EMS Assessment and Initial Care of Burn Patients Guidelines from the American College of Surgeons and American Burn Association By Joe Lewis, M.D.

EMS Assessment and Initial Care of Burn Patients Stop Further Injury A. Remove victim from source. B. Extinguish or remove buring clothing. C. Chemical Burns 1. Continuous water rinse or lavage 2. Prolonged eye irrigation scene 3. Remove contaminated clothing 4. Avoid injury wear clothes and PPE

EMS Assessment and Initial Care of Burn Patients Maintain ventilation A. Administer humidified 100% oxygen by mask to treat possible carbon monoxide poisoning. B. Examine airway for signs inhalation injury; 1. Singed nasal hairs. 2. Carbonacious material in upper airway. 3. Edema or inflammatory changes in the upper airway.

EMS Assessment and Initial Care of Burn Patients C. Maintain Airway D. Consider Airway thermal injury if these signs and symptoms are displayed: – Difficulty breathing – Sooty, expectorated sputum – Strider – Cough – Nasal hair or oral mucosa burns – Hoarseness – Decreased PaO2: FiO2

EMS Assessment and Initial Care of Burn Patients Maintenance of peripheral circulation in patients with circumferential burns. A. Remove rings and braclets-give to family. B. Clinical Signs of impaired circulation: 1. Cyanosis 2. Impaired/delayed capillary filling 3. Progressive neurologic signs: paresthesias and paresis, i.e numbness and weakness. 4. Doppler extremity pulses.

EMS Assessment and Initial Care of Burn Patients Physical Examination A. Check for associated injuries. B. Estimate extent and depth of burn -Rule of Nines- Childs head is disportionately larger than adult head. C. Estimate weight of the patient.

EMS Assessment and Initial Care of Burn Patients Initial Burn Wound Care A. Clean and debride loose tissue. B. For small burns <15% BSA use moist sterile dressings. C. For serious or large BSA burns use dry dressing to avoid hypothermia. D. Commercial burn dressing are great but a standard hospital sheet works as well E. Cover burns with dry sterile dressing or cover with a clean sheet.

EMS Assessment and Initial Care of Burn Patients History A. Circumstances of injury B. Pre-existing illness C. Medications D. Allergies E. History of enclosed space fire? F. History of alcohol or drug use?

Adult Rule of Nines Head and neck 9% Front torso 18% Back torso 18% Upper extremities 9% Each Lower extremities 18% Each Genitalia 1% Total 100%

Rule of Nines

Pediatric Rule of Nines Head and Neck 18% Front torso 18% Back torso 18% Upper Extremities 9% Lower Extremities13.5% each Genitalia 1% Total 100%

Severity of Burn Injury 1. Superficial or First Degree – Epidermis – No Blisters 2. Partial Thickness or Second Degree – Deeper dermal layers – Blisters 3. Full Thickness or Third Degree – Full skin thickness – Charring 4. Full Thickness – Full thickness involving bones and muscles

Superficial Partial Thickness

Deep Partial Thickness

Deep Full Thickness

Determining Criticality of Burns Minor - Superficial burns and small partial thickness burns <15% BSA Moderate - Partial thickness of >15%-30% BSA small full thickness burns Severe Partial thickness of >30% BSA + Full Thickness >15% BSA Burns to hands, feet, face, genital or with circumferential patterns are critical Inhalation injuries are always critical

Carbonacious Sputum

EMS Assessment and Initial Care of Burn Patients Intravenous Fluid Therapy A. Required by patients with burns greater then 20% of total body surface. B. Secure large bore IV in good vein. C. Estimate fluid needs for 1st 24 hours postburn D. Administer 1/2 of calculated volume in 1st 8hrs. Calculations: Adults 2-4ml LR x weight in kilogram x percent burn = 24 hour requirement. Children less then 4 ml/kg/% plus maintenance fluids.

EMS Assessment and Initial Care of Burn Patients Analgesics per local protocol, currently none at Schofield, but you could wait for City and County and after they treat pain, you could transport, if they agree.

EMS Assessment and Initial Care of Burn Patients Burn Center Criterion Burn Size > 20% BSA in Patient 50 Third degree Burn > 5% BSA Airway or Inhalational Injury Carbon Monoxide > 15% Electrical or Lightening Injury Deep Burns face, hands, feet, perineum or major joints- hip. knee. elbow