Burn Case Scenario Lee Faucher Sarah Larson Kim

Burn Case Scenario Lee Faucher Sarah Larson Kim Maerz

Setting the scene • You are one of a two person crew with same training. No driver. Nearest burn center 3 hours by ground. Nearest trauma center 15 minutes by ground. Two air ambulances could be requested. No weather problems.

Page (T = -8 minutes) • Please respond to structure fire, City fire already present. One patient extricated from building.

Arrival (T = 0) • Find one 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli.

Begin assessment of patient • Do you need help? • Is there an airway concern? • Does he need an IV?

At scene ( T = +2 minutes) • Fire fighters bring out three more victims from the building – 5 year old, not breathing, no pulse, minimal burns – 12 year old, crying in pain, answers questions, burns to bilateral arms and hands – 32 year old, answers questions, only areas not burned is chest and back

Now what?

Patients needing help • 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli. • 5 year old, not breathing, no pulse, minimal burns • 12 year old, crying in pain, answers questions, burns to bilateral arms and hands • 32 year old, answers questions, only areas not burned is chest and back

Primary Triage • 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli.

Primary Triage • 5 year old, not breathing, no pulse, minimal burns

Primary Triage • 12 year old, crying in pain, answers questions, burns to bilateral arms and hands

Primary Triage • 32 year old, answers questions, only areas not burned is chest and back

Patient classification after triage • 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli. Priority 1 • 5 year old, not breathing, no pulse, minimal burns Dead • 12 year old, crying in pain, answers questions, burns to bilateral arms and hands Priority 2 • 32 year old, answers questions, only areas not burned is chest and back Priority 2

Priority 1 patient: 30 year old male with burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli. • Airway • Breathing • Circulation

Priority 1 patient: • How much do you need to do to make him “good enough” and “stable” for transport?

Priority 2 patient: 12 year old, crying in pain, answers questions, burns to bilateral arms and hands • What is the potential for airway problem? • How soon will resuscitation need to be started? • How much do you need to do to make him “good enough” and “stable” for transport?

Priority 2 patient: 32 year old, answers questions, only areas not burned is chest and back • What is the potential for airway problem? • How soon will resuscitation need to be started? • How much do you need to do to make him “good enough” and “stable” for transport?

Dead patient: 5 year old, not breathing, no pulse, minimal burns • Should you do something?

September 11, 2001 • 8: 20 am – American Airlines Flight 77 Departed Washington Dulles at 8: 20 am – 58 passengers, crew of 6 • 9: 38 am – A 757 -200 crashes into the Pentagon

Patient Admissions Patient # Gender % TBSA Arrival 1 F 0 <1 2 F 21 <1 3 M 22 <1 4 F 66 <1 5 M 49 <1 6 F 68 <1 7 M 41 7 8 M 42 10 9 M 32 28 10 M 10 31

Start getting the burn off • 23 excision and grafting procedures done in the first 96 hours • Supplies delivered by car from as far away as Dallas, TX

Products consumed IV Fluids Silvadene cream Burn Dressing Gauze 4 X 4 gauze Kerlix gauze Ace Bandages Allograft Synthetic “skin” Autograft PRBCs 141 Liters 950 Jars 2006 packs 18, 490 3108 rolls 2111 26, 700 sq cm 30, 365 sq cm 22, 087 sq cm 269 units

Post-Burn Weeks

Outcomes Patient # Gender % Age + TBSA Mortality Outcome Risk 1 F 0 32 N/A Survived 2 F 21 74 11 Survived 3 M 22 61 4 Survived 4 F 66 115 62 Survived 5 M 49 100 41 Survived 6 F 68 109 44 Died 7 M 41 80 15 Survived 8 M 42 71 9 Survived 9 M 32 63 1 Survived 10 M 10 82 23 Survived