((If the trainee does not begin cooling the burn within the first 2 minutes โ 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 โ 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 โ facilitator prompts 'How much of the body surface area is affected?'))
((If cooling is not performed for a minimum of 20 minutes โ facilitator states 'Father asks: How long do we need to keep the water running?'))
((If oxygen is unnecessarily applied โ facilitator prompts 'What is your clinical indication for oxygen in this patient?'))
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.
- Ensure scene safety and don appropriate PPE including gloves.
- Perform Primary Survey โ confirm airway patent, breathing adequate, circulation intact, GCS 15.
- Assess burn site โ identify erythema and intact blisters to right volar forearm, approximately 4cm x 5cm.
- Estimate TBSA using Rule of Nines โ 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).
- Assess for inhalation injury โ inspect nose and mouth for soot, singeing, or blistering โ NONE present.
- Immediately cool the burn with tepid water (approximately 15ยฐC) for a minimum of 20 minutes โ do NOT use ice, ice packs, butter, creams, or toothpaste.
- Record the time the burn occurred (approximately 10 minutes prior to EHS arrival) and the time cooling commenced.
- Remove any jewellery or clothing near the burn site if not adhered to the wound โ check for watch or bracelet on right wrist.
- Perform Vital Sign Survey including pain score โ document pain 7/10.
- Reassure patient (Liam) and father continuously throughout.
- After 20 minutes of cooling, apply damp sterile non-adherent dressing to the burn site.
- Do NOT rupture blisters.
- Perform Secondary Survey โ confirm no other burns or injuries.
- Reassess pain score following cooling and dressing โ expect reduction to approximately 4/10.
- Advise father that Liam should be assessed by a doctor given the age of the patient and the presence of blistering.
- Arrange transport or advise ambulance for further assessment and wound review.
- Monitor patient continuously โ record observations every 10 minutes.
- Document burn mechanism, TBSA estimate, time of burn, cooling duration, dressing applied, and pain scores on patient care record.
- Scenario ends on arrival of ambulance and IMISTAMBO handover.
- Attention to hand hygiene will be given throughout the scenario.
Clinical references: Burn Trauma ยท Primary Survey ยท Secondary & CNS Survey ยท Pain Assessment ยท Minor Wound Management