Burn injuries range from minor burns that can be taken care of with basic first aid on the fireline to life-threatening injuries that require complex treatment and surgical teams at regional burn centers. Due to recent changes in both technology and the American Burn Association referral guidelines, NWCG has updated their burn protocol recommendations which can be found on the NWCG website and in the current Interagency Standards for Fire & Fire Aviation Operations (Red Book). Firefighters should familiarize themselves with these new protocols.

A burn injury that is beyond basic first aid treatment should be sent to the nearest emergency department for evaluation. Any life-threatening issues such as airway, pain control, and fluid resuscitation can, and should, be treated at a local emergency department. Bypassing local emergency departments to go directly to regional burn centers can put the patient at risk, delay initial treatment, and result in unnecessary travel and risk to both the patient and others. Of note, if a local EMS/aeromedical resource responds and transports the patient, they will follow their destination protocols.

In the emergency department, a licensed independent provider will determine what care should be initiated. This may include any of the below:

• Immediate transfer to a burn center after stabilization
• Remote (tele) consultation with a burn center
• Treatment and referral to local primary care or wound care

The NWCG burn protocol has a flow sheet that addresses the processes in the emergency department as well as a handout that can be provided to the physician to help guide treatment for our firefighters.

When a patient does not need emergent transfer to a burn center it is common for burns to continue to evolve and develop over the course of days to weeks. This means that treatment does not end after the initial emergency department visit. It is imperative to follow the directions from the emergency department and attend all follow-up appointments. All burn patients being discharged from an emergency department should receive/request a follow-up referral.

Discussion Items:

• What does a minor burn that could be taken care of with first aid look like?
• What would your crew do if they had a member sustain a large burn on the hand? Consider initial treatment by your crew.
• When would you activate EMS/IWI? Which Emergency Room would they go to?