burn is an irreparable event , which results in numerous physical , psychological , social , and economic complications .
the burned patients should be merely treated in a professional burn center due to vast clinical range of these patients . since
, a percentage of mortality in burned patients is for the patients transportation from other centers ; this study has aimed to investigate the manner of their transportation to imam mosa kazem hospital .
this is a descriptive cross - sectional study on 98 subjects selected through sequential sampling from thermally burned patients being referred to isfahan burn emergency center by ambulance from august 2011 to november 2011 .
the data including demographic information and event details , burned surface , burning grade and the province of origin were collected by a questionnaire , as well as a checklist related to caring team standards , transportation team , transportation equipment , and outcomes .
based on the findings , the longest transportation time was 6.35 ( 4.30 ) hours .
there was no association between patients hypothermia and cooling the burn in the patients at the event location .
there was a significant association between intake of fluid within transportation and urine output and hypovolemia ( p = 0.00 ) .
most of the defects of treatment were related to the equipments and infection control devices .
the findings showed that burned patients transportation is so far from standards in iran , and the authorities should pay specific attention to that in form of vast national investigations .
it is among the most mortality and disability causes in iran and developed western countries .
burn is the third mortality cause after car accidents and drowning in the united states while this is the sixth in iran .
at least , eight people daily die of burning in iran with mean age of 35.7 years .
burn can be as a result of direct contact of materials or things with skin and lungs which are categorized a thermal , chemical , electrical , radiation and inhalation burns .
thermal burns are the results of direct contact with flame , hot liquids , steam and materials like fuel or tar as well as hot things .
the burned patients are predisposed to hypothermia , hypovolemia and hypoxia due to impaired skin and burning severity .
burning complications increase the risk of infection , healing disorder and high mortality . on time and appropriate on - site intervention of the surrounding individuals toward the burned persons can reduce the injury to minimum while inappropriate and non - scientific interventions can result in irreversible injuries and even mortality .
appropriate transportation of the burned patient to professional burn centers prevents complications and further injuries to skin , resulting in the least injury severity .
transportation of the burned mostly has two phases : the first phase transportation from the burn location to the primary center , and the second from the primary center to the secondary professional burn center .
many of the burned , receive early treatment in local emergency wards before being transported to burn centers .
transportation is suggested to be carried out within the first four hours postburning to prevent complications , and not to be longer that four hours . in case of transportation in specific patients such as the burned patients who should be transferred to professional centers , or when only a few hospitals have been assigned as a professional center ,
the transportation time to the professional center may be a little longer than to emergency ward .
safe transportation of the patients requires appropriate programming in hiring the trained staffs , use of appropriate equipments , and through an efficient communication among the referrer , transporter and receiver
. the patient should be transferred at appropriate time , through efficient staff , and to appropriate location .
various studies have argued that the burned patients who had received better nursing care from location of event to hospital show lower mortality .
the physician and the nurse accompanying the burned patient should have adequate knowledge and skills concerning burn care to be able to prevent complications in the patients .
hypothermia in burning is the result of impaired skin and being exposed to the environment as well as getting necked and disturbed body heat process . in this case
the most emergency priority , after management of respiratory problems , is prevention of irreversible hypovolemic shock , which can be treated by fluid and electrolytes therapy . for the patients with
urine output of the patient should be measured and recorded in the first 24 hours postburning . as the risk of infection is very high among the burned patients due to various reasons , dressing of the patients wounds during transportation to prevent wounds infection is crucial so that the patient should never be transported with open wounds , or without a sterile cover .
burned patients should be ideally cared in professional burn centers , there are eight professional burn centers in iran which admit burned patients from other provinces .
this low number causes the long transportation time of the burned patients in some areas .
this problem shows the importance of patients transportation and prevention of early outcomes due to inappropriate transportation including hypothermia , hypoxia , and hypovolemia . since isfahan imam mosa kazem hospital , as a professional burn center , daily admits a high number of the patients from various cities in the province and other provinces , the researcher decided to investigate the present condition in order that the results would bring about strategies to modify these patients care and their appropriate transportation based on international standards .
the researcher started sampling after getting permission from isfahan nursing and midwifery school and declaring the research goals to the head of hospital , manager and matron .
