Prehospital burn management: variability in critical interventions and implications for emergency care

Abstract

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.