Superficial burn to forearm — child at community fair

Patient Information

Dispatch: You are called to the First Aid Post at the Midland Community Fair. A parent has brought in an 8-year-old boy (Liam Nguyen) who has burned his forearm on a camp oven display approximately 10 minutes ago.
Patient: Liam Nguyen — 8yr (26kg)
Incident History: Pt was watching a camp cooking demonstration when he reached out and made contact with the side of a hot camp oven. Parent applied nothing to the burn. Pt is crying and holding his right forearm.
Emergency Contact: Thanh Nguyen (Father (present on scene)) — 0412 387 654

Initial Rapid Assessment

Response: Alert
Airway: Patent. No airway obstruction. No stridor. No soot or singeing around mouth or nose.
Breathing: Self-ventilating. No respiratory distress. Rate and effort normal.
Circulation: Strong radial pulse. Skin warm and well perfused. Localised redness and blistering noted to right volar forearm approximately 4cm x 5cm. Nil active bleeding.
Disability: GCS 15 (E4V5M6). Alert and oriented to time, place and person. Distressed and crying due to pain.
Exposure: Burn to right volar forearm. Area approximately 4cm x 5cm with erythema and small intact blisters. No burns to face, hands, feet, or other body areas. No soot. No singed hair.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	22	108	100/65	<2s	15	4 4 ++	36.8	–	7
10 mins	99% (RA)	Nil	18	96	100/65	<2s	15	4 4 ++	36.8	–	4

History Taking

Treatment Response

Diagnosis

This patient is suffering from a superficial (partial thickness) thermal burn to the right volar forearm, approximately 4cm x 5cm, caused by contact with a hot camp oven surface.

Facilitator Triggers — if trainees miss a critical step

! (If the trainee does not begin cooling the burn within the first 2 minutes — father becomes increasingly anxious and asks 'Aren't you going to do something? It's still really hot!')
! (If the trainee attempts to remove any blistered skin or rupture blisters — facilitator states 'The blisters are intact. What is your rationale for this action?')
! (If the trainee does not perform a Rule of Nines assessment or estimate TBSA — facilitator prompts 'How much of the body surface area is affected?')
! (If cooling is not performed for a minimum of 20 minutes — facilitator states 'Father asks: How long do we need to keep the water running?')
! (If oxygen is unnecessarily applied — facilitator prompts 'What is your clinical indication for oxygen in this patient?')

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 — identify erythema and intact blisters to right volar forearm, approximately 4cm x 5cm.
4 Estimate TBSA using Rule of Nines — right volar forearm burn estimated at approximately 1% TBSA in an 8-year-old (does NOT meet fluid replacement threshold of >10% TBSA for children aged 18 months and over).
5 Assess for inhalation injury — inspect nose and mouth for soot, singeing, or blistering — NONE present.
6 Immediately cool the burn with tepid water (approximately 15°C) for a minimum of 20 minutes — do NOT use ice, ice packs, butter, creams, or toothpaste.
7 Record the time the burn occurred (approximately 10 minutes prior to EHS arrival) and the time cooling commenced.
8 Remove any jewellery or clothing near the burn site if not adhered to the wound — check for watch or bracelet on right wrist.
9 Perform Vital Sign Survey including pain score — document pain 7/10.
10 Reassure patient (Liam) and father continuously throughout.
11 After 20 minutes of cooling, apply damp sterile non-adherent dressing to the burn site.
12 Do NOT rupture blisters.
13 Perform Secondary Survey — confirm no other burns or injuries.
14 Reassess pain score following cooling and dressing — expect reduction to approximately 4/10.
15 Advise father that Liam should be assessed by a doctor given the age of the patient and the presence of blistering.
16 Arrange transport or advise ambulance for further assessment and wound review.
17 Monitor patient continuously — record observations every 10 minutes.
18 Document burn mechanism, TBSA estimate, time of burn, cooling duration, dressing applied, and pain scores on patient care record.
19 Scenario ends on arrival of ambulance and IMISTAMBO handover.
20 Attention to hand hygiene will be given throughout the scenario.

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

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