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Chapter 23Chapter 23BurnsBurns

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectivesDescribe incidence, patterns, sources of burn injuryDescribe incidence, patterns, sources of burn injury

Describe local and systemic responses to burn injuryDescribe local and systemic responses to burn injury

Classify burn depth, extent, severity Classify burn depth, extent, severity

Discuss pathophysiology of signs and symptoms of Discuss pathophysiology of signs and symptoms of burn shock burn shock

Outline physical exam of burn patientOutline physical exam of burn patient


ObjectivesObjectivesDescribe field management of burn injuryDescribe field management of burn injury

Discuss signs and symptoms and management Discuss signs and symptoms and management of patients with:of patients with:

Inhalation injuryInhalation injuryChemical injuryChemical injuryElectrical injuryElectrical injuryRadiation injuryRadiation injury


Mosby, Inc. items and derived items © 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Sanders: Mosby's Paramedic Textbook, Revised 3rd Edition PowerPoint Lecture Notes

Chapter 23: Burns

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Scenario,Scenario,As you pull up to the scene of a house fire you see As you pull up to the scene of a house fire you see firefighters struggling to pull an elderly male out the firefighters struggling to pull an elderly male out the front door. They frantically shout for you. Your patient front door. They frantically shout for you. Your patient is unconscious. You immediately notice soot and is unconscious. You immediately notice soot and burns on his face. His clothing is smoldering, and you burns on his face. His clothing is smoldering, and you note white, leathery, waxy burns on his arms. You note white, leathery, waxy burns on his arms. You can hear the highcan hear the high--pitched stridor as he struggles to pitched stridor as he struggles to breathe, and the acrid smell of his burning flesh fills breathe, and the acrid smell of his burning flesh fills the air.the air.


DiscussionDiscussionWhat is your first concern as you approach this What is your first concern as you approach this scene?scene?

What immediate life threats do you anticipate What immediate life threats do you anticipate with this patient?with this patient?

What are your priorities of care for this man?What are your priorities of care for this man?

Why will he need the resources of a burn Why will he need the resources of a burn center?center?


Burn InjuryBurn Injury10,000 deaths/year10,000 deaths/year

More common in menMore common in men

Death rates high in kids and older adultsDeath rates high in kids and older adults

Most deaths happen in homeMost deaths happen in home

High incidence in lowHigh incidence in low--income householdsincome households



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Major Sources of BurnsMajor Sources of BurnsInteraction between energy (thermal, chemical, Interaction between energy (thermal, chemical, electrical, or radiation) and biological matterelectrical, or radiation) and biological matter

Thermal burnsThermal burnsMost common typeMost common typeFlames, scalds, or contact with hot substancesFlames, scalds, or contact with hot substancesFrostbite is a type of thermal injuryFrostbite is a type of thermal injury

Chemical burnsChemical burnsSubstances that produce chemical changes in skin with or Substances that produce chemical changes in skin with or without heat productionwithout heat production


Major Sources of BurnsMajor Sources of BurnsElectrical injuries Electrical injuries

Lightning injuriesLightning injuriesDirect contact with electrical currentDirect contact with electrical currentArcing of electricity between two contact points Arcing of electricity between two contact points near skinnear skinFlash burns if fuel source is ignitedFlash burns if fuel source is ignited


Radiation InjuryRadiation InjuryIonizing and nonionizing radiationIonizing and nonionizing radiation

Burns may result from high level of radiation Burns may result from high level of radiation exposure to a specific areaexposure to a specific area

RareRare



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Pathophysiology of Thermal Burn InjuryPathophysiology of Thermal Burn Injury

Tissue destruction depends on:Tissue destruction depends on:Temperature and duration of exposureTemperature and duration of exposure

Ability to resist burn injury depends on:Ability to resist burn injury depends on:Water content of skin tissueWater content of skin tissueThickness and pigmentation of skinThickness and pigmentation of skinInsulating substances (e.g., skin oils, hair)Insulating substances (e.g., skin oils, hair)Peripheral circulation of skinPeripheral circulation of skin

