Objectives

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After reading this article, you will be able to:

1.
2.
3.
4.

Explain the basic functions and different layers of the skin.
Describe the varying degrees of burns.
Calculate the surface area of a patient affected by burns.
Describe thermal, electrical, chemical, and radiation burns and their treatment.

Case Study
It’s just before noon and you are part of a third-alarm assignment to a warehouse fire in the industrial district. The first arriving unit reports
heavy fire involvement in the northwest corner of the structure and employees self-evacuating through the front door. As you arrive on the
scene, secondary explosions rip through the northeast corner of the structure, belching thick black smoke and debris into the crowd of
evacuating employees and advancing firefighters. To call it chaos would be a gross understatement. Command quickly pulls all units back
and begins to set up defensive operations, which includes the arduous task of accounting for all companies. The crew from Medic One
establishes a medical sector and calls for Medic Two and Engine Eight to begin triaging the mass of bodies that are still on the ground
after the explosions.
Fourth and fifth alarms are struck simultaneously, and all mobile intensive care units are asked to stage and prepare for critically burned
patients. It doesn’t take long for you to get into the action; firefighters meet you at the side door of your ambulance with one of their own.
He has second- and third-degree burns to his face, chest, abdomen, and right arm. It appears that he was in the process of zipping up his
coat when the explosions caught everyone off guard. His shirt is charred, and in some places it appears to be stuck to his skin. He is in
obvious pain and is starting to show signs of breathing difficulty. The firefighters who brought him to you start him on oxygen and
reluctantly rush back into the crowd of patients. Your partner secures a 16-gauge intravenous catheter in the left forearm and records a
blood pressure of 110/80 with a pulse of 120. Respirations are becoming more rapid, and lung sounds are diminished with a high-pitched
stridor. Recognizing the need for immediate airway control, you follow your rapid sequence intubation protocol and secure a good tube.
You approximate the total burned surface area at 35 percent and calculate your fluid infusion rate accordingly.
As you begin your secondary assessment, you remove the patient’s clothing and cover him with sterile burn sheets. The clothes that are
stuck to his skin are left in place to be removed by the emergency room staff. Your emergency transport to the burn center will take just
over a half-hour, so your partner jumps in the driver’s seat and leaves you to continue the patient’s care. The bits and pieces you hear
over the radio indicate that there are several patients with varying levels of injuries, ranging from chemical exposures to crush injuries with
associated thermal burns. Your quick airway control and adequate fluid therapy ultimately stabilizes the patient long enough to get to the
burn center. He has several weeks of painful treatments and a few close calls with infections, but, ultimately, he walks out of the hospital a
month later and returns to his family and, eventually, to his job.
If burn cases all went that easily, with that much perfectly choreographed drama, there wouldn’t be a need for any continuing education on
burns. In actuality, burns can be very complex and pose safety hazards to both you and your patient. There are several times when
everything will fall into place perfectly, but for the times that don’t, it’s not a bad idea to have a little refresher at the front of your mind to
help remind you of some of the dos and don’ts regarding burns.
First Degree Burn7

Functions of the Skin
Before we get into the treatment of the different types of burns, it is important to review some of the basics. To start with, we need to
understand the functions of the largest organ of our body and the effects that burns have on it. Some of the vital functions of the skin
include protection from infection, temperature regulation, and fluid containment. If the skin is damaged or simply missing, its ability to
perform these functions is compromised, and the effects can be profound.
Infection is one of the most persistent killers of burn victims.¹ Depending on the extent of the burn and the events leading up to the injury,
infection can develop in several hours or several days. That is why it is so important for us to be as sterile as possible when we are
treating our burned patients. The use of sterile burn sheets, a clean working environment, and appropriate decontamination and cooling
procedures can give the patient a better chance of remaining infection-free.
