ABSTRACT: Burn injuries are among the most difficult and challenging emergencies faced by all prehospital care providers. Periodic review of burn mechanisms and management is required for maintenance of knowledge and performance skills.

Charly's dynamic presentation begins by reviewing the anatomy and physiology of the skin. Following that, she reviews techniques of calculating burn depth and extent, providing "real-life" methods of making these calculations.

Depending upon the length of presentation, Charly will assist participants to understand burns occurring from thermal (heat), electrical, chemical, and radiation mechanisms. For each burn mechanism addressed, Charly will provide explanation regarding:

• Scene Safety Issues
• Initial and Focused examinations
• Medical and Psychological Treatment of each burn type
• Burn IV Therapy decisions and determining Flow Rates
• Decontamination Methods and Public/Patient Safety Considerations.

To complete her presentation, Charly discusses factors effecting destination decisions, and the significant emotional impact experienced by EMS providers when caring for severely burned patients.

LEARNING OBJECTIVES: After attending this presentation, participants will

1. recognize personal safety as being the highest priority when responding to burn emergencies; followed by patient safety, airway and C-spine management, oxygenation, and circulatory support.
2. recall the anatomy & physiology of the skin.
3. develop an understanding of burn injuries from thermal (heat) sources and (depending upon presentation length) burns from electrical, chemical, and radiation sources.
4. perform appropriate initial and focused assessments of burn injuries, including realistically accurate burn depth and extent estimations.
5. provide appropriate medical and psychological treatment for burn injuries, including decontamination and IV fluid administration.
6. make appropriate destination decisions based upon the burn mechanism, injury extent, and patient condition.
7. understand the importance of Critical Incident Stress Debriefing after caring for even a single patient with significant burn injuries.

1. INTRODUCTION: ANATOMY and PHYSIOLOGY of THE SKIN

2. SOURCES OF BURNS:
   
   • Thermal (heat/flame)
   • electrical
   • chemical
   • radiation.

3. SUPERFICIAL (First-degree) burns Review.

4. PARTIAL-THICKNESS (Second-degree) burns Review.

5. FULL-THICKNESS (Third-degree) burns Review.

6. Burn Management: PERSONAL SAFETY!

7. THERMAL BURNS: Miscellaneous mechanisms and scenarios.

8. EVALUATION of the burn's MECHANISM OF INJURY:
   
   • potential for INHALATION INJURY or
   • SPINAL TRAUMA.

9. Burn Management: INITIAL ASSESSMENT
   
   • Stop the burning / extrication
   • Airway, oxygen administration
   • Endotracheal intubation considerations
   • Consideration of associated medical emergencies
     (before and after burn incident)
   • Removal of rings, watches, other jewelry.

10. ESTIMATION of BURNED SURFACE AREA:
    
    • Rule of Nines for adults and infants
    • Palmar surface method of estimation.

11. Burn Management: FOCUSED ASSESSMENT & TREATMENT:
    
    • Trauma Assessment / Management
    • Cooling of burns
    • Hypothermia
    • Dry, sterile dressings
    • NEVER APPLY SALVES OR OINTMENTS TO BURNS!
    • EKG monitoring.

12. Burn Management: IV THERAPY:
    
    • Causes of hypovolemia in burns
    • IV considerations: Fluid resuscitation formulas vs.
      PREHOSPITAL considerations of fluid needs
    • Dextrose 50% in Water considerations
    • Drug and alcohol involvement considerations
    • Morphine sulfate or Valium considerations.

13. Burn Management: The importance of PSYCHOLOGICAL SUPPORT of the patient when dealing with:
    
    • Facial burns
    • Pain control
    • Pediatric patients.

14. SPECIAL CONSIDERATIONS:
    
    • Never bandage two burned areas together (fingers & toes, etc.)
    • Circumferential burns.

15. CHEMICAL BURNS: General Considerations:
    
    • Personal Safety
    • Protective clothing
    • Chemical information gathering
    • Removal of patient clothing
    • Appropriate containment of contaminated clothing
    • Contact lenses
    • Flushing with water
    • Disposal (drainage) of contaminated water
    • Contraindication of neutralizing agents or antidotes.

16. Special Considerations: DRY LIME, PHENOL, AND SODIUM:
    
    • Brushing prior to water flushing for dry lime
    • Use of alcohol flushing for phenol
    • Gentle brushing prior to oil coverage of sodium.

17. ELECTRICAL BURNS and LIGHTNING STRIKES
    General Considerations:
    
    • Scene safety issues
    • Electrical source considerations
    • Lightning considerations
    • Spinal injury considerations
    • Consideration of falls
    • Care priority review
    • Entrance and exit wounds.

18. RADIATION BURNS: General Considerations:
    
    • DO NOT ENTER AN AREA OF RADIATION!
    • Removal of nonessential equipment from the ambulance, prior to response
    • Liquid or dust contamination treatment
    • Drainage and ventilation concerns (on scene, enroute, receiving facility)
    • Absence of obvious radiation injury in prehospital phase.

19. PATIENT DESTINATION FACTORS: Burns that require the attention of specialized Burn Care or Trauma Centers include
    
    • Inhalation injuries
    • Significant burns of the face, feet, hands, or genitalia
    • High-voltage electrical injuries
    • Burns with significant secondary injuries
    • Chemical burns with progressive tissue destruction
    • Second-degree burns of more than 15% BSA
    • Third-degree burns of more than 5% BSA
    • Pediatric or Geriatric burns.

20. PSYCHOLOGICAL EFFECTS upon EMS responders
    when dealing with burn incidents
    (need for Critical Incident Stress Debriefing)

21. SUMMARY

1- to 11/2-hour sessions will consist of outline #'s 1 - 6,
thermal burn assessment & treatment, and outline #'s 19 & 20.
(Chemical, Electrical, and Radiation burn information
is still included in handout, however.)

For a full presentation (Thermal, Chemical, Electrical,
and Radiation burn information), please allow 2 to 3 hours.

Email Charly at: c-d-miller@neb.rr.com
Those are hyphens/dashes between the "c" and "d" and "miller"