•• Affects dissipation of heatAffects dissipation of heat


Local Response to Burn InjuryLocal Response to Burn InjuryBurn injury destroys cells or completely Burn injury destroys cells or completely disrupts their metabolic functionsdisrupts their metabolic functions

Cellular death ensuesCellular death ensuesCellular damage is distributed over a spectrum of Cellular damage is distributed over a spectrum of injuryinjury


Local Response to Burn InjuryLocal Response to Burn Injury

Major burns have three Major burns have three zones of injury zones of injury

Appear in bullsAppear in bulls--eye eye pattern:pattern:

Zone of hyperemia (A)Zone of hyperemia (A)Zone of stasis (B)Zone of stasis (B)Zone of coagulation (C)Zone of coagulation (C)



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Systemic Response to Burn InjurySystemic Response to Burn Injury

Hypovolemic shock associated with: Hypovolemic shock associated with: Decrease in venous returnDecrease in venous return

•• Decreased cardiac outputDecreased cardiac output•• Increased vascular resistance (except in zone of Increased vascular resistance (except in zone of

hyperemia)hyperemia)

Renal failure may occur due to:Renal failure may occur due to:•• Hemolysis (destruction of RBCs)Hemolysis (destruction of RBCs)•• Rhabdomyolysis (muscle necrosis)Rhabdomyolysis (muscle necrosis)


Systemic Response to Burn InjurySystemic Response to Burn Injury

Pulmonary Pulmonary

Gastrointestinal Gastrointestinal

Musculoskeletal Musculoskeletal

NeuroendocrineNeuroendocrine

Metabolic Metabolic

Immune Immune

EmotionalEmotional


Classifications of Burn Injury Classifications of Burn Injury Assess and classify as accurately as Assess and classify as accurately as possible in the prehospital settingpossible in the prehospital setting

Difficult because of progressive nature of injuryDifficult because of progressive nature of injuryAmount of tissue damage may not be evident Amount of tissue damage may not be evident for hours/days after injuryfor hours/days after injury



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Depth of Burn InjuryDepth of Burn InjuryFirst, second, and third degree (some include First, second, and third degree (some include fourth degree)fourth degree)

FirstFirst-- and secondand second--degree burns are partialdegree burns are partial--thickness burnsthickness burns

•• Usually heal without surgeryUsually heal without surgery

ThirdThird--degree burns are fulldegree burns are full--thickness burnsthickness burns•• Usually require skin graftsUsually require skin grafts


FirstFirst--Degree BurnDegree BurnPainful, red, dry, blanch Painful, red, dry, blanch with pressurewith pressure

Superficial layer of Superficial layer of epidermal cells is epidermal cells is destroyeddestroyed

Heals in 2Heals in 2--3 days3 days


SecondSecond--Degree BurnDegree BurnSuperficial partialSuperficial partial--thicknessthickness

BlistersBlisters

Injury extends through Injury extends through epidermis to dermisepidermis to dermis

If no infection, generally If no infection, generally heals without scarringheals without scarring



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SecondSecond--Degree BurnDegree BurnDeep partialDeep partial--thicknessthickness

Involves basal layer of dermisInvolves basal layer of dermisSensation in and around wound may be Sensation in and around wound may be diminisheddiminishedMay appear red and wet or white and dry, May appear red and wet or white and dry, depending on the degree of vascular injurydepending on the degree of vascular injuryMajor complication is wound infectionMajor complication is wound infection


Deep PartialDeep Partial--Thickness BurnThickness Burn


ThirdThird--Degree BurnDegree Burn

FullFull--thickness burnthickness burn

Epidermis and dermis Epidermis and dermis destroyed destroyed

Eschar present Eschar present Sensation and capillary Sensation and capillary refill absent refill absent Skin grafts needed for Skin grafts needed for timely and proper healingtimely and proper healing