Another function of the skin that is diminished when it is damaged is temperature regulation. Under normal circumstances, our skin
regulates our body’s temperature by insulating us from the cold and secreting sweat when we are hot. When it is not intact, not only does
it lose the ability to insulate or cool, the fluids that are freely leaking out rapidly remove heat energy.¹ It might be difficult to think of a
massively burned patient as being hypothermic, but it happens and it needs to be monitored. The best thing you can do to try to combat

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Never put ice directly on any burns.2 If cool water is not available. this can manifest over a period of several hours or several days. To be on the safe side. It gives you the total amount of fluids to be administered over the first 24 hours following the injury. ranging from butter to toothpaste.and second-degree burns is the presence of blisters.this is to cover the burns with sterile burn sheets. partial thickness. It is composed mostly of fat and connective tissues. Burns can break this protective covering in varying degrees. are similar to first-degree burns in that they are usually red in color. You need to calculate how long you will have the patient to get the amount of fluids that you need to administer. As mentioned earlier.000 ml of fluids. As with first-degree burns. pain. It is also a good idea to check pulse. elderly. second. or ill. it is important to differentiate between the different depths of skin that burns extend into. look for other causes. It can also cause problems if a patient is wearing jewelry and the hands or fingers begin to swell. the patient can become hypovolemic. As stated before. The formula can be a little tricky to calculate in the field. but you can make an attempt to provide some insulation to reduce the amount of heat energy being lost. your patient needs 1. In this instance.¹ The blisters that form are a good visual reference of the fluid shift that we discussed earlier. you start to run into problems. Something else to consider is first-degree burns that are circumferential around extremities may cause swelling that can inhibit circulation. You aren’t going to be able to stop the fluid from leaking. Regardless of which terminology you use. Unless the burn has exacerbated some other medical condition.¹ A good example of a first-degree burn is a sunburn. so if you are seeing symptoms of hypovolemia early on. you will find the subcutaneous tissue. we need to talk about the different layers of the skin. The total is then divided in half and this amount of fluid is given to the patient over the first 8 hours since the burn. Something to keep in the back of your mind is the fact that first-degree burns can mimic carbon monoxide poisoning in appearance. a cold compress will help reduce swelling and pain. you can treat it as you would a first-degree burn by cooling it with water.¹ If the second-degree burn is less than 15 percent. blood vessels. It also contains pigments that help protect us from ultraviolet radiation from the sun. and produce swelling. Second Degree Burn7 Degrees of Burns Several years ago. Fluid replacement formulas vary from department to department. second-degree burns will generally heal without permanent disfigurement. involve only the upper layers of the epidermis and the dermis. burns were simply first. They are characterized by redness. painful.000 ml. which we will get into shortly. and minor swelling. including frost bite. and sensation distal to the injury and report any deficiencies to the receiving facility. motor function. Texas. so follow your local protocols on fluid replacement requirements. don’t just assume that it is a mild steam burn or sunburn. There are many myths concerning how to treat a first-degree burn. So if he was burned at noon and you are going to be at the burn center at 1 p. Second-degree burns. or superficial burns. Nerve endings. it was decided that burns are now to be classified as superficial. 2/7 . which we will cover now. have the patient remove and secure anything that might be difficult to remove in the presence of swelling. The prognosis for these types of burns is usually very good. the skin is broken up into three main layers. For example. These blisters need to remain intact if at all possible. say you have a 100 kg patient with 50 percent of second. 4 ml X 100kg X 50 equals 20. Breaking them can allow bacteria and other microorganisms to enter the body through the broken skin and increases the chances of the wound becoming infected. all three of these layers play vital roles in keeping us protected from the outside elements. the use of running water increases the risk of hypothermia due to the larger surface area that you are trying to cool. When this happens. another complication of second-degree burns is hypothermia if the wounds are large enough and the blisters have been broken. any jewelry or restrictive clothing needs to be removed so the swelling associated with the injury doesn’t cause problems with circulation. Before we get to that. If the burn is larger than 15 percent. and the skin will make a full recovery to its original state.