1. Burn Case Scenario Lee Faucher Sarah Larson Kim Maerz

2. 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.

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

4. 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.

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

6. 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

7. Now what?

8. 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

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

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

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

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

13. 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. 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 Priority 1 Dead Priority 2

14. 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

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

16. 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?

17. 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?

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

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

20. Patient Admissions Patient #Gender% TBSAArrival 1F0<1 2F21<1 3M22<1 4F66<1 5M49<1 6F68<1 7M417 8M4210 9M3228 10M 31

21. 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

22. Products consumed IV Fluids141 Liters Silvadene cream950 Jars Burn Dressing Gauze2006 packs 4X4 gauze18,490 Kerlix gauze3108 rolls Ace Bandages2111 Allograft26,700 sq cm Synthetic “skin”30,365 sq cm Autograft22,087 sq cm PRBCs269 units

23. Post-Burn Weeks

24. Outcomes Patient #Gender% TBSA Age + TBSA Mortality Risk Outcome 1F032N/ASurvived 2F217411Survived 3M22614Survived 4F6611562Survived 5M4910041Survived 6F6810944Died 7M418015Survived 8M42719Survived 9M32631Survived 10M 8223Survived