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Today I worked a call involving a pretty serious burn. Let me describe the situation, and then I have a question for the experts here.
The pt was Hispanic with so-so English skills, so getting a good history was a little problematic. He was working on his truck and somehow released hot fluid from the radiator. I don't think it came from the cap, because he had no burns to the chest/neck/face, which you'd expect from a guy standing over the radiator. I suspect he was on his back messing around with the inlet/outlet lines or a leak; the burn pattern looked like the fluid dropped onto his abdomen and then flowed down into the groin and thigh. He was burned across the lower abdomen, right hip, right thigh, into the right groin (including the scrotum), and on the right forearm. The abdominal and hip burns had split skin across them. The other lower area burns were fiery on scene and developed blisters during transport. The forearm burn was reddened but did not blister during our contact time.
On scene we found the pt standing in the shower dousing the burns with water, so he had done a good job of cooling things down already. We covered the burns with dry dressings, started a line with LR, gave him some morphine and got truckin'.
Upon evaluation at the ED (a level 1 trauma center), the doc decided to send this pt to the burn center at Augusta, Georgia. He felt the overall status of the burns was not too bad for them to handle locally but the involvement of the scrotum was what pushed him to send the pt to the burn center.
So now to my questions, spurred by this call: what are your recommendations for dealing with a non-trivial burn in a wilderness/austere situation involving extended evac? Wet dressings or dry? Bacitracin ointment or not? Occlusive dressings or breathable? In my research and in personally questioning various docs I have gotten a wide range of answers that are sometimes divergent.
Most of the info out there (especially textbooks) assumes quick transport to expert care.
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