¹ One of the widely used formulas for fluid replacement in patients with 2nd degree and 3rd degree burns was developed by Parkland Hospital in Dallas. you should be 250 ml into your second bag of fluids when you arrive. Half of this is 10. Do this by dividing 10. or third degree. So if you are working on a firefighter at a structure fire and notice that he or she has redness to the skin.. and it provides an effective barrier against bacteria and other pathogens when intact.m. the patient will not see any long-term health effects. This is not the amount of fluids that you need to cram into the patient during your transport to the hospital. Layers of the Skin As you probably know. It is the last barrier between the outside world and our internal organs.000 ml of fluid by 8 to give you the ml needed per hour. and oil and sweat glands all occupy this layer of the skin and play a large role in the body’s ability to regulate temperature. the massive amounts of fluids that are being lost can result in something called a fluid shift.000 ml of fluids. The epidermis is the outermost layer of the skin. Over the years.250 ml per hour. The onset is not sudden. or full thickness. the other half will be given over the remaining 16 hours. The body removes fluid from the intravascular space and sends it to the burn to begin cooling and repairing the damage. One of the things that differentiate first. So be sure to cover the burns with sterile dressings to reduce the heat loss that comes with damaged skin and an increase of fluids leaving the wound. as it can lead to further complications. or occurs in people who are very young. First-degree burns. or partial thickness burns. especially if you don’t use it often. Anytime you break this barrier. but the best treatment is cool running water. so have the burn sheets ready to help insulate the patient after the burning process has stopped. Lastly.and third-degree burns. This formula requires that you know the degrees of burns and a percentage of body surface area involved. Even with the presence of blisters.¹ Directly beneath the epidermis lies the dermis.¹ Below the dermis. Depending on the size of the burn. so for the first 8 hours the patient needs to get 10. The formula is 4 ml of fluids (preferably Lactated Ringers) X patient’s weight in kilograms X the percentage of body surface area burned.

each accounting for 9 percent. Types of Burns Now that we have covered the functions and layers of the skin. the entire right arm. If your patient has burns or black soot around his or her nose or mouth.¹ Rule of Nines A: Rule of nines (for adults) B: Lund-Browder chart (for children) for estimating extent of burns.3 If you are having trouble approximating small burns. It is of utmost importance that you keep these burns as clean as possible. or full thickness burn. Rule of Nines The last thing we need to complete the burn formula mentioned earlier is an easy way to estimate the body surface area that is burned. but the second-degree burns that surround the third-degree burns can be horribly painful. It is equally important that you cover the wounds with sterile dressings to help with the loss of heat and that you start thinking about long-term fluid replacement. It breaks up the body into eleven regions. One of these charts is a Lund and Browder diagram. and cyanide disrupts 3/7 . but aggressive fluid therapy will be needed over the next several hours and possibly the next few weeks. be sure to keep an eye on the patient’s blood pressure. intubation might be your best option. Thermal burns can involve burns to the airway. It can be something as complex as a fully involved structure fire to something as simple as a hot curling iron. If you have a rapid sequence intubation protocol. The remaining 1 percent is reserved for the genital region. It is said that third-degree burns are painless. The industry standard for approximating a patient’s burn surface area is the Rule of Nines. a complete and thorough scene size-up must be completed before you begin treating your patient. Your patients will be in excruciating pain. In an adult patient. This will produce several problems. Since their total percentage is now 109 percent. Even if the fire is out. the lower back. the signs and symptoms of hypovolemia will generally not be acute. the emergency room can make adjustments to the percentage. Equally as bad as airway compromise. let’s get into the specifics on how to treat the different types of burns. you need to assume that the patient has inhaled super-heated fire gasses. which include checking the patient’s airway. Third Degree Burn7 The last type of burn that we will discuss is the third-degree burn. if you are going to treat a patient that has been burned in a structure fire. Follow your local protocols on which medications to administer. and circulation. To use the Rule of