In the Berlin metropolitan area, paramedics and emergency physicians caring for severely burned patients need to consider long transport times. Current adherence to prehospital treatment recommendations is unsatisfactory.

Because there is no convincing evidence regarding the suggestion to primarily use ketamine in severely burned patients and because Central European practitioners seem to prefer opioids as first-line analgesia, some aspects of the existing guidelines might need to be reviewed. Nevertheless, the international guideline recommendation to limit prehospital fluid administration to fixed amounts is based on reasonable considerations and currently insufficiently executed.

The training of EMS staff and emergency physicians should focus on adequate but cautious fluid administration in early resuscitation.

Currently, many patients are intubated after severe burn injuries. Our data underscore the potential for harm from unnecessary intubation.

Further research is needed to stratify the indications for prehospital intubation in severely burned patients.

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