21. Burns and Plastic Surgical Problems

Helicopters can be advantageous when transporting patients with serious burns for treatment at a burn unit.

Photo: Rigshospitalet



As a general rule, patients with second- and third-degree burns covering more than 10% of their body surface in the case of children, more than 15% in the case of adults, and more than 5% in the case of elderly people above 65 years, must always be transferred to a specialist burn unit.

Burns like the abovementioned or greater will put the patient into shock within 6 hours, and this will require intensive fluid regulation treatment in a hospital. Because of that, the transfer to burn unit is urgent and should be terminated within 6 hours.

All burns must receive cold-water treatment until the pain ceases (for 15-20 minutes minimum). This will often mean rinsing for hours. 

Minor burns

Including minor burns that are so small that anti-shock treatment is not necessary. These give rise to no aeromedical problems.

The burn should continue to be kept cold during transportation to the hospital, e.g. using cold water.

Circumferentially burned extremities with second- and third-degree burns can give rise to distal ischemia. If the clinical symptoms are present, an escharotomy (decompression incisions) should be performed, ensuring peripheral circulation, before transportation.

Major burns

As mentioned, patients with extensive burns have to be brought to specialist units, and the transport must be terminated within 6 hours of the occurrence of the injury. The burned areas should continue to be kept cold during transportation using cold water. This can be done by covering the areas with wet sheets or sterile cloths.

Before the transport can be carried out, intravenous accesses need to be obtained, fluid regulation treatment should be started, and heart rate and BP should be monitored.   

If there are any symptoms that the burns might compromise the patient’s circulation or respiration, as it can be seen with larger second- and especially third-degree burns on the chest or neck, an escharotomy should be performed. This may be done during transportation if conditions allow.

Helicopter is often the quickest means of transportation – especially if the relevant hospital is equipped with a helicopter-landing pad.

Large helicopters are able to transport hospital beds, which can be advantageous when transferring burn patients from one hospital to another.

If a 6-hour deadline cannot be met, the patient should be admitted to the nearest local intensive care unit; transfer to a specialist burn unit cannot then take place until termination of anti-shock treatment 3-4 days later. At such time, an ordinary bandage may be applied and transportation of the patient may be carried out by commercial airliner, escorted by a nurse or physician according to the patient’s condition.

Plastic surgical problems

Patients having had surgical procedures done usually do not experience any problems with regard to travelling by aeroplane. This is with exception of large pedicled flaps and free myocutaneos flaps. In theory, staying at cruising altitude for long periods of time can cause compromised oxygen supply in the peripheries of the flaps due to reduced oxygen tension. However, this will only cause problems if peripheral circulation is already poor beforehand.

For given reasons, it is recommended that the types of flaps mentioned are completely healed before going on a longer flight. If the healing process is progressing slowly and the patient needs to be transported anyway, the patient should have an oxygen supply of 2 l/min during the flight.

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