Palms. deadly levels of carbon monoxide may be present as well as the potential for structural collapse. Copious water is preferred. you can use the Rule of Palms. you can start your treatment. controlling temperature. Use the tools you have to get as close as possible to an accurate percentage. especially if the patient was in an environment such as a structure fire.Lastly. breathing. As stated before. it has the potential to produce inaccurate results. Always start with the basics. so their legs get assigned 13. the entire left arm. the degrees of burns. Thermal burns are usually caused by hot objects. Third-degree burns destroy the epidermis and the dermis and can burn all the way down to the bone in severe cases. and the front side and back side of each leg. two of which are carbon monoxide and cyanide. make sure that the patient has been moved to an area where it is safe to administer care. children get an extra 9 percent added to their head for a total of 18 percent. So take the time to get the patient out of the hazardous atmosphere as soon as it is safe to do so. If you suspect that a patient has burns to their airway. the chest. use the size of the patient’s palm to represent 1 percent of the total body surface area. we have to make an adjustment. the upper back. use a heavy wool or cotton blanket to smother the flames. Also. This goes without saying. Since fluid therapy will continue for several hours. These burns completely render the skin incapable of protecting the body from infection. There are other charts that you can reference that might be harder to use but might also provide a more accurate percentage. it would be a good idea to start pulling out the paralytics. and probably most importantly. so the Rule of Nines needs to be adjusted to include the Rule of Thirteen Point Fives. fire gasses contain several deadly elements that can cause problems. you’re going to need to put the fire out. you need to start thinking about pain management. the abdomen. and your patient will deteriorate rapidly. but if that is not available. your first priority is to stop the burning process. but if your patient is still on fire. Children proportionately have larger heads. or containing fluids. While this method is an easy to use tool for approximating surface area burned. If you are going to administer narcotics. As with almost any incident. Carbon monoxide bonds with red blood cells and prevents them from carrying oxygen.¹ Pain management is also very important at this point. For example. and I’m sure that they would appreciate the most pain medications that you are allowed to administer and that they can safely handle. Basically. these regions are broken down into the entire head. It’s true that third-degree burns destroy the nerve endings and are technically incapable of producing pain. a few of which are burns to the upper and lower airway and carbon monoxide or cyanide poisonings. The body will flood the lungs with fluids. if needed.5 percent per leg instead of 18 percent for adults. The lungs do not respond well to super-heated gasses. such as morphine. and the approximation of body surface area affected. swelling to the patient’s upper airway as a result of burns will begin to rapidly shut down the patient’s ability to move air. so it is okay if you are off by a little. Once the scene is secure. Once you have assured scene safety and rendered the patient safe to work on.

Voltage can be defined as the difference between a source of high concentration to a point of low concentration. If you are running out of things to do. or amps. so do the best you can for the situation that you are given. there is a little more that goes on when someone is exposed to electricity. and one of the fire hoses was being drained. start approximating the total body surface that has second. and intravenous sites need to be changed regularly. start with your head to toe assessment. The harder electricity has to work to move. it has the potential to stop beating. sometimes you don’t have a choice as to where to get a good vein. or face might also meet the criteria for transport to a burn center. burns over a certain percentage might need to be treated at a burn center. the more heat it generates. Also. and when even as little as 50 milliamps cross its surface. the amps would be the gallons of water per minute inside the fire hose. would be if it were 100 degrees outside. So while it’s true that it was the gallons per minute. be sure to continuously monitor changes in airway. Once you have determined where the patient is to be transported. Moist skin and mucous membranes provide lower resistance and will produce less damage. and for the most part it’s true. What you can’t see is all of the damage done to the inside of the body where the current flowed through. start working on getting intravenous access and begin pain management. If available. If at all possible. and ensure that you aren’t overloading the patient with fluids by monitoring breath sounds and vital signs. Having said that. Places like thick. the gallons per minute. It is busy enough generating its own electrical impulses to keep the blood circulating. think about how irritated the firemen who have to put all the hose away. Massive fluid shifts might cause imbalances in electrolytes and result in changes to the heart’s electrical activity. While that statement is usually true.