Burns (fire/flame) Date Last Search Run: Mar 03, 2025 Table last updated: Mar 03, 2025 Data last added: Mar 03, 2025

Recommendation		RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION		SUPPORTIVE (Green)	NEUTRAL (Yellow)	AGAINST (Red)	NOT YET GRADED (White)
	1 (strong evidence exists)	Opioids	Crystalloid Fluid		Balanced crystalloids Dry Dressing
	2 (fair evidence exists)	Nitrous Oxide	Wet/hydrogel dressing
	3 (weak evidence exists)

Interventions

Balanced crystalloids

Level

Direction

Primary Outcome

Patient/Process

Setting

Reference

Crystalloid Fluid

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
I	Neutral (Yellow)	Mortality	Patient	ICU	Lewis SR, Pritchard MW, Evans DJ, Butler AR, Alderson P, Smith AF, et al. Colloids versus crystalloids for fluid resuscitation in critically ill people. The Cochrane database of systematic reviews 2018; 8. Medline
II	Neutral (Yellow)	Interventions assoicated with decreased mortality in severely burned patients	Patient	PH-Paramedic & MD	Josuttis D, Kruse M, Plettig P, et al. Prehospital treatment of severely burned patients: a retrospective analysis of patients admitted to the Berlin burn centre. Scand J Trauma Resusc Emerg Med Aug 2024; 32(1):70. Medline
III	Supportive (Green)	Dyspnoea clinical score and on arterial blood gases	Process	ED-MD	Bak V., et al. Hemodynamic Changes During Resus Burn Pt. Using Parkland Formula. J. Trauma 2009; 66(2):329-36. Medline
X	Not Yet Graded (White)	-			Hsiao KH, Kalanzi J, Watson SB, Murthy S, et al. Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review. Burn Open Nov 2024; 8(4). Medline

Dry Dressing

Level

Direction

Primary Outcome

Patient/Process

Setting

Reference

Nitrous Oxide

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
II	Supportive (Green)	Analgesia	Patient	PH-Paramedic	McKinnon KDL. Prehospital analgesia with nitrous oxide/oxygen. CMA Journal 1981; 125:836-40. Medline
III	Supportive (Green)	Pain relief	Patient	PH-Paramedic	Amey BD., Ballinger JA., Harrison EE. Prehospital Administration of Nitrous Oxide for Control of Pain. Ann Emerg Med 1981; 10(5):247-51. Medline
III	Supportive (Green)	Patient satisfaction	Patient	PH-Paramedic	Johnson JC., Atherton Gl. Effectiveness of Nitrous Oxide in a rural EMS System. The Journal of Emergency Medicine 1991; 9:45-53. Medline
III	Supportive (Green)	Analgesia	Patient	PH-Paramedic	Peterson TD., Kerns DE. Prehospital Pain Control: Nitrous Oxide Inhalation. Iowa Medicine 1989; 15-7. Medline

Opioids

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
I	Supportive (Green)	Analgesia	Patient	PH-Paramedic	Bounes V., Charpentier S., Houze-Cerfon CH., Bellard C., Ducassé JL. Is there an ideal morphine dose for prehospital treatment of severe acute pain? A randomized, double-blind comparison of 2 doses. Am J Emerg Med 2008; 26(2):148-54. Medline
I	Supportive (Green)	Pain relief using the visual analog scale score	Patient	PH-Paramedic	Galinski M., et al. A randomized double-blind study comparing morphine with fentanyl in prehospital analgesia. Am J Emerg Med 2005; 23:114-9. Medline
II	Supportive (Green)	Analgesia	Patient	PH-Paramedic	Ricard-Hibon A., et al. Compliance with a morphine protocol and effect on pain relief in out-of-hospital patients. J Emerg Med 2008; 34:305-10. Medline
III	Supportive (Green)	Pain rating	Patient	ED-MD	Coletta F, Pirolli R, Annunziata R, et al. Efficacy and Adverse Effects of IV Morphine for Burn Pain Management in the Emergency Department: An Observational Study. Pain Ther May 2024. Medline

Wet/hydrogel dressing

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
II	Neutral (Yellow)	Clinical effectiveness	Patient	PH-Paramedic	Goodwin NS, Spinks A, Wasiak J. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature. International wound J 2016; 13(4) 519-25. Medline