Bystander rescue–victims of thermal injury

Prof. John Pearn

1Queensland Children’s Hospital, South Brisbane , Australia


The clinical outcome for victims of thermal injury depends significantly on bystander action at the scene of the initial burn. Bystander action may save life, by rescue or by the extinguishing of flames; or by reducing complications which lead to death from respiratory injury or from secondary infection. Best-practice first aid may reduce the need for skin grafting; and can modify the rate and quality of healing. However, before first aid can begin, rescue and control of the incident site is crucial to the outcome of thermal injury. Bystanders are faced with an inescapable decision whether to attempt a rescue (or not), and the decision to choose the best method for the extinguishment of flames. This is the “rescue phase”, currently a relatively neglected theme. In 1981, the St John Ambulance Association introduced the primacy of “D” for “danger” in the pedagogic first-aid mnemonic, now in its current form of DRSABCD. Most secondary threats to the victim and risks to the rescuer come from high-energy sources [e.g. flames], and most involve a repetition of the primary incident. Current doctrine teaches four elements in how best to act in the rescue phase of a casualty suffering from thermal injury. These imperatives are: (a) assess for danger; (b) to use protection if a rescue is undertaken; (c) to train in techniques for extinguishing the flames of a burning casualty; and (d) to train in the methods of physical retrieval to a safe place – where the standard dictates of DRSABCD can continue.


Major General Professor John Pearn is a Senior Paediatrician at the Queensland Children’s Hospital. He is a former Surgeon General of the Australian Defence Force; and for 10 Years was the National Director of Training for St John Ambulance Australia. He is a long serving member of the Australian Resuscitation Council

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