¹ Because of the path electricity follows. Electrical burns can be incredibly damaging and even lethal under the right circumstances. The more heat it generates. and ask your patient if there is anything you can do to make him or her more comfortable. would be enough to get your shoes wet. among other things. So if you were walking by a fire engine. you will generally see an entrance and an exit wound. Think of it as the pressure of water in a fire hose. The harder they work. breathing. do not respond well to electrical currents. Ensure that you are providing adequate and appropriate pain management. burns to the hands. so be prepared to act on it.¹ Using the same fire hose analogy. either get en route as soon as possible or call for a helicopter. If you blow both of the patient’s antecubital veins trying to get intravenous access.¹ Many departments have recently started carrying continuous positive airway pressure (CPAP) machines to assist patients who are suffering from pulmonary edema associated with burns to the lungs. your shoes are wet. Not knowing what the patient has been exposed to. Once scene safety is established and the primary assessment is complete.” it still wasn’t a good idea to walk in front of the flow of water. or “amps that got ya. joints. try not to focus only on the burns that the patient has. So in either case. you need to start thinking about what is going to happen next.¹ 4/7 . Swelling that was not evident at the time of initial patient contact may begin to produce problems for the patient during transport.or third-degree burns (first-degree burns don’t count when using the Parkland burn formula). Not unlike a tired firefighter. and it is measured in amperes. The last part of your initial assessment is to check the patient’s circulation. It might be useful to the receiving facility to see what changes. The badly burned patient will be on fluid therapy for several hours or days. it is a good idea to monitor your patient for changes to their heart by beginning electrocardiogram recording. repeat your electrocardiogram or obtain a 12-lead electrocardiogram. try to save the larger veins for the hospital.¹ Lastly. let’s cover some of the basics of electricity. During your time with the patient. This resistance can vary across the body. and this is an area where electrical contact can be deadly. The increased resistance will produce increased damage.cellular respiration by interrupting the formation of oxygen in the mitochondria. the more destructive the damage. and administer high-flow oxygen. calloused skin on the hands and feet provide the most resistance. The rate of the flow of electricity is called the current. The same hose under pressure flowing at 250 gallons per minute would knock you off your feet. ensure that you are giving the right amount of fluids by double-checking your burn formula. the hotter they get and the more likely they are to tear something up. Depending on the material burned. The increased pressure in the lungs helps to force the fluids out and increases the ability to effectively exchange oxygen at the alveoli. Another element of electricity is how hard it has to work to get from one place to the next. If your nearest burn center is an extended distance from where you currently are. if necessary. Another important aspect is to make sure the patient is as comfortable as possible. from the previous two analogies. In the latter case. feet. the best thing you can do is to take control of the airway. Depending on your protocol. Electrical Burns “It’s not the volts that’ll get ya. if any. This is referred to as resistance or Ohms. if needed. As you make your way down the body. you could very well be injured. it’s the amps. among other internal organs. there can be numerous other substances in the smoke. Your patient might have other traumatic injuries that are masked by the pain or general appearance of a badly burned body. have developed in the patient’s electrical activity. Before we get to the burns. depending on your local protocol. Also. Once you have completed your primary and secondary assessments and are comfortable that you have identified all of the threats to your patient. electricity looks for the path of least resistance. if appropriate. and circulation. you limit the hospital’s ability to provide fluid therapy. If you need another analogy. and none of them are good for you. Our hearts. and you aren’t generally in a very good mood. This means to start thinking about fluid replacement therapy and removing any clothing and jewelry that will restrict circulation if and when the swelling associated with the burn begins.” I’m sure you’ve heard that expression before.

