BonnerCountyEMS System Patient Care Treatment Guidelines-Trauma and Environmental Emergencies

Environmental Emergencies: Burns - 6030

Burns

Prehospital Management of Burn Trauma

History
  • Type of exposure (heat, gas, chemical)
  • Inhalation injury
  • Time of injury
  • Past medical history
  • Medications and allergies
  • Other trauma present
  • Loss of consciousness
  • Tetanus immunization status
/ Signs and Symptoms
  • Burns (percentage of BSA and degree)
  • Dizziness, swelling, pain
  • Unconscious
  • Hypotension/ Shock
  • Airway failure/ Respiratory distress
  • Singed facial or nasal hair
  • Hoarseness/ wheezing/ cough
  • Speech difficulties
/ ASSESSMENT
  • Superficial (1st degree)- red and painful
  • Partial thickness (2nd degree) blistering
  • Full thickness (3rddegree)-painless, charred leathery skin
  • Thermal burn, Radiation injury
  • Chemical burn, electrical burn

TREATMENT GUIDELINES

R-EMR / E -EMT / A-AEMT / P-PARAMEDIC / **M-Medical Control **

***Higher level of providers are responsible for lower level treatments***

  • Initial Patient Contact (2000). Remove patient from hazard.
  • Using Rule of Nines (A3), determine total BSA involvement and degrees of burns, and determine the nature of the burn (thermal, chemical, electrical or radiation).
  • Identify entrance and exit for electrical burns.
  • Remove jewelry (rings, bracelets and constricting items and non-adherent clothing.
  • Airway Management (4000) and Oxygen Administration (9000). Assess for burns to airway.
  • For total BSA (TBSA) involvement is <10%, cooling of area with sterile water or NS or burn gel may be performed. Keep burn area as clean as possible.
  • Cover burn with dry sterile sheet dressing. Prevent hypothermia. Elevate burned extremity.
  • For Chemical Burns,remove contaminated clothing without exposing provider(s) to chemical. If substance is powder form, gently brush residual chemical off skin and away from patient’s body. Flush area or irrigate eye(s) if affected with water for 15 minutes (continue during transport). Do not contaminate other eye or allow patient to rub eyes.
/ R
  • Assist ALS with Cardiac Monitor for electrical burns, Respiratory Failure, or age >50.
  • Pulse Oximetry (9001) for Respiratory Distress (4002) and/or if Oxygen is used.
  • For critical burns (see below), call Medical Control to activate Trauma Systems.
  • For non-critical burns (<15% TBSA, no inhalation injury, normotensive), complete evaluation and Transport to appropriate facility.
/ E
  • Establish two large IVswith NS, draw labs; do not delay transport for IV access.2
  • For critical burns, administer IV NS 20 cc/kg bolus rapidly via two lines and reassess.2
/ A
  • ALS required for all Critical Burns.
  • Reassess and treat volume and airway status. Intubate early for upper airway involvement.
  • Administer Analgesia as needed for Pain Control (2060). Evaluate for CO poisoning.
/ P
  • **Call Medical Control for Critical Burns to determine most appropriate receiving hospital destination and for concerns of possible child abuse.**
/ M

2EMT providers may perform these procedures if credentialed with the appropriate OM.

Critical Burns include burns (second-degree or worse) than 15% BSA, with Multi-System Trauma, and with airway compromise. Potential CO exposure should be treated with 100% Oxygen. Severe (second-degree or worse) burns encircling the hands or feet, or to the face and genitalia are also considered critical burns.

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BCEMS Medical Director

Effective: 04/01/14final 10/2/2018 page 1of 1