Date of Issue: 07/01/2019



SUBJECT:BurnsPURPOSE:To clearly establish the Department’s position on the clinical care and treatment of patients presenting with burns.SCOPE: This Operating Guideline shall be applicable to all personnel; paid and volunteer, operating as an agent of Shamong EMSRESPONSIBILITY:All Department Officers will ensure overall compliance with this operating guideline. The primary responsibility of the emergency care and treatment of medical and trauma patients falls under Emergency Medical Technicians, paid and volunteer, operating as an agent of Shamong EMSPROCEDURE: Observe scene for safetyIn all cases of burns, all attempts to seek expert?information on the source of the fire, possible toxic fumes, danger to patient and rescuers, special handling procedures, etc., should be sought immediately. Rescuers should be positioned upwind and at a safe distance from the source. ?If it is unsafe for rescuers to enter the scene, wait for properly trained and equipped personnel to effect extrication. ?With electrical burns considerAll attempts to seek expert information on the voltage and amperage of electricity, danger to patient and rescuers, special ?handling procedures, etc., should be sought immediately. ?Rescuers should be positioned at a safe distance from the source. Never come into contact with a patient, or the surface on which the patient is positioned if the area has not been cleared. ?The surface is a potential electrical conductor, until the source has been ?effectively removed or terminated. ?If it is unsafe for rescuers to enter the scene, wait for properly trained and equipped personnel to perform extrication. ?Once extrication is complete and rescuers and patient are safely positioned then begin your assessment.Assessment Perform complete primary and secondary assessment, including obtaining a complete set of manual vital signs. ?Open and maintain a patent airway ?Assess for singed nose hairs, soot in sputum, facial or mucous membrane burns, hoarseness, etc.Remove all jewelry and clothing?Complete patient assessment utilizing the Rule of Nines to determine involved total body surface area (TBSA) as well as the following table to determine burn depth and severity. ??Chemical Burn ConsiderationsIf chemical is powder in form, remove as much as possible prior to?applying irrigation ?If chemical is one that reacts with water, such as lye, remove as much?as possible prior to applying irrigation ?Electrical Burn ConsiderationsDetermining entrance and exit burns ?Assume all patients in contact with high voltage electrical sources will have underlying complications due to trauma. Treatment Stop the burning process, cool the localized area only with sterile water or tepid tap waterInitiate copious water irrigation as soon as possible. Do not use a high?pressure flow!Provide and maintain appropriate airway management.Administer and maintain appropriate dose of oxygen based on patient’s condition.Cover burns with dry, sterile dressings.Leave all blisters intact.Maintain normothermia.Chemical burn considerations.If chemical is powder in form, remove as much as possible prior to?applying irrigation ?If chemical is one that reacts with water, such as lye, remove as much?as possible prior to applying irrigation.If possible, transportation to a burn center.If there is significant associated trauma, affect transport to a trauma center. ?DocumentationPatient location at time of burnBurns sustained within an enclosed space suggest possible inhalation injuryMechanism of burnThermal (fire, explosion, steam, boiling water, etc.)Chemical (Lye, Silver Nitrate, Hydrochloric Acid, etc.)Electrical (low voltage, high voltage, etc.)Radiation Type of burnSuperficial (1st Degree)Partial thickness (2nd Degree)Full thickness (3rd Degree)Approximate duration of exposure and time of burn injuryApproximate burn percentage using the rules of 9The adult body is divided into anatomical regions that represent 9%, or multiples of 9%, of the total body surface. Therefore 9% each for the head and each upper limb; 18% each for each lower limb, front of trunk and back of trunk.The palmar surface of the patient's hand, including the fingers, represents approximately 1% of the patient's body surface.Body surface area differs considerably for children - the Lund and Browder chart takes into account changes in body surface area with age and growth.If not available:For children <1 year: head = 18%, leg = 14%.For children >1 year: add 0.5% to leg, subtract 1% from head, for each additional year until adult values are attained.Pertinent negativesPresent or absence of chest pain, respiratory distress,Singed hair on or around the face (facial hair, nose hair, eyebrows, etc.)Presence or absence of soot in nose or mouthAny other associated symptomsTransport Guidelines Patients with minor burns without the possibility of smoke inhalation may be transported to closest hospital to the incident. Partial thickness burns greater than 10% of TBSA.Burns that involve the face, hands, feet, genitalia, perineum, or major joints.Third degree burns in any age.Electrical or chemical burns.Inhalation Injury.Any patient with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality.In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit.EnforcementFailed compliance with the policy and procedures outlined in this document may result in the employee’s entry to the department’s progressive counseling and discipline process. ................
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