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FourthFourth--Degree BurnDegree BurnIncluded in some burn classificationsIncluded in some burn classifications

FullFull--thickness injury that penetratesthickness injury that penetratesSubcutaneous tissueSubcutaneous tissueMuscleMuscleFasciaFasciaPeriosteumPeriosteumBoneBone


Extent and Severity of Burn InjuryExtent and Severity of Burn Injury

Common methodsCommon methodsRule of ninesRule of ninesLund and Browder chartLund and Browder chart

American Burn Association (ABA) has devised American Burn Association (ABA) has devised a categorization of burns to determine severitya categorization of burns to determine severity


Rule of NinesRule of NinesDivides total body surface Divides total body surface area (TBSA) into area (TBSA) into segments that are segments that are multiples of 9%multiples of 9%

Rough estimate of burn Rough estimate of burn sizesize

Most accurate for adults Most accurate for adults and children >10 y/oand children >10 y/o



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Lund and Browder ChartLund and Browder ChartAccurate method to determine area of burn Accurate method to determine area of burn injuryinjury

Assigns numbers to each body partAssigns numbers to each body part

Used to measure burns in infants and young Used to measure burns in infants and young childrenchildren

Allows for developmental changes in percentages Allows for developmental changes in percentages of body surfaceof body surface


Lund and Browder ChartLund and Browder Chart


American Burn Association CategorizationAmerican Burn Association Categorization

Classifies burns as major, moderate, and Classifies burns as major, moderate, and minorminor

Considers: Considers: Patient's agePatient's ageMedical or surgical problemsMedical or surgical problemsBurns of:Burns of:

•• Face and neckFace and neck•• Hands and feetHands and feet•• GenitaliaGenitalia



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Burn Center Referral CriteriaBurn Center Referral CriteriaBurn categorizations used to determine Burn categorizations used to determine which patients need transport to specialized which patients need transport to specialized burn centersburn centers

American College of Surgeons and American American College of Surgeons and American Burn Association have 10 guidelines for burns Burn Association have 10 guidelines for burns that usually require burn center referralthat usually require burn center referral


Burn ShockBurn ShockShock results from:Shock results from:

Edema and accumulation of Edema and accumulation of vascular fluid in the tissues in vascular fluid in the tissues in the area of injurythe area of injurySystemic fluid leakSystemic fluid leak

Burn shockBurn shockEmergent phaseEmergent phaseFluid shift phaseFluid shift phaseHypermetabolic phaseHypermetabolic phaseResolution phaseResolution phase


Burn ShockBurn ShockTherapy aimed at supporting patient through Therapy aimed at supporting patient through hypovolemic shockhypovolemic shock

Crystalloid solution (e.g., lactated RingerCrystalloid solution (e.g., lactated Ringer’’s solution) s solution) fluid of choice in initial resuscitation fluid of choice in initial resuscitation Three formulas for calculating fluid replacement Three formulas for calculating fluid replacement volume:volume:

•• Parkland formulaParkland formula•• Modified Brooke formulaModified Brooke formula•• Consensus formulaConsensus formula



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Assessment of the Burn PatientAssessment of the Burn Patient

Initial assessmentInitial assessmentAirwayAirway

•• Especially patients with inhalation injuryEspecially patients with inhalation injury

BreathingBreathingCirculationCirculationNeurological statusNeurological status


Probability of Upper Airway ObstructionProbability of Upper Airway Obstruction


HistoryHistoryChief complaint (pain, dyspnea)Chief complaint (pain, dyspnea)

Circumstances of injuryCircumstances of injuryEnclosed space?Enclosed space?Explosive forces involved?Explosive forces involved?Hazardous chemicals involved?Hazardous chemicals involved?Related trauma?Related trauma?