the subjects were selected through sequential sampling from thermally burned patients , transferred to isfahan burn hospital by ambulance in a two - month interval from august to november 2011 .
the other patients with electrical , chemical , or those taken to hospital by personal cars were omitted from the study .
then , the patients were transferred to dressing room by the stretcher , next , the researcher described the research goals to the patients transferring team and selected the subject and started data collection .
first of all , subauxiliary temperature was measured for the patient by a hg thermometer , and then 2 cc of atria blood sample was taken for abg and sent to laboratory .
next , patient s blood pressure was measured by a monitoring device and recorded and finally , urine output of the patient was measured and recorded .
the data were collected by a questionnaire containing demographic characteristics and some information on the event , burn surface percentage , the degree and the province of origin .
the other data were collected by a checklist including four domains : caring standards , transportation team , equipments and ambulance medications , and transportations outcomes .
the standards in the checklist were assigned in the spectrum of  adequate  and  not adequate . 
the checklist was either ticked by the researcher or the project cooperator , and laboratory results were recorded in that too .
the employed checklist in the present study was confirmed by content validity through consideration and evaluation of some academic members in medical and nursing school , isfahan emergency center and some personnel in imam mosa kazem hospital .
the data were analyzed by descriptive statistical tests such as central indices , dispersion , frequency distribution , and fisher s exact test and chi - square test through spss .
there were 98 subjects of whom 68.4% were male . from 14 various provinces except isfahan transported to the center , khouzestan province had the highest number of transportation to this center ( 29 patients ) .
mean time of departure to destination was 6.35 ( 4.30 ) hours for private ambulances , and 2.10 ( 1.13 ) hours for inter centers transportation .
the most frequent cause of thermal burn was for gas explosion in 26 subjects ( 36.7% ) , and burn of petrol and cresson in 34 subjects ( 34.7% ) , respectively .
the most frequent burn percentage was 30 - 60% in 38 subjects . in 20 subjects
only 12 subjects had received o2 during transportation of which 8 subjects ( 72.8% ) had received that through mask , 2 subjects ( 18.2% ) through nasal canola and one subject by intubation . only two subjects ( 2% )
fisher s exact test showed no significant association between patients o2 intake and hypoxia in the present study [ table 1 ] .
body temperature was  36.5c in 17 subjects ( 17.3% ) while only three subjects had body temperature lower than 35c .
from all subjects , in 89 ( 93.7% ) the burn had been cooled by running water of whom 48 ( 63.9% ) had received that for 5 minutes . in eighty - five subjects ( 90.4% ) ,
no significant association was seen between patients hypothermia and cooling their burn at the event location in the present study .
the association between the received o2 during transportation and hypoxia seventy subjects had been kept warm during transportation of whom 39 ( 54.2% ) were kept warm by a blanket and 33 ( 45.8% ) by a sheet .
fisher s exact test showed that there was a significant association between being kept warm during transportation and patients hypothermia ( p = 0.003 ) [ table 2 ] .
only 54 patients ( 56.3% ) had received adequate fluid during transpiration , and only in one subject urine output had been recorded in transportation form . for 44 subjects ,
sixty - nine subjects ( 73.4% ) had received lactated ringer s serum , 12 normal saline , and 13 subjects ( 13.8% ) had received ringer s serum .
chi - square test showed a significant association between the amount of received fluid during transportation and patients urine output in the present study ( p = 0.000 , table 3 ) analgesic medication had been administrated for 84 patients ( 86.6% ) during transportation of whom 18 subjects ( 21.7% ) had received morphine , 22 ( 26.5% ) methadone and 43 subjects ( 51.8% ) had received pethidine .
forty - two subjects ( 42.9% ) had appropriate dressing at the time of transportation .
the association between patients hypothermia and keeping them warm during transportation the association between received fluid and urine output appropriate transportation team members had been selected for 93 subjects ( 94.9% ) , and the defects were for equipments , infection control accessories such as a sterile gown , a cap , a disposable mask , gloves , and antiseptic liquids .
based on the obtained data in the present study , most of the thermally burned patients , hospitalized in imam mosa kazem center , had been transported by ambulances .
reported that 5.5% of the patients had been transported to the first medical center by ambulance while 94.5% by personal cars .
this issue can be due to the patients receiving their primary care in their local centers , and then , being transported .
