4-14 PEDIATRIC BURNS

Consider the need to stop the burning process prior to initiation of other interventions if necessary to ensure patient and provider safety.

EMR - Emergency Medical Responder

1. Establish patient responsiveness.
2. If cervical spine trauma suspected, and trained to do so, manually stabilize the spine.
3. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
4. Open the airway via chin lift or modified jaw thrust.
5. Suction as necessary
6. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
7. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
8. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
9. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
10. Assess circulation and perfusion.
11. Stop the burning process. If a dry chemical is involved, brush it off, then flush with copious amounts of water. If a caustic liquid is involved, flush with copious amounts of water. Remove all of the patient’s clothing prior to irrigations. Be prepared to treat for hypothermia, which may arise secondary to these interventions. For chemical burns with eye involvement, immediately begin flushing the eye with normal saline. Continue flushing throughout assessment and transport
12. Call for ALS intercept  

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. If spinal injury is suspected, continue manual stabilization while placing a rigid cervical collar, if indicated. Immobilize the patient on a long backboard or similar device.
2. Apply occlusive dressing or saran wrap if available to the burned area if estimated body surface area involved is >10%. To prevent hypothermia, avoid moist or cool dressings to large areas and do not leave wounds or skin exposed. If not available,  a burn sheet or dry dressings May be utilized.
3. Initiate transport and Contact MEDICAL CONTROL to discuss need for ALS intercept.

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

1. Consider need for vascular access and administer NS at a TKO rate. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 years old, and signs of poor perfusion are present, request ALS intercept and initiate transport.
2. If access is obtained and signs of poor perfusion are present, administer 20 mL/kg NS bolus.
3. If evidence of poor perfusion persists, administer additional 20 mL/kg NS bolus.
4. Initiate transport and Contact MEDICAL CONTROL to discuss the need for ALS intercept and for further fluid orders, if indicated. Time should not be spent on scene solely to establish IV access.

Intermediate - Perform/Confirm All Above Interventions

1. Evaluate need for advanced airway management and ventilatory support.
2. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement. Note that 2 IV lines are preferable if possible. Scene time should not be delayed for IV placement.
3. Administer appropriate pain medications via pediatric pain protocol.
4. Initiate transport and Contact MEDICAL CONTROL for further orders.

Paramedic - Perform/Confirm All Above Interventions