That is why it is important to have as many resources available to help determine the effects of the chemicals you might have to deal with. and protect others from going near it until someone from the power company arrives and shuts off the power. It is for this reason that you should never try to chemically neutralize one with the other. Rather than destroying tissue with heat as in a thermal or electrical burn. chemical burns denature the biochemical makeup of cell membranes and destroy the cells. As you move into your head to toe exam for trauma. it is impossible to know how to treat each and every one of them. and assuming that the power line is dead because you don’t see it sparking anymore are all completely unacceptable actions.¹ Begin electrocardiogram monitoring as soon as possible. you have experienced the denaturing of salmon by fresh lime juice. Along with airway. relying on breakers that may have tripped.4 Large doses of hydrofluoric acid may be fatal and the burns are extremely painful. There is no specific antidote for chlorine. which increases the risks of infection. many of the chemicals that are within a certain class behave in similar ways. as swelling could shut down the patient’s ability to move air. Different chemicals will have different effects on our skin and mucous membranes. There are some agencies that are nebulizing sodium bicarbonate for patients with inhalation injuries from acids. A particularly nasty acid is hydrogen fluoride. Several resources are available to emergency responders free of charge. It is commercially used for removing rust. the best solution may be alcohol or even oil. Pulling meters down. As with the rest of the burns. and circulation pay close attention to deformities in the form of fractures that may have been caused by the muscle contractions associated with prolonged electrical contact. Depending on the source of electrical contact. This decision should be left up to your medical control or your department.¹ This thick coagulation of tissue usually limits the depth of the damage.” but when chemicals react violently with water. the reaction you get when you mix an acid with a base gives off heat. but not until the patient is removed from the source of electricity. The best and safest option would be to let personnel trained in hazardous materials remove and decontaminate the patient prior to any patient contact by you. One of the more common ones is the Emergency Response Guidebook. Faced with this situation.¹ The treatment of electrical burns is similar to the treatment of thermal burns in that there can be large areas of skin missing. hypothermia.4 Treatment usually includes dealing with the airway complications and managing pain after decontamination has been completed. Alkali burns will travel deeper into the layers of the skin and cause more problems. your patient will complain of symptoms ranging from a sore throat to complete lung collapse due to the increased fluids the lung produces to deal with the irritation. The fluoride ion penetrates the skin and binds intracellular calcium and magnesium. The lime juice. You can also find information about the chemicals from shipping papers if the exposure happens while the product is being transported or from material safety data sheets if the emergency occurs at a factory or warehouse. pain medication should be considered. In some cases. If your burn center is an extended transport and your patient is in cardiac arrest from the electrocution. You might run into chlorine in a pool supply store or at a water treatment plant. your patient might have more than one entrance or exit wound. like K-Y Jelly. but it can also immobilize the muscles of the respiratory system.¹ If you have ever had Ceviche at a Mexican restaurant. and hypovolemia. a neighbor may be stealing electricity and the meter you pulled was not attached to that electrical source. you will have to deal with the patient the safest way you know how. “The solution to pollution is dilution. you might be better off transporting to the closest appropriate facility. get the patient far away from the source of electricity. and blisters. are quite the opposite. inflammation. start with your basics. so please don’t mess with our wires. When chlorine gas is introduced to the airway tract. If that option is not available. let’s briefly go over what happens to tissue when it is exposed to chemicals. So a general understanding of these groups might make patient assessment a little easier and safer. Chemicals such as dry lime need to be brushed off prior 5/7 .” Once your patient is safe to treat. Bases. Refer to department policies or contact medical control to get guidance if you need help making this decision. Acids usually form a thick mass or coagulation at the point of contact. It is also found in many automotive cleaning products. Downed power lines may be dead because of a blown fuse. A good example of this is the slippery feeling you get on your fingers when you spill liquid bleach on them.Another dangerous effect of continuous electrical current is its ability to cause muscle contractions that will prevent a person from opening their hand and letting go of a charged wire. Sometimes. and cleaning brass and crystal. The best decontamination for most chemicals is flushing with copious amounts of water. look for entrance and exit wounds. This mixture is applied to the site of the burn and is continued until the pain is gone. So as safely as possible. Fortunately. and look for changes in the heart’s electrical rhythm. The rational is that the heat from the sodium bicarbonate will do less damage than the heat from the acids if left alone. you might consider transport to a burn center. and depending on the body surface area involved. “cooks” the salmon until it is white and flakey. When mixed with water. This process is called coagulation necrosis. Patients exposed to hydrofluoric acid are usually treated with a mixture of calcium gluconate and a water-based lubricant. Dermal contact can cause burning pain. on the other hand. Before we get to the chemicals. If the current is not shut off. Treat any external burns as you would a thermal burn. breathing. Chemical Burns With the thousands of new chemicals being produced every year. you are going to need to get started as soon as possible. not only can it stop the heart. They destroy tissue in a process known as liquefaction necrosis. Add to this the internal injuries caused as the current looks for a way out and it can really make for a bad day. being very acidic. Consider intubation early if the current passed through the upper airway. Something that stuck out from a half-hour training class put on by a local electrical company several years ago and that is very good advice is: “We don’t mess with your fires. it forms hydrofluoric acid. etching glass. but nothing says that the power company doesn’t have a way to restore power by switching on another fuse remotely.

