Saving Lives is not Enough - UK study on how to protect burn victims more effectively
A casualty-centred proposal identifying how Fire and Rescue Services can improve pre-hospital care and quality of life outcomes for burn survivors.
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This report sets out ten recommendations (Elements) for improving the pre-hospital care, experience and outcomes for burn survivors. The
primary audience for these is the Fire and Rescue Service, although by necessity they require the engagement of the wider emergency service family. These new and transformative insights are achieved by placing the survivor journey and experience at the centre of the research and using an evidence-based approach.
The Elements relate to operational practice and first aid options and do not address clinical practice.
The report concludes with Lessons Learned, which discuss inter-agency service planning and customer experience recommendations. The intended audience for these is policy makers in the emergency services, public sector, customer experience sector and anyone with an interest in policy innovation.
The saving or preserving of life where it is imminently threatened by an emergency will always be the main priority for first responders and subsequent care providers. But with ongoing advances in technical knowledge and capability, being content to save a life is no longer enough.
The quality of life achieved for survivors matters very much. This extends well beyond any obvious physical injury to include the potential for long-term health risks including psychological injury and being left vulnerable to secondary consequences or harm.
Surviving a burn can be a long, painful and challenging process both physically and psychologically. Even small burns can be life changing due to an inability to resume previous work or as a result of adjusting to visible differences and others’ reaction to them. The research suggests it is within the current ability of the pre-hospital responders to better recognise and address this broader set of aspirations.
The avoidance or mitigation of injuries starts from first contact (whether remote or at-scene), with every intervention or inaction being responsible for the eventual outcome. And yet, the pre-hospital period appears to focus on the desire to remove the survivor from the scene and transport them to hospital as quickly as possible, rather than fully recognising it as a distinct and important phase of care.
The Elements seek to improve the ability to locate and protect casualties, enhance the on-scene care and experience, and contribute towards the long-term quality of life outcomes. They should be considered as a single package of measures rather than individual pick and mix options.
They are presented as far as possible in a logical and chronological sequence relating to the progress of an incident from the 999 call onwards.
It is hoped this timeline approach highlights that each agency acting in isolation and in ignorance of the full survivor experience is unhelpful, as it forgoes the ability to demonstrate achievement of basic principles, such as “do no harm”.
However, some Elements such as psychological wellbeing and customer experience run through all stages of an incident or contact. Customer Experience may be more familiar as a commercial concept but the relevance of its principles and practice to emergency services and the care of burn survivors are discussed. The way an event is experienced by a professional responder and member of the public are very different.
The Fire and Rescue Service (FRS) has a long and proud tradition of saving lives from the risk of harm posed by fire. Traditionally, its role has been to remove casualties from a fire scene and then, as soon as possible, hand them over to the Ambulance Service or other first responders to administer medical care whilst FRS resources return to firefighting in order to limit property damage.
This is clearly an essential and valuable contribution but, arguably, has encouraged greater attention on property rather than people (the opposite of the approach taken to Road Traffic Collisions). It could also be considered as a narrow interpretation of what ‘saving lives’ means, in that it does not fully recognise potential long-term risks and consequences.1
In recognition of this, there are further opportunities for the FRS to:
i. improve the ability to locate and protect casualties
ii. enhance the on-scene care and experience, and
iii. contribute towards the long-term quality of life outcomes
As part of a ground-breaking study of human behaviour in Accidental Dwelling Fires (ADF), I have been fortunate to work closely with the burns sector since 2012. This helped build a missing and new understanding of the experience of being injured in an ADF from the burn survivor’s perspective, as well as the resulting impact on those who provide care after the FRS involvement.
With continuous advances in knowledge and medical interventions, the burns sector and associated charities have been able to set their sights beyond saving lives and injury treatment. The aspiration is to return the burn survivor to their psychological, social, physical, aesthetic and functional pre-incident condition and ability.2 Currently, the FRS is not aligned with this expectation and yet has a very influential role on the burn survivor’s experience and outcome in the earliest stages of an event.
Equally, due to its historical role, the FRS has not often been thought of as part of the pre-hospital care community by the burns sector. This means that there is limited dialogue between the respective organisations, and where it exists, it is often locally driven and based on specific medical interventions rather than a more strategic and holistic view of the entire burn survivor journey. With the addition of the human behaviour research, it is now possible for all parties to build a more complete end-to-end picture of the burn survivor experience and enhance multi-agency working.
This proposal sets out improvements required to bridge the current gaps. Each of the 10 Elements can be actioned individually but should be considered as a package of linked measures - similar to the care bundle approach used within the health service.
In combination, the Elements take a significant step towards raising the minimum standard of care that the FRS provides to casualties. By utilising the knowledge and skills within the FRS and its partners, it is likely that most of the Elements could be achieved within a short timescale and at relatively low cost.