterns regarding gender, age, and socioeconomic status. A key part of the professional role of the paramedic is community education. This education should stress prevention as the most effective management of these injuries. The number of deaths from burns has declined over the past several decades. This can be credited to several factors including better burn care, improvements in the quality of burn centers, and the recognition and affective management of shock related to burns. Critical care management of burn patients is often technically demanding, resource-intensive and costly. Prediction of mortality in this group of patients could provide a framework to which resource utilization could be provided and new therapies evaluated.
ANATOMY OF THE SKIN (DERMIS) The skin has three layers: the Epidermis, Dermis and Hypodermis. The Epidermis is the top layer; the Dermis is directly beneath it. The Epidermis has varying levels of thickness. The Epidermis acts as a barrier between the body and the external environment. The Dermis has two layers, the papillary (superficial) and reticular (deep) layers. The Hypodermis is a layer of adipose and connective tissue between the
skin and underlying tissues. Subcutaneous tissue is located under the Dermis and is not considered a layer of skin. Other structures, such as muscle and bone, are located beneath the subcutaneous layer. The skin has several functions: a barrier to water, protection from vapors, and resisting infection. The skin influences the body’s temperature through its ability to retain and release heat, it is one of the body’s most important protective organs.
HOW A BURN DEVELOPS (ETIOLOGY) A burn occurs when more heat is absorbed than the body’s tissues are able to manage. Burns can affect any anatomical structure, including skin, cells, muscle, bone and subcutaneous structures. Burns cause damage by direct injury and by releasing local mediators. The depth and severity of a burn are influenced by factors such as duration of exposure, energy source,
Classification of burn severity Burn severity/age Minor
Moderate Severe
Children <10% TBSA
Full-thickness <2% TBSA 10-20% TBSA
Full-thinkness <10% TBSA (non-critical Areas)
>20% TBSA
Full-thinkness >10% TBSA Burns in critical areas* Complicated burns **
«Appropriate pre- hospital management can reduce morbidity and mortality for burn patients»
and conductivity of tissues, patient age, and the patient’s underlying health status. For example, when very young or very old victims are exposed to the same source of heat for the same duration as others, they are more likely to experience more severe burns, because their skin tends not to be as thick. Tissue resistance can also influence the severity of the burn. Bone is the most resistant to heat accumulation, followed by nerves, blood vessels and muscle tissue. The most common mechanisms of burn related injury (WA hospital admission data from 2004/05-2006/07) include contact with hot drinks,
Adults <15% TBSA
Full-thinkness <2% TBSA 15-25% TBSA
Full-thickness <10% TBSA (non-critical areas)
>25% TBSA
Full-thinkness >10% TBSA Burns in critical areas* Complicated burns **
Elderly <10% TBSA
Full-thickness <2% TBSA 10-20% TBSA
Full-thinkness <10% TBSA (non-critical Areas)
>20% TBSA
Full-thinkness >10% TBSA Burns in critical areas* Complicated burns **
*Critical areas include face, hands, feet, perineum ** Complications include inhalation injury, high-voltage electrical burns, associated major trauma, infants, elderly, and comorbid medical problems (e.g. diabetes mellitus)
Arab Health Issue 3 2011 13
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