It is generally stored in oil. can be cleaned and returned to the patient. On the other hand. the wound is covered with the oil that it is transported in. the bodies of whoever is standing next to us. If continuous irrigation to the eyes or other mucous membranes is needed. and vomiting. Sodium is a member of the alkali metals family and can react violently with just the moisture in the air. and you never know when some lunatic might go through the mall with a “dirty bomb” and blow up the food court to smithereens.” both the patient and the co-worker have been exposed to a radioactive material. For example. and it is commonly referred to as Alpha. Exposure to radioactive materials is usually classified as acute or chronic. Some smoke detectors have small amounts of Americium 241 or Radium 2265 inside. personal effects. Internal ingestions can sometimes be treated by drinking water or an aluminum phosphate solution over several hours. concrete. be mindful that patients have the ability to off-gas certain chemicals. it depends on the type of radiation being emitted. “Hey. monitor the patient for hypothermia and hypotension. While the clothes are usually destroyed. It is for this reason that transportation by helicopter is generally not a consideration. consider hooking up an IV drip set to a nasal cannula. such as wallets. These types of exposures generally cause cancer several years later. and keep as much “stuff” between you and the source of radiation as possible.to being rinsed with water. As you begin your treatment. All of those tiny chunks of radioactive material will come to rest on people and could possibly end up in their lungs or stomachs. be sure to remove and safely store all clothes by double-bagging them. they don’t pose a significant threat. This can be placed across the bridge of the nose between the eyes and provide a continuous flow of fluids. and be very certain to advise the hospital that you are bringing in a patient that has been exposed to chemicals. blister agents that are used as chemical weapons will be very difficult to remove. X-rays obtained at a hospital in small and infrequent doses do not usually produce lasting harmful effects. So what makes radioactive materials dangerous? Well. which at a distance do not pose any real threat. and cell phones. If you are working a large incident. indigestion. After your patient has been decontaminated. Once your patient runs out of the room. cool. everyone in the area has been contaminated with radioactive material and needs to be decontaminated thoroughly by trained personnel. they still do pose a threat because they can get under the skin and cause external damage in the form of burns and internal damage in the form of tissue or cell destruction. Gamma radiation poses the largest threat because it passes straight through our bodies. Provide supportive care during transport. Alpha particles are very weak and generally can’t pass through a sheet of paper or intact skin. It is important to differentiate between whether the patient was exposed to or contaminated with radioactive materials because there is a difference. transport the patient only when it is safe 6/7 . stay as far away from the radiation source as you can while still able to perform your job functions. and it is recommended that after quickly removing as much of the material as possible. Patients who are exposed to radiation are safer to treat than patients who are contaminated with radioactive material. Beta. it is bad news if you are anywhere near one of these things when it goes off. They have protocols and procedures to follow to make ready prior to your arrival. or fire trucks are all better than nothing. So be prepared to think of alternate ways to decontaminate.5 Any of the physical burns you might encounter can be treated like a thermal burn: clean.¹ Radiation Burns Chances are good that you will never have to deal with a true radiological emergency. keys. That is because the radioactive material has been broken into millions of tiny pieces by the bomb and is now floating through the air on particles of dust and debris. Also. So it is of great importance to determine the type of radiation that the patient has been exposed to as well as how long he or she was in close proximity to it. The effect of the chemical on the pilot and crew in an enclosed space at altitude is never a good combination. Beta particles are slightly stronger and can pass through your skin but generally will not travel all the way through your internal organs. Symptoms from acute exposure include burns. Chronic exposure occurs in small doses over a