Winston chats to us about burns and the treatment of these in the prehospital environment    Top 3 tips:  Take a SAFE approach  Stop the burning process  Cool the burn but not the patient    Biography:    Dr de Mello undertook his medical training at Guy’s Hospital and Southampton. He served in the RAMC as a Regular and Reservist from 1976 to 2013 ending his military career as Colonel TA BATLS from 2007-2013. His NHS employment as an Anaesthetist and Pain Medicine Physician was at Mid Yorkshire and Manchester University Hospital. His clinical interests include pelvic pain, burns, pre-hospital care and trauma. He is a Founding Member of the Pre-Hospital Care Faculty at the Royal College of Surgeons Edinburgh and the College of Remote & Offshore Medicine at Malta. He retired in 2020 and is Trustee at the Vulval Pain Society UK and Chair of the Pre-hospital SIG at the British Burns Association.      Links and resources:   Clinical Pearls:  Take a SAFE approach: Shout for help, Approach with care, Free from danger and Evaluate the ABCs  Stop the burning process by getting the victim to drop to the floor and roll, remove clothing and jewelry  Provide supplemental oxygen after clearing the airway  Check both radial pulses  If a burn patient is hypotensive within a couple of hours of the injury look for another source of blood loss – check the mechanism of injury  Stop the burning process  Cool the burn for a minimum of 20 minutes using cool water for up to 3 hours post burn  Keep patient warm  Loosely cover the burn with clingfilm  Sit up (if permissible) especially in burns involving the head and neck to minimize the swelling  Clingfilm also provides analgesia  Beware circumferential burns  The normal oximeter cannot detect carbon monoxide – and will falsely give a high saturation reading  Fluid resuscitation in adults in pre-hospital burns can be simplified by adopting the   “small man, small burn small bag; big burn, big man big bag” – which simplifies to either a 500 ml or 1000 ml bag of Hartmann’s Solution intravenously/intraosseously per hour  TBSA calculation in the pre-hospital can be difficult and is usually overestimated  Electrical burns may need 24hour ECG monitoring in vulnerable patients  Chemical contamination needs copious irrigation with water ideally within 10 minutes of contact except for elemental sodium, potassium or lithium  Alkali burns are worse than acid