Source of burning agent (e.g., flame, metal, Source of burning agent (e.g., flame, metal, liquid, chemical)liquid, chemical)



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HistoryHistorySignificant medical historySignificant medical history

Patient medications (and drugs/alcohol) Patient medications (and drugs/alcohol)

Loss of consciousness at any timeLoss of consciousness at any timeSuspect inhalation injurySuspect inhalation injury

Last tetanus immunizationLast tetanus immunization


Physical ExaminationPhysical ExaminationVital signsVital signs

If severe burns or preexisting cardiac or medical If severe burns or preexisting cardiac or medical illness, monitor ECGillness, monitor ECG

Field care and hospital destination determined Field care and hospital destination determined by:by:

Burn depthBurn depthBurn sizeBurn sizeExtent of burned tissueExtent of burned tissueAssociated illness or injuryAssociated illness or injury


Goals of Prehospital Burn ManagementGoals of Prehospital Burn Management

Preventing further tissue injuryPreventing further tissue injuryMaintaining patent airwayMaintaining patent airwayAdministering oxygen and ventilatory supportAdministering oxygen and ventilatory supportFluid resuscitation (per protocol)Fluid resuscitation (per protocol)Rapid transport to appropriate medical facilityRapid transport to appropriate medical facilityClean technique to minimize patient's exposure to Clean technique to minimize patient's exposure to infectious agentsinfectious agentsPsychological and emotional supportPsychological and emotional support



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Stopping the Burning ProcessStopping the Burning ProcessProvide scene safety for rescue crewProvide scene safety for rescue crew

Minor firstMinor first--degree burnsdegree burnsCool the local area with cool waterCool the local area with cool water


Stopping the Burning ProcessStopping the Burning ProcessSevere burnsSevere burns

Move patient to area of safety Move patient to area of safety If clothing is in flames or smoldering:If clothing is in flames or smoldering:

•• Place patient on floor or groundPlace patient on floor or ground•• Roll in blanket to smother flames and/or douse with large Roll in blanket to smother flames and/or douse with large

quantities of cleanest available waterquantities of cleanest available waterRemove clothing while cooling burn so heat is not Remove clothing while cooling burn so heat is not trapped under smoldering clothtrapped under smoldering clothAfter burn is cooled, cover patient with clean sheet After burn is cooled, cover patient with clean sheet


Airway, Oxygen, and VentilationAirway, Oxygen, and Ventilation

Administer highAdminister high--concentration humidified (if concentration humidified (if available) oxygen available) oxygen

Assist ventilation as neededAssist ventilation as needed

If inhalation injury is suspected, closely observe If inhalation injury is suspected, closely observe for signs of impending airway obstruction:for signs of impending airway obstruction:

Laryngeal edema may be progressive and may make Laryngeal edema may be progressive and may make tracheal intubation difficult or impossibletracheal intubation difficult or impossibleDo not delay intubation in these patientsDo not delay intubation in these patients



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CirculationCirculationFluid resuscitation is based on:Fluid resuscitation is based on:

Severity of injurySeverity of injuryVital signsVital signsTransport time to hospitalTransport time to hospital

IV therapyIV therapy

If transport is to be delayed or interfacility transport is If transport is to be delayed or interfacility transport is possible, consider:possible, consider:

AnalgesicsAnalgesics——aggressive pain control aggressive pain control NG tube placementNG tube placementBladder catheterizationBladder catheterization


Special ConsiderationsSpecial ConsiderationsFacial burns swell rapidly Facial burns swell rapidly

Associated with airway compromiseAssociated with airway compromiseElevate stretcher at least 30 degrees (if not Elevate stretcher at least 30 degrees (if not contraindicated by spinal trauma) to minimize contraindicated by spinal trauma) to minimize edemaedema

Avoid pillow if ears are burned Avoid pillow if ears are burned


Special ConsiderationsSpecial ConsiderationsExtremity burnsExtremity burns

Remove jewelry to prevent vascular compromise Remove jewelry to prevent vascular compromise from edemafrom edemaAssess peripheral pulses frequentlyAssess peripheral pulses frequentlyElevate burned limb above patient's heartElevate burned limb above patient's heart