long period of time. if someone detonates a suitcase bomb with that same chunk of metal in it. Ionizing radiation is the most dangerous. or Gamma radiation. If the chemicals could be easily hosed off with a garden hose. but in the absence of that. and shielding. This type of bomb is referred to either as a “dirty bomb” or a radiological dispersion device. depending on the specific agents used. it causes massive destruction in the form of burns and can eventually lead to cancer if the exposure is strong enough. However. It is highly reactive and requires copious amounts of water once the majority of the powder is removed. if your patient was sitting in his or her office and a co-worker brought in a warm chunk of metal and said. While it is passing through. Be mindful of where the runoff is going so you don’t contaminate the patient or yourself. large piles of earth. and usually whatever else gets in its way. Whatever you call it. look what I found buried in the ground behind the army-navy store. You need to spend as little time as possible in the area where the radiation is. with the exception of lead. so as long as you aren’t eating them or inhaling them into your lungs. Also. A giant sheet of lead would be perfect to hide behind.6 As with any other incident involving hazardous materials.¹ Lastly. Acute exposure generally consists of a large dose occurring over a short period of time. he or she is technically safe to treat. However. make sure that there is some sort of identification in the bag to tell you who it belongs to. It acts even worse when exposed to water. they wouldn't be very effective weapons. The most important things you need to remember with any radiological emergency are time. some of you may work near industrial facilities that either store or use radioactive elements. The decontamination procedures for patients who have been contaminated generally involve a thorough soap and water wash with prolonged irrigations to the eyes and any open wounds. and cover with sterile dressings. distance. some of you may be near these types of facilities without knowing it. Not all radioactive materials are immediately deadly. and transport to the appropriate facility. bring as much information to them as possible regarding the type of chemical that the patient was exposed to.

Scott V. 6. Nothing is ever easy in EMS and burns are no exception. “The Potential Hazard of Ionizing Radiation in Smoke Detectors. 2. April 2003. NJ: Prentice-Hall. Chemical and radiological burns can involve lengthy decontamination procedures and pose a great risk of immediate and long-term problems for the patient and any rescuers who might have been exposed to the same hazardous materials. Thermal burns often require cooling with large amounts of water and a rapid and sterile transport to an appropriate facility. Managing Hazardous Materials Incidents: Medical Management Guidelines for Acute Chemical Exposures. R. and Cherry. Summary In this article. 4. Electrical burns often involve internal injuries. B. “UTSW / BIOTEL EMS SYSTEM: APPENDIX D. 7/7 . and the ability to predict complications before they happen. Mayo Clinic Staff.” Mayo Clinic. “Paramedic Care: Principles and Practice. Center for Domestic Preparedness. All rights reserved. 5. Rosalie.to do so for you and the patient. 7. be sure to notify the hospital that you have a potentially contaminated patient so they can prepare for your arrival. Aguilar. Volume 4. We also reviewed the different layers and how to classify burns depending on the depth at which they extended into the skin. 21 February 2008.” WMD Hazardous Materials Technician Training. Mike. Ed. But with the appropriate safety precautions. 3. Bertell. All burn types require that we remove the patient from the source of the heat as soon as it is safe to do so. 2001. 2001. Lastly.. Copyright © CE Solutions. 19 April 2008. pp.” Biotel. Porter. Department of Health and Human Services. et al.S.” International Institute of Concern for Public Health. we discussed some of the basic functions of the skin and how important it is to monitor for the absence of these functions when the skin is damaged by burns. Upper Saddle River. 172–207. Anniston. AL. R. Bledsoe.” Trauma Emergencies. 22 April 2008. Wright. Illustrations by Louis Saldivar. Agency for Toxic Substances and Disease Registry. and it can be difficult to get access to the patient if the source of electricity cannot be shut off by appropriately trained individuals. “WMD Radiological Toxicology. “Burns: First Aid. our patients have a good potential for full recoveries.E.. Author John Wright. 3rd ed. References 1.A.