Saving Lives Is Not Enough: More is Needed in the UK

Saving Lives Is Not Enough: More is Needed in the UK

By: David Wales

Saving Lives Is Not Enough (SLINE) is the title of a report co-authored by David Wales and Kristina Stiles and published by the Emergency Services Times (August 2019). It details the findings and recommendations from research undertaken in the UK, to understand the experience of burn survivors. A snippet of this report is outlined in this short article.

Between 2010 and 2014, 63,734 people received a burn injury requiring treatment by a specialist burns service, of which 11,190 were fire or accelerant related.

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.

This research began in recognition of the limited dialogue between the agencies along the care pathway and the lack of a co-ordinated, end-to-end view. Further, it became apparent that the pre-hospital phase offered potential for improving the experience and outcomes for burn survivors.

The report sets out ten recommendations (elements) for improving the pre-hospital care, experience and outcomes for burn survivors. The primary audience for these is the Fire and Rescue Service, although by necessity they require the engagement of the wider emergency service family. These new and transformative insights were uncovered by placing the survivor journey and experience at the centre of the research and using an evidence-based approach. The elements relate to operational practice and first aid options and do not address clinical practice.


The following research objectives were set for this study:

  1. To map the end to end journey of a burn and scald survivor
  2. To understand the experience and (non-clinical) requirements from the perspective of a burn or scald survivor
  3. To examine the role of the Fire and Rescue Service and others involved in the pre-hospital phase.

The research was undertaken using a mixed methods approach. These included data analysis, content analysis, literature review and ethnography based on engagement with burn care professionals over a six-year period from 2006 to 2016. These were supplemented by customer experience methodologies such as journey mapping.


Objective 1: The burn or scald survivor experience is in effect a fragmented ‘sum of the parts’ model rather than a coherent and integrated system by design. This is due to the lack of an owner (individual or a body) with responsibility for the entire survivor journey and the absence of a formal and integrated end to end planning process.

Objective 2: The report identifies that the experience of being a burn survivor is very different to the experience of the professional responders. For the survivor, it is very much an emotional experience and one in which how they are made to feel is important.

Objective 3: The Fire and Rescue Service, and other pre-hospital responders, currently focus on the immediate preservation of life and removal of the survivor from the scene to hospital. This approach does not recognise the requirement, and opportunity, to provide scene-based care that will also achieve the best quality of life outcome for the survivor.


Phase Number Element
Remote assistance 1 Use the 999 call to manage casualties during the pre-attendance period
Search and rescue 2 Use an evidence-based model to improve search and rescue tactics
3 Develop the ability to protect casualties from first contact
Treatment at scene 4 Recognise that age matters
5 Assess the benefit of fully cooling burns prior to removal from fire ground
6 Develop a water strategy for the optimal cooling of burns
7 Attend burn and scald only incidents to provide first aid
Scene to surgeon 8 Communicate circumstances of burn injury to clinical care providers
Psychosocial recovery 9 Assess the influence of FRS actions and terminology on psychosocial recovery
Customer experience 10 Introduce a customer reported experience and outcome framework

Lessons Learned

The elements address what may be considered operational issues. Recognising that practice evolves within a wider environment led to the identification of two strategic recommendations:

  • an integrated customer experience vision, principles and framework should be developed to direct individual and combined emergency service activity
  • inter-agency partnerships should ensure that they routinely adopt transparent, structured, consistent and evidence-based methodologies for service planning and design

Report link:

Author Bio:

After a distinguished career in the Fire and Rescue Service, David founded SharedAim, a customer experience and organisational improvement consultancy. He is 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.

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