Burn Injury Assessment: An Interactive Lesson Plan

Greg Friese is a featured speaker at EMS World Expo 2014, scheduled for November 9–13 in Nashville, TN. For more information, visit EMSWorldExpo.com.      

The Virtual Training Director is a column for training officers that utilizes the content of feature articles in EMS World Magazine to help facilitate training sessions. Use or adapt this lesson plan for your organization, its personnel and its local protocols.

Essential Information

   Burns are associated with dramatic mechanisms and often present visual damage that can range from the curious to the horrific. In the Burning Issues article, you will find an excellent primer on burn injury types, assessment and prehospital care. The authors remind us of the importance of burns relative to trauma, as well as the need to manage ABC life threats before specifically caring for burns. EMS providers need to use mechanism of injury details and patient assessment findings to identify the burn cause, severity and type. Use that information to prepare a treatment plan and implement transport to the most appropriate receiving facility.

   Rather than simply presenting a lecture on burns based on the information in the article, I have outlined an interactive training session for participants to create simulated burn injuries that other participants will assess. Before your training session, ask members to read the article so they have the necessary burn knowledge needed for the interactive small group work. (Remember: You can make and distribute copies of any of our articles for education purposes.)

   Time needed: 1 to 2 hours.

Instructor Preparation

   Prepare a moulage kit with enough supplies, appliances and applicators for groups to simultaneously moulage multiple burn patients. You may also wish to prepare patient profiles that each team may use if time is too limited for them to prepare their own patient profile.

Training Objectives

• Understand causes of burns
• Explain different levels of burn severity
• Differentiate types of burns
• Practice burn assessment in small group scenarios
• Review local burn injury treatment protocols

Group Training Outline

1. Introduce the training topic of burn injury assessment by describing the team activity to prepare a patient and then assess all of the other patients.

2. Review the following concepts from the article. Add additional content as needed based on your group's knowledge and experience.

• Burn severity: superficial, partial-thickness and full-thickness
• Systemic inflammatory response syndrome
• Zones of injury: hyperemia, stasis and coagulation
• Burn types: thermal, electrical and chemical

TEACHING TIP: Ask participants to define these terms in their own words with concrete examples.

3. Preparation of interactive activity. Divide participants into three- or four-person teams. Make one person in each team a patient. Each team will plan and deliver a patient assessment scenario that includes:

• Selecting a specific burn MOI--chemical, thermal or electrical
• Using moulage to apply a simulated burn injury to their patient
• Preparing other vital sign and injury findings appropriate to the patient's burn injury and MOI

TEACHING TIP: Each team will probably need 15 to 30 minutes to plan their scenario and apply moulage to their patient. Give a check sheet to each team so they plan all needed components. Assist participants in applying moulage that is realistic for the burn injury type and severity.

4. Assessment rodeo

In a large classroom or outdoor space, arrange patients in a circle, about 15 feet apart. The remaining members of each team will have five to seven minutes with each patient to:

• Determine mechanism of injury
• Expose injuries
• Identify ABC life threats
• Check vital signs
• Gather patient history
• Perform a physical exam to identify traumatic injuries, if present; assess the burn type and depth; calculate burn total body surface area.
• Outline a treatment and transport plan

TEACHING TIP: The instructor tracks the time and calls out when it is time for teams to rotate clockwise to the next patient. If every team starts one position clockwise of their patient, the transitions will be smooth. Each team should assess all of the other patients.

5. Patient scenario discussion. After assessing each patient, reconvene the group in the classroom. Have each team report on a single patient, or you can facilitate a discussion about each of the patients.

TEACHING TIP: Discuss interventions in the context of your local protocols and available receiving facilities.

6. Debrief

• Photograph all of the burn moulage for future training programs
• Award a prize for best moulage application
• Discuss what was done well to understand assessment of burns
• Answer team members' questions about burns by asking, "What questions do you have about assessment and treatment of burns?"
• Conclude the training session with a 3-5-minute reminder about the relative importance of airway management, pain management and fluid resuscitation for burn patients. Finish with a reminder that, when present, trauma is a higher treatment priority than burns.

Alternative Training Topics

• Assess burns by viewing images of burns. Create a slide show of 10 to 20 actual burns. Potential image sources include: news media, hospital image collections or an Internet image search.
• Complete a train-the-trainer program so all members of your department can deliver a fire- and burn-prevention program to kids during station visits, open houses and other community events to help continue the decline in burn deaths. Training program resources are available at:
  • www.firehouse.com/training/drills/sec_prevention.html
  • www.usfa.dhs.gov/kids/parents-teachers/
  • www.firepreventionweek.org.

From the authors of the Burning Issues article:

   The Burn Injury Assessment virtual training activity is well designed. In addition to offering a practical and useful approach, Greg Friese highlights key items that apply to any burn scenario. These include:

• The importance of burns relative to trauma. When trauma and burns are both present, trauma takes priority.
• The need to manage ABC life threats before caring for burns.
• The consideration of mechanism of injury details and patient assessment findings to identify the burn cause, severity, and type.
• The integration of information to prepare a treatment plan and implement transport to the most appropriate receiving facility.

   If you can incorporate these factors within your training program, your personnel are likely to experience a realistic session that has the potential to support them in providing optimal care.

Greg Friese, MS, NREMT-P, is the director of education for CentreLearn Solutions, LLC. He specializes in the development, production and distribution of online education for emergency responders. Greg is a leading advocate for the use of social media by EMS agencies and training organizations. Greg is a regular conference presenter, the co-host of the EMSEduCast, the founder of the EverydayEMSTips.com blog, marathon runner, and participant in many online EMS communities.