Saving Lives is Not Enough

Saving Lives is Not Enough is a casualty-centred proposal identifying how fire and rescue services can improve pre-hospital care and quality of life outcomes for burn survivors. In ten recommendations (Elements) it argues that existing practice fails to recognise the crucial importance of this early phase and, as a result, does not provide burn survivors with the best care, experience or quality of life outcomes. It sets out how the Fire and Rescue Service is well placed to make a greater contribution but needs to change its focus and practice.

The saving or preserving of life where it is imminently threatened by an emergency will always be the main priority for first responders and subsequent care providers. But with ongoing advances in technical knowledge and capability, being content to save a life is no longer enough.

The quality of life achieved for survivors matters very much. This extends well beyond any obvious physical injury to include the potential for long-term health risks including psychological injury and being left vulnerable to secondary consequences or harm.

Surviving a burn can be a long, painful and challenging process both physically and psychologically. Even small burns can be life changing due to an inability to resume previous work or as a result of adjusting to visible differences and others’ reaction to them. The research suggests it is within the current ability of the pre-hospital responders to better recognise and address this broader set of aspirations.

A brief overview of five of the ten Elements is provided below to give a flavour of the recommendations.


“It [the report] sets out how the Fire and Rescue Service is well placed to make a greater contribution but needs to change its focus and practice”


Element 1

Use the 999 call to manage casualties during the pre-attendance period (remote assistance). It is suggested that the 999 call include the requirement to seek information from the caller about the presence and status of casualties. If necessary, first aid advice could then be provided remotely by the FRS control or by transferring the call to the Ambulance Service. The call should also be routinely kept open until the crews arrive in order that any further developments in terms of casualties are known about and updates passed onto incoming crews.

Element 3

Develop the ability to protect casualties from first contact. It is proposed that the FRS should develop the ability to enter a property routinely equipped to protect casualties from smoke and heat as soon as they are located and during their egress. Ideally, any solutions should seek offer casualties the same level of protection as that of the FRS personnel.

Element 6

Develop a water strategy for the optimal cooling of burns. Most burn and scald injuries occur within the domestic environment. In the UK, mains-delivered water is easily accessible within these settings and is an optimal water source to deliver the initial cooling for thermal and chemical injuries. The versatility of mains-delivered water provides multiple cooling options within a sheltered and controlled environment.

Element 7

Attend burn and scald-only incidents to provide first aid. Specialist burn services see a wider range and higher volume of burn injuries than the FRS encounter. The most prevalent injuries are scalds from hot liquids. A typical burn or scald is usually not life-threatening and the response time of the Ambulance Service may reflect this lower prioritisation, potentially missing the opportunity to cool the burn in a timely manner. In such situations, or when the Ambulance Service is under pressure, the FRS could provide an alternative response in order to deliver appropriate first aid.

Element 8

Communicate circumstances of burn injury to clinical care providers. Understanding the circumstances of a burn injury may be of vital importance to those providing medical interventions whether at the scene, hospital or in a specialist burn service. A range of information, often obvious to the FRS at the scene, could inform better treatment and outcomes if it were provided to the clinical care teams. The FRS should liaise with the burns sector to identify what scene information would most assist clinical care teams to enhance their diagnosis, treatment and understanding of burns.

Remaining Elements

The other Elements cover: using an evidence-based model to improve search and rescue tactics; recognised that age matters; assess the benefit of fully cooling burns prior to removal from fire ground; assess the influence of FRS actions and terminology on psychosocial recovery; and, introduce a customer reported experience and outcome framework.

The report concludes with two lessons learned that look at national policy regarding customer experience and the process of inter-service planning. It argues that the latter needs to be improved to avoid a ‘sum of the parts’ outcome.

The proposals offer a tangible opportunity for a national multi-agency collaboration with a view to support and, more importantly, expect an evidence-based, standardised practice approach to casualty-centred pre-hospital burn care.

The report can be downloaded from

An infographic and presentation slide set to aid discussion have also been produced and are freely available on request by completing the contact form at:


About the Authors:

David Wales

Founder – SharedAim

After a distinguished career in the Fire and Rescue Service, David now runs a customer experience and organisational improvement consultancy. He also has voluntary roles as the International Research Lead for the National Fire Chiefs Council and an Evidence Champion with the Alliance for Useful Evidence. He is currently studying for a MSc in Risk, Crisis and Disaster Management.

He instigated and led an award-winning research project to understand human behaviour in dwelling fires, which has been highly influential in the UK and internationally. It also had a significant personal impact and led David to champion the need to put the customer (external and internal) at the heart of service design. His interest in organisational decision-making, leadership, the future workforce and innovation grew from there.

David is an established author (including co-author of Saving Lives is Not Enough report) and presenter and has extensive experience of working regionally and nationally across multiple sectors.



Kristina Stiles

Head of Clinical Services

The Katie Piper Foundation

Kristina is a burn specialist nurse with an interest in pre-hospital and trauma burn care and first aid, active in bridging the gap between the Fire and Rescue Service, Ambulance, HEMS, trauma and specialist burn services.

A founding member and past Chair of the British Burn Association’s (BBA) Pre-Hospital Specialist Interest Group and BBA Education Committee member, Kristina is an advocate for the pre-hospital care providers in recognition that they are an essential part of the patient’s journey through burn injury and are an integral part of the seamless burns team.

Kristina is a visiting lecturer to higher education institutions, has authored national burn clinical practice guidelines, published in peer reviewed journals, presented at national and international burns and emergency care conferences and is the co-creator of The Burns Game and the co-author of the Saving Lives is Not Enough report

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