Another EMS Scenario

[Engine58]

ok..heres a EMS scenario that happened to me. I didnt have any patient contact only up until we loaded her into the ambulance but anyway here it goes.. I'll give u as much info that I could remember. this is coming from a BLS standpoint

Dispatch Information Hi-Rise Fire possible burn victim unknown severity of burns. You arrive on scene to find a apartment fire on the 4th floor of a 6 floor senior citizen/assisted living building. EMS command tells your crew to stage on the floor below the fire.


pt information Firemen carry down a 40 Year old Female major 3rd degree burns throughout her body. Firemen found her laying on the floor next to a burning couch. with some burning debris on her legs. she is breathing but barely & unconcious Severe burns to her face especially nasal & mouth area(sorry but this was a while ago & not sure of vitals)

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Andrew
South Amboy, New Jersey
Explorer Engine 6 So. Amboy Fire Dept & Cadet Morgan FAS
"EMTS DON'T DIE THEY JUST STABILIZE" http://engine058.boltpages.com/southamboyfiredepartmentexplorerpost6/

[This message has been edited by Engine58 (edited 04-22-2001).]

[BFD847]

This sound like one of those unfortunate calls that is going to have a sad ending. From a BLS stand point your as well as ALS stand point assumming all burning material has been removed is airway and breathing. Needs an air way and quick. BLS- EOA, PTT if available or for ALS ETT./ BVM with 100% humidified O2. Rapid transport. ALS units would add a couple of IV's.

[WFDFFEMTI]

As already stated, airway is a big issue. Next would be to start dressing the burns whatever the local protocol is. Me says dry sterile dressings.
ALS should be called, precaution, and treat for shock.

[N2DFire]

Same here.
Airway Airway Airway.
Facial Burns to Mouth & Nose are a 99.99999 % Positive indicator for more serious airway burns. Treat as early and as agressivly as you can (i.e. Intubate).

Fluid replacement per protocol. I belive Ringers is still prefered over N.S. but I'm not sure. (Makes no difference here - all we carry is N.S.anyway)
Consider Air Evac if indicated & available.
Another Biggie - Keep the Pt. Warm. The skin is a major regulator in body Temp - now it's dammaged big time. (Plus in the extinguishment phase the Pt most likely got wet) so even if it's 100 Degrees in the back of your rig - make sure the Pt is wrapped up & warm (not roasting).

Otherwise - just monitor & treat the ole ABC's and you should be o.k.

As stated before - A Pt. in this condition most likely will not have a good outcome.

Good Case Andrew - glad to see someone kept the ball rolling on doing scenarios.

Take Care - Stay Safe
Stephen
FF/Paramedic

[ALSfirefighter]

I'm also with N2D, (as always as it seems), call for ALS immediately. This is not as a precaution. This patient needs immediate advanced airway interdiction. For me as a medic, the helicopter would be called if I'm going to be delayed getting back to the bus(Its 15 mins. by ground to our trauma 1, 3mins. to Trauma2). Intubation with the biggest tube I can fit, (the airway due to the burns is going to swell rapidly, as well as the lower airway structures) humidfied O2, 2 14ga. IV's at 100CC's an hour, and I'd also call for a bolus of Morphine, despite the patients already decreased LOC, this will aid in slowing her overall metabolism, and keep her sedated in the event she would come around. Enroute to the hosp./LZ, as WFD said dress the wounds if I have time. And unfortunately everywhere is different, I like moist (not saturated, covered by dry. This should aid in slowing evaporative loss of plasma/fluid. And as N2D said keep them warm, this also (even though she is critical) will raise her small chance of survival a few percentage points.

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The above are my thoughts/opinions based on my area protocol. They do not refelct that of any dept./agency I work for, deal with, or am a member of. http://www.firehouse.com/forums/biggrin.gif

[Engine58]

Yes...as some of you have said it did have an unfortunate ending...but surprisingly this victim started getting better but finally passed away do to her throat being severely burnt.This was my first bad call I ever been on, and man was it a shocker when the firemen came running down the stairs fullspeed yelling for EMS & that they have a victim....But yea...ALS was dispatched and The Helicopter was dispatched as soon as we seen her...But helicopter was cancelled do to its ETA...so she was transported to the nearest trauma center which is 15 minutes away then was transported VIA helicopter to St Barnaba's Burn Center in Livingston NJ...AMbulance ride to the Burn center would of been a good hour away...possibly more depending on the traffic...but we basically just made sure she had a pulse...slapped the 02 on her full blast and loaded her and went to the ER... then the fun part of Transporting many other victims of hte fire...Smoke Inhalation,Chest pains,shortness of breath etc....IT sure was a fun filled evening....NOT!! especially since I was soaking wet from teh sprinklers going off in the Stairwell...but anyways..figured I'd fil you guys in on what happened that day.. Thanks for the Answers.........Someone elses turn now for a Scenario! http://www.firehouse.com/forums/biggrin.gif hehe

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Andrew
South Amboy, New Jersey
Explorer Engine 6 So. Amboy Fire Dept & Cadet Morgan FAS
"EMTS DON'T DIE THEY JUST STABILIZE"
http://engine058.boltpages.com/southamboyfiredepartmentexplorerpost6/

[mike m]

Andrew seeing how you stated your call you probably did everything you did for your patient,i've been in this business alot of years and to this day some of the real bad ones still stick in my mind.what upsets me about this job,is your well being and how you handled this type of job.it's nothing to be ashamed of to talk to a CISD counselor.25 years ago when i was new to this field we did'nt have the support groups that we have today.maybe if we had this support alot of good ppl could have been saved from the scars. keep up the good work andrew you will go far in this field mike m

[emtwannabe]

I would have started O2 15lpm attached to a BVM which would be attached to an ET tube. Double IV lifelines to replace fluids. NS is all we carry, too. As long as the pt has a pulse, not much else we can do while waiting for the helicopter, which would have been summoned immediately. Was the pt unresponsive? Forgive me for being a rookie, but what if the patient goes into cardiac arrest? How do you do CPR on a pt whose chest is covered in full-thickness burns? Thanks for the scenarios. It's how I learn best. I am in my intermediate class so these treatments are at an intermediate level. As a Basic, all I could do is O2, and BVM. Makes me glad I am moving up. Wish me luck.

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GOD is my Medical Director and JESUS is my EMS crew chief.

[Fyresq50]

Emtwannabe- just a quick answer to your question of how to do CPR on someone with full thickness burns- Do it the same. ABC's are still the priorities. Gotta treat them first. Without the ABC's, none of the rest matters.

Jim