Lee Faucher Sarah Larson Kim Maerz Burn Case Scenario Lee Faucher Sarah Larson Kim Maerz

Setting the scene You are one of a two person crew with same training. No driver. Nearest burn center 3 hours by ground. Nearest trauma center 15 minutes by ground. Two air ambulances could be requested. No weather problems.

Page (T = -8 minutes) Please respond to structure fire, City fire already present. One patient extricated from building.

Arrival (T = 0) Find one 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli.

Begin assessment of patient Do you need help? Is there an airway concern? Does he need an IV?

At scene ( T = +2 minutes) Fire fighters bring out three more victims from the building 5 year old, not breathing, no pulse, minimal burns 12 year old, crying in pain, answers questions, burns to bilateral arms and hands 32 year old, answers questions, only areas not burned is chest and back

Now what?

Patients needing help 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli. 5 year old, not breathing, no pulse, minimal burns 12 year old, crying in pain, answers questions, burns to bilateral arms and hands 32 year old, answers questions, only areas not burned is chest and back

Primary Triage 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli.

Primary Triage 5 year old, not breathing, no pulse, minimal burns

Primary Triage 12 year old, crying in pain, answers questions, burns to bilateral arms and hands

Primary Triage 32 year old, answers questions, only areas not burned is chest and back

Patient classification after triage 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli. 5 year old, not breathing, no pulse, minimal burns 12 year old, crying in pain, answers questions, burns to bilateral arms and hands 32 year old, answers questions, only areas not burned is chest and back Priority 1 Dead Priority 2 Priority 2

Priority 1 patient: 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli. Airway Breathing Circulation

Priority 1 patient: How much do you need to do to make him “good enough” and “stable” for transport?

Priority 2 patient: 12 year old, crying in pain, answers questions, burns to bilateral arms and hands What is the potential for airway problem? How soon will resuscitation need to be started? How much do you need to do to make him “good enough” and “stable” for transport?

Priority 2 patient: 32 year old, answers questions, only areas not burned is chest and back What is the potential for airway problem? How soon will resuscitation need to be started? How much do you need to do to make him “good enough” and “stable” for transport?

Dead patient: 5 year old, not breathing, no pulse, minimal burns Should you do something?

September 11, 2001 8:20am American Airlines Flight 77 Departed Washington Dulles at 8:20am 58 passengers, crew of 6 9:38am A 757-200 crashes into the Pentagon

Patient Admissions Patient # Gender % TBSA Arrival 1 F <1 2 21 3 M <1 2 21 3 M 22 4 66 5 49 6 68 7 41 8 42 10 9 32 28 31

Start getting the burn off 23 excision and grafting procedures done in the first 96 hours Supplies delivered by car from as far away as Dallas, TX

Products consumed IV Fluids 141 Liters Silvadene cream 950 Jars Burn Dressing Gauze 2006 packs 4X4 gauze 18,490 Kerlix gauze 3108 rolls Ace Bandages 2111 Allograft 26,700 sq cm Synthetic “skin” 30,365 sq cm Autograft 22,087 sq cm PRBCs 269 units

Post-Burn Weeks

Outcomes Patient # Gender % TBSA Age + TBSA Mortality Risk Outcome 1 F 32 N/A Survived 2 21 74 11 3 M 22 61 4 66 115 62 5 49 100 41 6 68 109 44 Died 7 80 15 8 42 71 9 63 10 82 23