Diagnostic and therapeutic difficulties encountered by paramedics while providing pre-hospital medical assistance to a severely burned patient – a case study

Aim: Analysis of the management of a patient with severe inhalation burns in the light of powers of a paramedic in Poland and current guidelines may enable to improve the quality of medical assistance provided by Emergency Medical Teams. Materials and methods: We analyzed management provided by the basic emergency medical team in a patient with a thermal burn in compliance with current recommendations and the powers of paramedics in Poland. The patient was found to have a 2nd/3rd degree burn covering approximately 50% of the total body surface area and a respiratory failure which was probably caused by inhalation burns. Due to the lesions, the paramedic made the following interventions: he cleared the airway with an oropharyngeal tube, started assisted ventilation, established intravenous access to a peripheral vein on the foot, administered 500ml of 0.9% NaCl and medical oxygen, cooled the burned area and assessed body temperature. The medical records lacked information on blood pressure values, saturation, blood glucose levels and administration of analgesics. Conclusions: 1. It may be difficult to ensure airway patency, intravenous access and monitor peripheral circulation in patients with deep burns of the face, neck and upper extremities. 2. It is necessary to improve skills of medical staff regarding the complex care of severely burned patients, particularly monitoring of vital signs and conicopuncture, establishing intraosseous access and pain management.