Evaluation of updated National Burn Service escharotomy guidelines—where do we cut now?

Abstract

**Objective**: An escharotomy is a time-critical/emergency limb or life-saving procedure. It may need to be performed by health professionals with little or no previous experience. Both situations occurred during the 2019 White Island (Whakaari) volcanic eruption. While online resources are included as part of the New Zealand National Burn Service website, on review the illustrations were found to lack clarity. The goal of this research was to create updated national escharotomy resources and to test their effectiveness. **Methods**: A literature review alongside expert opinion and a medical illustrator were used to produce up-to-date escharotomy illustrations. A cohort of plastic surgery registrars at Middlemore Hospital, New Zealand, undertook survey-based evaluations. We determined new guideline effectiveness on participant performance following data analysis. **Results**: Of 18 plastic surgery registrars surveyed, 45 per cent were trainees. Our new guidelines produced an improved accuracy of escharotomy placement of 100 per cent, 85 per cent and 90 per cent on torso, upper and lower limbs respectively. On average the greatest improvement was in the non-SET registrars (54% vs 32%). Using new guidelines, 100 per cent of participants felt they could safely perform an escharotomy. **Conclusion**: Our updated National Burn Service escharotomy resources have been evaluated and determined to be easy to use. By incorporating detailed illustrations, we have provided useful and effective escharotomy incision placement guidelines. Difficult areas of the body will require attention in future revisions of this resource. These updated illustrations are a vital step in allowing an escharotomy to be safely performed by those who need to perform an escharotomy but are unfamiliar with the procedure.