According to this study:

* IV and airway access present the greatest challenges.

* The safety of the patient is not compromised by long-distance travel.

In a recently published study evaluating errors in the initial evaluation and transportation of burn patients, researchers found that, overall, patients can be safely transported long distances to a regional burn center; the most common complications found were the inability to secure IV access and to establish an airway.

The researchers examined transportation of burn patients to a single regional burn center from more than 90 miles away. The primary outcomes were the duration of transportation, errors in the estimation of burn size (and, consequently, in fluid replacement), the appropriateness of intubation, and complications. During a three-year period, the records of 424 patients were analyzed. The mean age of the study subjects was 31.8 years. Three-quarters of the patients were men. Approximately 17% had sustained inhalation injuries, and the mean burn size was 16.7% of the total body surface area. It took an average of 7.2 hours from the time of injury for patients to arrive at the burn center.

An overall comparison of mean burn sizes as assessed at referring institutions and at the burn center revealed that referring clinicians tended to overestimate the burn size: 22.8% versus 16.7%, respectively. Specifically, the overestimations were made in patients with smaller burns (0% to 15% of total body surface area). No significant differences were found in the overall volume of fluid replacement, however, in either the mean liters received or the mean liters predicted to be needed. Only 61% of the 111 patients intubated prior to arrival at the burn center actually had inhalation injuries, and approximately half of the patients were extubated within 24 hours. The researchers also noted that no deaths occurred during the transport of any of the patients. The two most common complications--the inability to secure an airway and either the loss of an IV line or the inability to secure one-occurred in small numbers of patients (three and four patients, respectively).

The analysis demonstrated that the error most commonly made before arrival at the burn center was the overestimation of burn size, which can cause problems if, as a consequence, fluid is incorrectly administered. However, despite those errors in estimation, no significant errors in fluid administration were noted. The authors surmise that that might be attributable to some patients receiving either more or less fluid than was predicted to be necessary, which could cancel out errors in the calculation of the mean amount. Nevertheless, the absence of deaths and the low rate of complications led the authors to conclude that burn patients can be efficiently and safely transported over long distances to regional burn centers.-AK