Scenario — Superficial burn injury at community fair

foundation Trauma · Elderly · 75yr · male

Patient Information

Dispatch	You are called to the First Aid Post at the Cottesloe Community Fair. A 75-year-old male (Barry Hutchinson) has been brought in by a bystander after spilling a cup of hot water on his forearm at a food stall.
Patient	Barry Hutchinson — 75yr (75kg)
Incident History	Pt was queuing at a hot beverage stall when he knocked a cup of boiling water off the counter. The water spilled over his right forearm. Bystander walked him to the FAP approximately 5 minutes ago. No cooling has been applied.
Emergency Contact	Margaret Hutchinson (Wife) — 0412 883 541

Initial Rapid Assessment

Response	Alert
Airway	Patent. No airway obstructions. No airway swelling or stridor. No soot or blistering to mouth.
Breathing	Unlaboured. Normal rate and depth. No wheeze or crackles. Speaking in full sentences.
Circulation	Radial pulse present, regular, adequate strength. Skin flushed and red to right forearm. No active bleeding.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Anxious but calm.
Exposure	Right forearm: approximately 4–5% TBSA. Redness, intact blistering beginning to form, moist wound bed. Skin intact. No circumferential involvement. No soot or burns to face, hands, or other areas.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	16	96	148/88	<2s	15	4 4 ++	36.8	–	7
10 mins	98% (RA)	Nil	14	88	142/86	<2s	15	4 4 ++	36.8	–	4

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a superficial (partial thickness) burn to the right forearm caused by hot water, covering approximately 4–5% TBSA.

Facilitator Triggers — if trainees miss a critical step

! (If cooling is not commenced within the first 2 minutes of assessment, inform the trainee that the patient's pain score increases to 9/10 and blistering appears more extensive — prompt: 'What is your priority intervention right now?')
! (If the burn area is not assessed using Rule of Nines, ask the trainee: 'Can you estimate how much of the body surface area is affected?' — guide them to approximately 4–5% for a forearm.)
! (If the trainee attempts to apply a dry dressing without cooling for 20 minutes first, the facilitator states: 'The patient says it still feels like it is on fire — the dressing is causing more pain.' — redirect to cooling first.)
! (If the trainee does not remove Barry's watch and rings from the right hand before swelling increases, prompt: 'You notice the patient's watch is still on his right wrist above the burn — what do you want to do?')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE including gloves.
2. Perform Primary Survey — confirm airway patent, breathing adequate, circulation intact, GCS 15.
3. Assess burn site — right forearm, estimate TBSA using Rule of Nines (forearm = approximately 4–5% TBSA). Confirm redness and early blistering with intact skin — consistent with superficial partial thickness burn. Note: reddened intact skin should not be included in TBSA calculation.
4. Commence cooling immediately — irrigate burn area with cool running water or pour cool water over the site for a minimum of 20 minutes at approximately 15°C. Do not use ice or ice water.
5. Remove jewellery and watches from the affected limb (right wrist/hand) before swelling increases. Do not remove items adhered to the wound.
6. Perform Vital Sign Survey including BP, HR, RR, SpO2, temperature, pain score (document as 7/10 initially).
7. Take full IMISTAMBO history — note allergies (Penicillin), regular medications (Ramipril, Atorvastatin, Aspirin), and relevant medical history (hypertension, hypercholesterolaemia).
8. Reassess pain score following cooling — expect reduction from 7/10 toward 4/10.
9. After 20 minutes of cooling, apply damp sterile dressings over the burn site. Do not use fluffy or adhesive dressings.
10. Assess for signs of inhalation injury — soot, hoarseness, black sputum, stridor — confirm absent in this case.
11. Confirm this burn does NOT meet criteria for direct transfer to Tertiary Burns Centre (< 10% TBSA, no airway burns, no burns to face/hands/feet/perineum/genitalia).
12. Continuous reassurance throughout — elderly patients may be distressed.
13. Monitor patient persistently, recording full observations every 10 minutes.
14. Arrange transport to nearest emergency department for wound assessment and review, given age and extent of blistering.
15. Scenario ends on arrival of ambulance and IMISTAMBO handover.
16. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Burn Trauma · Primary Survey · Pain Assessment · Minor Wound Management

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Signs/Symptoms	Pain and redness to right forearm. Blistering forming at the site. Skin feels hot to touch.
Allergies	Penicillin — rash.
Medications	Ramipril 5mg daily, Atorvastatin 40mg nocte, Aspirin 100mg daily.
Pertinent History	Known hypertension and hypercholesterolaemia. No known diabetes. No prior burn injuries.
Last Oral Intake	Hot coffee and a sausage roll approximately 20 minutes ago.
Events Leading	Patient was standing at a coffee stall waiting to be served. He knocked a takeaway cup of boiling water off the counter and it poured over his right forearm.
Treatment Prior	Nil. No cooling applied prior to arrival at FAP.

Onset	Approximately 10 minutes ago — boiling water spilled at food stall.
Pain	Burning pain to right forearm.
Quality	Constant, burning sensation.
Radiates	Nil.
Severity	7/10 at rest.