DESIGNATION OF CONDITION
Signs and symptoms may include any one or all of the following: Partial thickness - burns involving the epidermal and dermal layers characterized by reddening or blistering skin. Full thickness – burns involving all skin layers, muscle fascia, and/or charred black or grayish skin, dry in appearance.

EMPHASIS ON PATIENT CARE

Airway management, fluid replacement, and transport to a burn center after stabilization.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT

1. Stop the burning process and remove from source.
2. ABC’s, high flow Oxygen.
3. Evaluate the Patient and determine type of burn.
4. History of the Injury (GLOBAL SURVEY/MECHANISM OF INJURY)
5. Record time of injury and location: [indoor (closed space) outdoors, etc.]
6. Mechanism: scald, flame, chemical, electrical, explosion, etc.
7. Roughly estimate extent of injury using the RULE OF NINES.
8. Determine age of patient.
9. Note any significant medical history.
10. Initiate transport to appropriate medical facility. Consider air evacuation and contact Medical Control for destination decisions.
11. Place dry sterile dressings over burns, with no two burned surfaces touching.
12. Maintain body temperature.

INTERMEDIATE PRE-HOSPITAL MANAGEMENT

13. Enroute, initiate a large bore IV of an isotonic solution and titrate it to adequate vital signs.
14. Initiate a second IV in an unburned area if possible and if patient condition warrants. If > 20% BSA affected, consider a 20 cc/kg fluid bolus.

15. For use of narcotic analgesics, Contact On-line Medical Control see Pain Management Protocols.

PARAMEDIC PRE-HOSPITAL MANAGEMENT

16. With facial or airway involvement (singed nasal hair, soot inside nares, stridor etc.) early invasive airway management should be considered.
 

See Airway Management Protocols and Pain Management Protocols (airway).
Note: Do not apply electrodes to burned areas.

RULE OF NINES

RULE OF PALM

Another way to estimate the total BSA of a burn patient is the Rule of Palm.
The patient's palm, excluding the digits, is approximately 1 percent body surface area.

BURNS / CHEMICAL

DESIGNATION OF CONDITION

Signs and symptoms include the following: evidence of dry or liquid chemical contamination and reddening and/or blistering of the skin.

EMPHASIS ON PATIENT CARE

Decontamination, prevention of further injury and exposure, safety of providers.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT
1. Assess the scene for safety. Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.
2. Initial Management - Assess airway, breathing and circulation and manage as indicated.

• Decontaminate small areas by irrigating with water.
• Remove all contaminated clothing.
• Brush away dry chemical, prior to irrigating.
• Irrigate for minimum of 20 minutes.
• Contact HazMat team for full body contamination.
  

3. Remove jewelry and all clothing prior to transport.
4. Transport to appropriate medical facility. Must contact On-Line Medical Control if considering Air-Evac.
5. Focused H&P - History, physical exam, vital signs.

• Estimate percentage of Body Surface Area (BSA).
• Assess for additional associated trauma.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT
6. En-route, initiate one or two large bore IVs (determined by patient condition) of an isotonic solution to maintain adequate vital signs.
7. For use of narcotic analgesics, see Pain Management Protocols.

Note: Do not apply electrodes to burned skin areas.