Circumferential burnsCircumferential burnsThreat to patient's life or limbThreat to patient's life or limbTourniquetTourniquet--like effect on extremity or chestlike effect on extremity or chest



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Inhalation Burn InjuryInhalation Burn InjuryEpidemiologyEpidemiology

IncidenceIncidence

Morbidity/mortalityMorbidity/mortality

Risk factorsRisk factors

Prevention strategiesPrevention strategies


Carbon Monoxide PoisoningCarbon Monoxide PoisoningColorless, odorless, tasteless gas Colorless, odorless, tasteless gas

Produced by incomplete combustion of carbon fuelsProduced by incomplete combustion of carbon fuelsDoes not physically harm lung tissueDoes not physically harm lung tissue

Affinity for hemoglobin 250x oxygenAffinity for hemoglobin 250x oxygenSmall concentrations of CO can cause severe physiological Small concentrations of CO can cause severe physiological impairmentsimpairmentsEffects of carbon monoxide poisoning related to blood CO Hgb Effects of carbon monoxide poisoning related to blood CO Hgb levellevel

TreatmentTreatment


Inhalation Injury above the GlottisInhalation Injury above the Glottis

Upper airway structures Upper airway structures susceptible to injury if susceptible to injury if exposed to high exposed to high temperaturestemperatures

Signs and symptomsSigns and symptoms

Prehospital carePrehospital care



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Inhalation Injury below the GlottisInhalation Injury below the Glottis

Mechanisms of direct injury to lung Mechanisms of direct injury to lung parenchyma areparenchyma are

HeatHeatToxic material inhalationToxic material inhalation

Signs and symptoms often delayed Signs and symptoms often delayed

Prehospital care Prehospital care


Chemical Burn InjuryChemical Burn InjuryThree common types of caustic agentsThree common types of caustic agents

Alkalis (strong bases with a high pH)Alkalis (strong bases with a high pH)•• Hydroxides and carbonates of:Hydroxides and carbonates of:

Sodium, potassium, ammonium, lithium, barium, calciumSodium, potassium, ammonium, lithium, barium, calciumOven cleaners, drain cleaners, fertilizers, heavy industrial Oven cleaners, drain cleaners, fertilizers, heavy industrial cleaners, cement and concretecleaners, cement and concrete

Strong acidsStrong acids•• Rust removersRust removers•• Bathroom cleanersBathroom cleaners•• Swimming pool acidifiersSwimming pool acidifiers

Organic compounds (chemicals that contain carbon)Organic compounds (chemicals that contain carbon)•• WoodWood•• CoalCoal


Chemical Burn InjuryChemical Burn InjuryIntraoral chemical burns Intraoral chemical burns sustained by a boy who sustained by a boy who ingested bleachingested bleach



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Chemical Burn InjuryChemical Burn InjurySeverity of chemical injury related to:Severity of chemical injury related to:

Chemical agentChemical agentConcentration and volume of chemicalConcentration and volume of chemicalDuration of contactDuration of contact


AssessmentAssessment——Chemical InjuryChemical InjuryDetermine:Determine:

Type of chemicalType of chemicalConcentration of chemical Concentration of chemical Volume of chemical Volume of chemical Mechanism of injuryMechanism of injury

•• Local immersion of body part, injection, splashLocal immersion of body part, injection, splash

Time of contaminationTime of contaminationFirst aid before EMS arrivalFirst aid before EMS arrivalAppearance (chemical burns vary in color)Appearance (chemical burns vary in color)PainPain


ManagementManagementScene safetyScene safety

Consider protective gearConsider protective gear

Remove all clothing, including shoesRemove all clothing, including shoes

Brush off powdered chemicalsBrush off powdered chemicals

Irrigate affected area with copious amounts of waterIrrigate affected area with copious amounts of water



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Chemical Burn Injury to the EyesChemical Burn Injury to the Eyes

