https://doi.org/10.4081/ecj.2026.15500
Prehospital burn management: variability in critical interventions and implications for emergency care
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 28 September 2026
Burn injuries are a major form of trauma and require timely and effective prehospital management to optimise patient outcomes. In this review, current approaches to prehospital burn care are examined, focusing on immediate treatment strategies, areas of variability in clinical practice, and the main critical issues reported in the literature. A focused narrative mini-review was conducted using a literature search of PubMed, Web of Science, and the Cochrane Library. The search identified 227 records, of which eight studies published between 2015 and 2025 met the eligibility criteria and were included in the narrative synthesis. The findings revealed substantial variability in key aspects of prehospital burn management, including total body surface area estimation, fluid resuscitation, pain management, airway management, and initial wound care. Several studies reported a tendency toward overestimation of burn size and variability in fluid administration practices, although the relationship between these factors and major clinical outcomes was inconsistently reported. Pain management was generally addressed appropriately, whereas reassessment and documentation practices were less consistently reported. Variability was also observed in airway management, burn cooling, and wound coverage. This review highlights the persistent heterogeneity of prehospital burn care and identifies opportunities for improvement through greater standardisation, targeted training, and the implementation of evidence-informed decision-support strategies.
Downloads
1. World Health Organization. Burns [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Sep 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/burns
2. Yin X, Huang S, Zhu Z, et al. The global, regional, and national burden of burns: An analysis of injury by fire, heat, and hot substances in the Global Burden of Disease Study 2019. Injury 2025;56:111955. DOI: https://doi.org/10.1016/j.injury.2024.111955
3. American Burn Association. Advanced Burn Life Support (ABLS) Provider Manual [Internet]. Chicago (IL): American Burn Association; 2018 [cited 2025 Sep 2]. Available from: https://ameriburn.org/wp-content/uploads/2019/08/2018-abls-providermanual.pdf
4. British Burn Association. Standards and Strategy for Burn Care: A Review of Burn Care in the British Isles. London: British Burn Association; 2001. [cited 2025 Sep 2]. Available from: https://www.britishburnassociation.org/wp-content/uploads/2017/07/NBCR2001.pdf
5. European Burns Association. European Practice Guidelines for Burn Care: Minimum Level of Burn Care Provision in Europe. Version 4 [Internet]. Amsterdam: European Burns Association; 2017 [cited 2025 Sep 2]. Available from: https://www.euroburn.org/wp-content/uploads/EBA-Guidelines-Version-4-2017.pdf
6. Koyro K, Bingoel A, Bucher F, et al. Burn guidelines: an international comparison. Eur Burn J 2021;2:125-39. DOI: https://doi.org/10.3390/ebj2030010
7. Susi B, Privitera D, Zanfardino G, et al. The initial management of mild and moderate burned patients in the emergency department: an expert consensus statement. Emerg Care J 2025;21:13763. DOI: https://doi.org/10.4081/ecj.2025.13763
8. Alanazy A, Alruwaili A. The impact of pre-hospital emergency medical services on the outcomes of patients with burn: a systematic review and meta-analysis. Emerg Care J 2025;21:13074. DOI: https://doi.org/10.4081/ecj.2025.13074
9. Tran DP, Arnold DH, Thompson CM, et al. Evaluating discrepancies in percent total body surface area burn assessments between prehospital providers and burn center physicians. J Burn Care Res 2022;43:225-31. DOI: https://doi.org/10.1093/jbcr/irab131
10. Alsaqabi F, Ahmed Z. The accuracy of prehospital fluid resuscitation of burn patients: a systematic review. Eur Burn J 2022;3:517-26. DOI: https://doi.org/10.3390/ebj3040044
11. Josuttis D, Kruse M, Plettig P, et al. Prehospital treatment of severely burned patients: a retrospective analysis of patients admitted to the Berlin burn centre. Scand J Trauma Resusc Emerg Med 2024;32:70. DOI: https://doi.org/10.1186/s13049-024-01239-5
12. Maudet L, Pasquier M, Pantet O, et al. Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience. Scand J Trauma Resusc Emerg Med 2020;28:84. DOI: https://doi.org/10.1186/s13049-020-00771-4
13. Ashman H, Rigg D, Moore F. The assessment and management of thermal burn injuries in a UK ambulance service: a clinical audit. Br Paramed J 2020;5:52-8. DOI: https://doi.org/10.29045/14784726.2020.12.5.3.52
14. Schiefer JL, Perbix W, Grigutsch D, et al. Pre-hospital care of patients with severe burns in Germany: a review of 29 years of experience. Ann Burns Fire Disasters 2020;33:267-75.
15. Thom D. Appraising current methods for preclinical calculation of burn size: a pre-hospital perspective. Burns 2017;43:127-36. DOI: https://doi.org/10.1016/j.burns.2016.07.003
16. Adams R, Elmgren S, Liu YM, et al. One team: identifying prehospital provider needs for burn patient outreach and education. J Burn Care Res 2025;46:1243-8. DOI: https://doi.org/10.1093/jbcr/iraf110
17. Romanowski KS, Palmieri TL, Sen S, Greenhalgh DG. More than one third of intubations in patients transferred to burn centers are unnecessary: proposed guidelines for appropriate intubation of the burn patient. J Burn Care Res 2016;37:e409-14. DOI: https://doi.org/10.1097/BCR.0000000000000288
18. Badulak JH, Schurr M, Sauaia A, Ivashchenko A, Peltz E. Defining the criteria for intubation of the patient with thermal burns. Burns 2018;44:531-8. DOI: https://doi.org/10.1016/j.burns.2018.02.016
19. Allorto NL. Primary management of burn injuries: balancing best practice with pragmatism. S Afr Fam Pract (2004) 2020;62:a5202. DOI: https://doi.org/10.4102/safp.v62i1.5202
20. Oprita B, Burlacu G, Ispas VM, et al. Emergency Treatment Of Burns In Adults: Characteristics Of Adult Patients And Acute/Pre-Hospital Burn Management. Eur Burn J 2025;6:19. DOI: https://doi.org/10.3390/ebj6020019
Ethics Approval
CRediT authorship contribution
Federica Cini, conceptualization, investigation, writing – original draft; Christian Ramacciani Isemann, methodology, supervision; Lorenzo Righi, conceptualization, supervision, writing – review & editing.
Supporting Agencies
Data Availability Statement
All data generated or analyzed during this study are included in this published article.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
