Life threatening burn injuries on holidays: problems of primary care, homeland referral and treatment at a domestic burn centre

Life threatening burn injuries during vacations abroad raise special proble ms. Depending on the infrastructure of the country, adequate medical care c an be delayed and communication between the patient and the medical staff i s frequently impossible due to language barriers. Often the patient finds h imself in a critical condition, isolated from supporting relatives and fina ncial difficulties may occur. By summarising three cases referred to our ce ntre, we aim to emphasise particularities of the primary management of burn ed victims at foreign hospitals, their transport, and following therapy at a domestic burn unit. Primary shock treatment and vital surgical interventi ons, e.g, escharotomy or treatment of the concomitant trauma, are subject t o the facility of the hosting country. After management of the acute phase and initiation of local wound treatment, the next step should be to stabili se and prepare the patient for transport. Aeromedical transportation with p hysician attendency, as well as contact with a domestic burn centre can be established via responsible organisations. At the domestic hospital, every burn victim from abroad deserves special attention. Wound colonisation with different bacterial species or fungi than the usual spectrum of the centre and the risk of crossinfections should be taken in account of the treating medical team. An structure plan for appropriate and continuing surgical tr eatment is necessary to prevent deterioration of the patient's condition an d to optimise wound closure with autologous skin grafts or allogenic materi als. (C) 2001 Elsevier Science Ltd and ISBI. All rights reserved.