What is it about?
Although little is known about the true impact of pre-hospital burn care for patients, early management with first aid, which includes cooling with water and dressing or covering the burn is vital to relieving pain and aiding recovery from these terrible injuries. This paper examines the evidence for a very popular and widely used burn dressing product used by more and more emergency first responders and members of the public which has replaced traditional first aid approaches in many ambulance services. However, it has not been closely examined in respect of its efficacy - how well it does its job to help burn patients. This is very important information to know if patients are going to benefit from the procedures we use to treat them.
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Why is it important?
This paper is important for four reasons. Firstly, hydrogel burn dressings are now commonplace in many ambulance services, first aid organisations and elsewhere. They are used all over the world. Given they are so widely used it is imperative to know if they actually benefit patients or would patients be better managed through another method? Secondly, this paper is the very first systematic review of the evidence base to inform determinations on the efficacy or otherwise of this commercial product. The paper come at a time when many questions are being asked about approaches to pre-hospital burn care in the setting of almost no evidence and no consensus on recommendations to responders in the first line of burn treatment. Thirdly, in the era of evidence based medicine and the less than ideal reputation of pre-hospital practice in respect of a compelling evidence base it is vital that attempts be made to quantify this deficiency as much as support existing practices. Fourthly, patient care matters. Elevating clinical standards through analysis of both practice and theory is an ethical mandate and symbol of our philosophical position on care for the injured and sick. This demands that treatments achieve goals quantified, not so much in terms of economic cost/benefits but in respect of patient recovery and well being, an expedited return to a productive and meaningful lifestyle and the amelioration and prevention of undue hardship whether through physical or psychological trauma.
Perspectives
This endeavour sprang from a challenge to practices I and many others had taken for granted for a long time. Pre-hospital care is a desert of evidence based practices. Many paramedic protocols arise from adherence to doctrine, existing orthodoxies, a "followers" not innovators mindset and a sense of pecking order subjugation. Bottom of the tree stuff. When my immediate manager asked me to examine whether our ambulance service paramedics had good reason to be confident about this commercial product I took on the brief. I discovered our own ambulance practices were as much a slave to the pre-conditions and unchallenged ideas as anybody else's. But peoples lives, health and well-being are at stake so it matters that we get it right. Four years on, one discovers the road to evolution is a long and sometimes precipitous one. It is also arduous and demanding. But discovery comes with challenge and effort yields rewards even though a final outcome seems distant on the horizon. My participation in pre-hospital burn care and research has created new friendships, new contacts, new revelations and understandings and many new challenges. Change is slow, mendacity and sloth common place, but people deserve advocates, the sickest amongst us, the most deserving.
Mr Nicholas S Goodwin
Ambulance Victoria
Read the Original
This page is a summary of: The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature, International Wound Journal, July 2015, Wiley,
DOI: 10.1111/iwj.12469.
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