Essex and Herts Air Ambulance: a focused case series for pre-hospital practice

Burns and scalds are relatively common in children and can be distressing for all involved. General principles of early management are to limit the progression of the burn through cooling, and to manage pain in order to perform a thorough assessment and improve the patient's experience. Assessment of burns includes an estimation of body surface area involved, an appreciation of the depth of burn, and the consideration of ‘special areas’ affected. A number of tools and guides exist that help standardise this assessment. However, it is impossible to truly know the size and extent of the burn during the first contact meeting in the pre-hospital environment as a burn matures and develops over the course of 72 hours. Treatment regimes are focused upon improving blood flow to the area of stasis, a fragile circumferential area between the zone of coagulation, in which the tissue is already unsalvageable, and the zone of hyperaemia, where blood flow to the surrounding tissues in increased. We report the case of a 2-year-old boy who sustained a scald to the abdomen after pulling over a freshly made cup of tea. We describe an approach to burns in children, in collaboration with parents. This case highlights the need for early adequate analgesia, thorough assessment, and triage to the correct hospital where the patient's injury can be appropriately managed. We also highlight areas in which an extended care service such as a helicopter emergency medical service (HEMS) team can help, particularly in terms of supplementary analgesia and transfer to specialist units.