the present study showed that 2/3 of the transportation had been made by ordinary ambulances .
since the present study showed that the share of emergency center to give services to the city citizens is high , a basic strategy should be considered to enhance the process of burned patients transportation and equip the ambulances . in the present study ,
most of the patients had been transported from another center to imam mosa kazem hospital . in kousha
s study , 51% of the hospitalized patients were from other centers of which most of them had been transported between provinces by private ambulances .
authorities should pay close attention to the services of private organizations and the quality of their services .
contrary to the other studies , most of the burns were for scalds in the present study .
about 36.7% of the patients had been transported to isfahan burn center due to gas explosion .
this increase in number of burns with gas explosion can own to the fact that since this sort of burn is of extant surface and occurs outdoors , isfahan emergency center was employed to transport the patients . on the one hand ,
cng cars and devices are utilized more in the recent years , which reveals the necessity of public education concerning use of cng cars and devices , and periodical cng car technical tests .
percentage of burn surface of the patients hospitalized in isfahan burn center is consistent with barillo s .
the findings of the present research showed that o2 therapy was very low among transported patients while andrew s reported only 0.5% of cases had o2 sat < 80% . in other studies , about 94.2% of the patients had received o2 at the time of transportation . in the present study , patients received o2 while transportation was not significantly associated with hypoxia .
it can be possibly due to insufficient o2 therapy and lack of patients respiratory monitoring .
s study , 1.6% of the patients were hypothermic , and the lowest temperature was reported as 36.6c .
high percentage of hypothermia among the patients in the present study can be , like other studies , due to long distance of transportation and not paying attention to keeping the patients warm during the transportation . in the present study , like that of lonnecker s
there was an association between keeping the patients warm during transportation and hypothermia ( p = 0.003 ) .
in lechleuthner study , only 1.5% of the patients did not have adequate fluid therapy while in the present study , many patients had not received adequate fluid during transportation .
this finding shows that the patients in the present study were at a higher risk of hypovolemia and hypotension .
the findings in the present study showed that there was a significant association between the fluid received during transportation , and hypovolemia and patients urine output ( p = 0.00 ) .
many patients had received analgesic medication in the present study while in lechleuthner s study , 22% of the patients had received analgesic medication .
the difference in these percentages can possibly be due to long distance of transportation in the present study compared to other studies .
most of the patients had been transported by appropriate transportation team members in the present study , which almost concords with other studies .
the fewest defects were for equipments related to infection control indicating that infection control is ignored at the time of transportation .
in malmir s study , the highest defect has also been for medications and medical facilities in ambulance . based on the obtained findings
, it is concluded that burned patients transportation in iran is so far from standards . since the consequences of inappropriate transportation affect wound healing process and result in longer hospitalization and higher treatment costs
, it is suggested to diminish treatment costs of the burned patients through assigning a trained and professional transportation team for these patients .
one of the main limitations of the present study was the season the research was conducted in .
the prognosis of the transported patients to burn centers is also suggested to be analyzed .
 background and goal : burn is an irreparable event , which results in numerous physical , psychological , social , and economic complications . the burned patients should be merely treated in a professional burn center due to vast clinical range of these patients.since , a percentage of mortality in burned patients is for the patients transportation from other centers ; this study has aimed to investigate the manner of their transportation to imam mosa kazem hospital.materials and methods : this is a descriptive cross - sectional study on 98 subjects selected through sequential sampling from thermally burned patients being referred to isfahan burn emergency center by ambulance from august 2011 to november 2011 . 
 the data including demographic information and event details , burned surface , burning grade and the province of origin were collected by a questionnaire , as well as a checklist related to caring team standards , transportation team , transportation equipment , and outcomes . 
 the data were analyzed by descriptive statistical tests.results:based on the findings , the longest transportation time was 6.35 ( 4.30 ) hours . 
 there was no significant association between patients o2intake and hypoxemia . 
 there was no association between patients hypothermia and cooling the burn in the patients at the event location . 
 there was a significant association between intake of fluid within transportation and urine output and hypovolemia ( p = 0.00 ) . 
 most of the defects of treatment were related to the equipments and infection control devices.discussion:the findings showed that burned patients transportation is so far from standards in iran , and the authorities should pay specific attention to that in form of vast national investigations . 
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