plicate the management, prolong recovery or effect mortality

Hospitals without qualified personal or equipment for the care of the critically burned children

Transportation

Transportation of the burn victim may involve several steps, – but most often two. The first, is from the site of the accident to a local hospital, or to a similar point for stabilization. The second transport is from the referring hospital to the burn center, where the final treatment is provided. The first transport distance is often short and need for planning is less. Most often in Europe this is done by ambulance and the care during this transport is provided by paramedics or nurses which are stationed in the ambulance. The activities that have been undertaken at the scene of the accidents and during transport are then reported by the paramedics/nurse and/or documented in their report, which may be of complementary value when receiving the patient at the local hospital. In the report data regarding the patient, the circumstances at the scene as well as surveillance data may be found. At this point it is also important to identify the patient and obtain relevant data regarding relatives so that information can be passed on or complementary questions regarding the background of the patient can be obtained.

The second transport is most often done from a local hospital, where the patient has been stabilized and some important burn related treatments have been commenced, such as: intubation/ventilatory treatment in cases of compromised airway; fluid treatment for burn shock. In cases of circulatory compromise escharotomies should have been performed. Important is also that in the early care other trauma induced injuries should have been diagnosed and attended to, – especially if urgent and/or life threatening.

The choice of transport means depend on several factors of which local geography may be important, e. g., in an island or in an archipelago where airborne transport is almost obligatory. In general, transport exceeding 100 km often calls for airborne transport, such as helicopters or aircraft. Smaller hospitals may not have a helicopter landing facility

and the first transport then involves an ambulance transport to the airfield. Tertiary referral hospitals (burn centers) in Europe most often have helicopter landing facilities. Specifically, if the patient needs ventilator or other specific intensive care treatments or interventions during transport a specially designed intensive care type ambulance is needed (Figs. 5 and 6).

It is important to stress the need for monitoring during transport, especially in major burns and in ventilated patients. For these patients active heating devices, ventilators and invasive blood pressure monitoring is relevant. It is important for the referring physician to be aware of the monitoring facilities provided by each type of transport system as this may pose a risk if the patient is not properly monitored and/or if interventions if needed are difficult or impossible to undertake during the transport. In some smaller helicopter types critical care interventions may at times be difficult to perform and for such situations ground transport may be preferred. Also the referring physician needs to be updated on the skills and training of the transport surveillance personal, who should be properly trained and have the relevant equipment for the transport that is planned.

Fig. 5. Transportable critical care bed including equipment. Mobile critical care bed, developed for the aircraft emergency services (Sweden). It contains ventilator, breathing gas supplies, intravenous infusion systems as well as monitoring devices. The equipment is standardized so it facilitates transports involving both vehicles and aircraft in the same transport procedure (with permission Liber AB)

Fig. 6. Large interior of ambulance prepared for transporting critically ill patients. The space aside the bed facilitates critical care procedures during transport. It is also feasible to embark a standard critical care bed for transport purposes. The cabin holds complete power supplies as well as mounting racks for standard ventilators, infusion pumps as well as for patient surveillance equipment (with permission Liber AB)

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