3-6 TRAUMA-BURNS

Perform Initial Trauma Care per protocol.

EMR - Emergency Medical Responder

1. Assess and Maintain Scene Safety
2. Remove patient from the source and stop the burning process.  Remove involved clothing.
   1. Thermal Burn: Apply water to stop the burning process. If > 10% of BSA involved, limit water exposure to 2 minutes to avoid hypothermia.
   2. Chemical Burn: Brush off visible dry chemical before flushing vigorously with water for 15 minutes
   3. Tar Burn: Cool tar with water but do not attempt to remove
   4. Electrical Exposure: Assess wounds.  Recognize possible cardiac dysrhythmia.
3. Airway: Assess, secure and maintain an adequate airway. Refer to the airway management protocol. Note that any soot, swelling, stridor or hoarse voice may indicate airway involvement
4. Breathing: Apply high-flow oxygen, regardless of pulse oximetry reading, since patients with a possible carbon monoxide exposure or cyanide poisoning may have a falsely elevated pulse oximetry reading.
5. Circulation:
   1. Assess and treat for Shock
   2. If Shock is present, look for other causes such as associated Trauma.
   3. Remove all rings, jewelry and restrictive clothing from affected areas
6. Burn Area
   1. Estimate involved area by Rule of 9’s or utilizing the approximation that the area of the patient’s palm = 1% BSA.
   2. If it is estimated that the patient has <10% BSA involved, apply a moist cool lavage or saline soaked towels.
   3. If it is estimated that the patient has >10% BSA, apply occlusive dressings or saran wrap to the area if available to avoid hypothermia or shivering. If not, then dry dressings or a burn sheet may be utilized.
   4. Patients with significant burns benefit from additional cover to prevent hypothermia
7. Initiate ALS Intercept if any of the following are noted:
   1. Burns to head/face with respiratory distress or stridor (upper airway obstruction)
   2. Age less than 5 or greater than 55 with 2^nd/3^rd degree burns over 10% BSA
   3. Any patient with 2^nd/3^rd degree burns over 20% BSA
   4. Any patient with 3^rd degree burn over 10% BSA
   5. Burns associated with Major Trauma
   6. High voltage electrical burns
   7. Patient with significant pain where prehospital pain management would be appropriate based on transport time.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Apply cardiac monitor using monitoring electrodes if trained to do so and indicated.
2. Consider ALS Intercept for pain management.
3. Assess for bronchospasm and treat with albuterol (Ventolin) nebulizer.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Establish IV access. Contact MEDICAL CONTROL for fluid orders.

Intermediate - perform/confirm all above interventions

1. Consider IO access if patient is hypotensive. Contact MEDICAL CONTROL  for order.
2. If greater than 10% BSA administer 500 mL bolus of NS and then contact Medical Control for further fluid orders. (Adult patient only)
3. Contact MEDICAL CONTROL for consideration of administration of pain medications. If approved, utilize pain management protocol for doses and monitoring.

Paramedic - perform/confirm all above interventions