Purpose: To survey the emergency transportation status of burn patients in the area.
 Method: We retrospectively examined the emergency medical system records of burn patients transported by the Nara Wide Area Fire Department, which holds jurisdiction over central and southern Nara Prefecture（population 852,307, area 3,361km²）, between January 2014 and December 2018.
 Results: A total of 593 cases were included, 417（70.3%）of which were mild.
 The median number of calls for hospital acceptance was 1（interquartile range 1-2）, but infants aged under 6 required 3 or more calls in 39 cases（20.2%）, a higher rate than for other age groups. In addition, the median on-scene time was slightly longer for adults aged 18 to 64 and seniors aged 65 and over（18 and 19 minutes, respectively）.
 Conclusion: This survey of the emergency transportation status of burn patients revealed that infant burn cases required more calls for hospital acceptance, whereas the on-scene time was slightly longer for adults and seniors.

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 Introduction: Allograft is well known to be useful in the treatment of extensive burn patients, but considering the small amount of stock in Japan where a large number of burn patients are expected in event of a disaster, artificial dermis is used to the maximum extent. Thus, it is highly important to be familiar with the treatments for burn patients. At this facility, since the suspension of skin bank activities in August 2015, we have been actively utilizing artificial dermis and evaluating its usefulness. For 96% of burn patients in 2016 and 86% of burn patients in 2017, we used artificial dermis without using Allograft. Using artificial dermis alone, the lives of over 80% of patients with widespread burns were saved. We report the usefulness of artificial dermis based on a retrospective study of the use of Allograft and artificial dermis in patients with extensive burns.

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 Major burn patients develop coagulopathy or anemia; therefore, blood products are necessary for the treatment of major burns in many cases. Patients with major burns who refuse blood products because of their religious affiliation, such as being a Jehovah’s witness, are challenging because blood transfusion cannot be used as an intervention. A 60-year-old man presented to the emergency department with a scald burn covering 52% of the total body surface area after falling into hot water. He was a Jehovah’s Witness and refused to accept blood transfusions as treatment. Treatment was initiated using only crystalloids without blood products. He did not develop coagulopathy or anemia, and the burn wounds healed with conservative treatment. The guidelines state that the rights of patients should be fully respected, but it has also been suggested that if there is a conflict in treatment policy, the patient may be transferred to another hospital. However, this does not solve the problem. We need to communicate sufficiently with the patient and family, and provide effective medical care.

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 Hand burns account for more than 80% of all burns. Deep burns of the hand are classified as “severe burns” based on Artz’s criteria.” The anatomical features of the dorsum and palm are different. As the skin on the extension side is thin, damage due to a burn can easily extend to the underlying tissue such as the extensor tendons, joints, or bones. This can result in infection and contracture in the post-burn hand when there is a long period before epithelization. After the underlying tissue is exposed, the dorsum of the hand should be constructed with free flaps or local flaps, but adaptation must be examined in consideration of the need for surgery and postoperative rest. We report the reconstruction of an exposed extensor tendon in both thumbs with deep burns using a pedicled groin flap and digital artery island flap.

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 A 28-year-old woman presented with burn wounds on her upper left arm. She was injured while using a hairdryer when she experienced an epileptic seizure. Her medical history included syphilis and epilepsy. Debridement and split-thickness skin grafting for the burn wound were carried out. Cerebrospinal fluid analysis demonstrated RPR（+）and the patient was diagnosed with neurosyphilis. We concluded that the seizure was caused by neurosyphilis. The patient was treated with a penicillin G intravenous injection drip. In recent years, there has been an increase in the number of patients with syphilis. Therefore, when young patients present with burn wounds caused by neurological symptoms, a syphilis test should be considered.

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 A 79-year-old-man sustained flame burns covering 24% of his body. He had third-degree burns mainly on his scalp, face, and neck. Debridement of the neck, back, and upper extremities was performed. On day 5, his condition deteriorated, and he developed septic shock due to infection of his scalp and hand regions. Debridement of these regions was performed, resulting in a 20×20 cm scalp defect with exposed bone. The burn was diagnosed as a scalp burn involving the calvaria. A few weeks later, the cranial region had no granulation tissue and the patient developed septic shock due to infection of necrotic bone. On day 67, debridement of the necrotic bone was performed using a steel bur. The outer cortex was removed to expose viable bone and artificial dermis（Integra^®）grafting was performed. After the operation, split-thickness skin grafting was performed twice. The postoperative course was uneventful. On day 224, the patient was transported to another hospital. It is helpful to quickly remove the necrotic bone, including the outer cortex, in cases of scalp burns involving the calvaria.

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