Out-of-hospital chest escharotomy: a case series and procedure review

Initial care for the burned trauma patient focuses on the rapid assessment and stabilization of airway, breathing, and circulation. Circumferential chest burns may restrict respiratory effort and inhibit adequate ventilation. When this occurs, chest escharotomy is the recommended treatment to restore chest expansion and therefore ventilation. Emergency medical services (EMS) providers infrequently encounter patients with circumferential chest burns, and escharotomy is generally not included in their scope of practice. The authors could not locate any documentation of other escharotomies performed in the out-of-hospital setting. This case series describes the care of two patients that required out-of-hospital chest escharotomy by physician members of a helicopter medical crew. The procedures of chest and neck escharotomies are reviewed, and the logistics of performing escharotomy in the prehospital setting are described.