CausesCauses

Signs and symptomsSigns and symptoms

Management Management Antidotes or neutralizing Antidotes or neutralizing agentsagentsNo agent superior to water No agent superior to water for treating most chemical for treating most chemical injuriesinjuries Use of nasal cannula for eye irrigation


Specific Chemical InjuriesSpecific Chemical InjuriesPetroleumPetroleum

Hydrofluoric acidHydrofluoric acid

Phenol (carbolic acid)Phenol (carbolic acid)

AmmoniaAmmonia

Alkali metalsAlkali metals


Electrical Burn InjuriesElectrical Burn InjuriesEpidemiologyEpidemiology

IncidenceIncidence

Morbidity/mortalityMorbidity/mortality



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Types of Electrical InjuryTypes of Electrical InjuryTissue damage produced by electrical current Tissue damage produced by electrical current depends ondepends on

Amperage (current flow)Amperage (current flow)Voltage (force)Voltage (force)ResistanceResistanceType of currentType of current

•• AlternatingAlternating•• DirectDirect

Current pathwayCurrent pathwayDuration of current flowDuration of current flow


Types of Electrical InjuryTypes of Electrical InjuryDirect contact burnsDirect contact burns

Arc injuriesArc injuries

Flame and flash burnsFlame and flash burns


Direct Contact BurnDirect Contact BurnDirect contact burnDirect contact burn——entry wound (hand)entry wound (hand)

Exit woundExit wound



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Effects of Electrical InjuryEffects of Electrical InjuryMusculoskeletal Musculoskeletal

Similar to crush injurySimilar to crush injuryMyoglobin released from muscle damageMyoglobin released from muscle damage

Cardiovascular Cardiovascular Significant dysrhythmiasSignificant dysrhythmiasTachycardiaTachycardiaHypertensionHypertensionHemolysis releases hemoglobinHemolysis releases hemoglobinBlood vessel necrosisBlood vessel necrosis


Effects of Electrical InjuryEffects of Electrical InjuryExternal burnsExternal burns

Respiratory injuryRespiratory injuryVentilation impaired Ventilation impaired

Neurological injuriesNeurological injuriesRespiratory center depressionRespiratory center depressionBrain tissue injuryBrain tissue injury

Myoglobin release and renal involvementMyoglobin release and renal involvement


Assessment and ManagementAssessment and ManagementScene safety for rescuers or bystandersScene safety for rescuers or bystanders

If patient is in contact with electrical source, If patient is in contact with electrical source, consult appropriate personnel before consult appropriate personnel before touching patienttouching patient

Once scene is safe, patient care can beginOnce scene is safe, patient care can begin



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Initial AssessmentInitial AssessmentProceed as for all other trauma patientsProceed as for all other trauma patients

Immobilize cervical spineImmobilize cervical spine

If apnea, provide assisted ventilation:If apnea, provide assisted ventilation:Intubation because apnea may persist for lengthy periodsIntubation because apnea may persist for lengthy periods

For breathing patient, maintain a patent airway and For breathing patient, maintain a patent airway and support with supplemental highsupport with supplemental high--concentration oxygenconcentration oxygen


Initial AssessmentInitial AssessmentIf patient is in cardiac arrest, resuscitation If patient is in cardiac arrest, resuscitation efforts should be implemented according to efforts should be implemented according to protocolprotocol


HistoryHistoryHistory History

Chief complaint (e.g., injury, disorientation)Chief complaint (e.g., injury, disorientation)Source, voltage, and amperage of electrical injurySource, voltage, and amperage of electrical injuryDuration of contactDuration of contactLevel of consciousness before and after injuryLevel of consciousness before and after injuryPast significant medical historyPast significant medical history



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Physical ExaminationPhysical ExaminationSearch for:Search for:

Entrance and exit woundsEntrance and exit woundsTrauma caused by tetany or a fallTrauma caused by tetany or a fall

Remove all clothing and jewelryRemove all clothing and jewelryAssess and document distal pulses, motor Assess and document distal pulses, motor function, and sensation in all extremities function, and sensation in all extremities Cover wounds with sterile dressingsCover wounds with sterile dressingsManage associated trauma appropriatelyManage associated trauma appropriatelyMonitor ECGMonitor ECG


ManagementManagementEarly fluid resuscitation is critical Early fluid resuscitation is critical

Establish two largeEstablish two large--bore IV lines in extremity bore IV lines in extremity without entry or exit woundswithout entry or exit wounds

•• Fluid of choice is LR or NSFluid of choice is LR or NS•• Flow rate determined by patientFlow rate determined by patient’’s clinical statuss clinical status


Lightning InjuryLightning Injury70 deaths/year70 deaths/year

DC of 200,000 ampsDC of 200,000 amps

Potential of 100 million voltsPotential of 100 million volts

Injury by direct strike or side flashInjury by direct strike or side flash

Cardiac arrest possibleCardiac arrest possible



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Lightning InjuryLightning Injury

Pathway of damage Pathway of damage often often overover rather than rather than throughthrough skin skin

Lightning burns are Lightning burns are linear, feathery, and linear, feathery, and punctate (pinpoint) punctate (pinpoint) Classified as minor, Classified as minor, moderate, or severemoderate, or severe


Assessment and ManagementAssessment and ManagementScene safety Scene safety Prevent injury from subsequent lightning strikesPrevent injury from subsequent lightning strikesAirway and ventilatory supportAirway and ventilatory supportBasic and advanced life supportBasic and advanced life supportPatient immobilizationPatient immobilizationFluid resuscitation to prevent hypovolemia and renal failureFluid resuscitation to prevent hypovolemia and renal failurePharmacological therapy (per protocol) Pharmacological therapy (per protocol) Wound careWound careRapid transport to appropriate hospitalRapid transport to appropriate hospital


Radiation ExposureRadiation ExposureIndustrial radiography is sourceIndustrial radiography is source

Rarely requires emergency careRarely requires emergency care

Scene safety is a priorityScene safety is a priority



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Radioactive ParticlesRadioactive ParticlesAlpha particlesAlpha particles

Skin will stopSkin will stopDangerous if ingested or inhaledDangerous if ingested or inhaled

Beta particlesBeta particlesPenetrate subcutaneous tissuePenetrate subcutaneous tissueFull PPE, including SCBA, neededFull PPE, including SCBA, needed

Gamma rays and xGamma rays and x--raysraysMost dangerousMost dangerousLead shields neededLead shields needed


Radiation ExposureRadiation ExposureNonionizing radiationNonionizing radiation

Not usually considered dangerousNot usually considered dangerousRadio waves and microwavesRadio waves and microwaves

Ionizing radiationIonizing radiationNuclear weaponsNuclear weaponsReactorsReactorsRadioactive materialRadioactive materialXX--ray machinesray machinesThreat to rescue personnelThreat to rescue personnel


Measurements of RadiationMeasurements of RadiationRoentgensRoentgens

RAD (radiation absorbed dose)RAD (radiation absorbed dose)

REM (roentgen equivalent man)REM (roentgen equivalent man)

Radiation dosesRadiation doses



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Emergency Response to Emergency Response to Radiation AccidentsRadiation Accidents

Approach with cautionApproach with caution

Do not enter scene until it is secured Do not enter scene until it is secured Rescue personnel, emergency vehicles, and Rescue personnel, emergency vehicles, and command post positioned 200command post positioned 200--300 ft upwind of site300 ft upwind of siteShould not eat, drink, or smoke at accident site or in Should not eat, drink, or smoke at accident site or in any rescue vehicleany rescue vehicle


Emergency Response to Emergency Response to Radiation AccidentsRadiation Accidents

Contact appropriate local authorities Contact appropriate local authorities

Wear suitable protective clothing Wear suitable protective clothing

Dose meters should be available for all rescue Dose meters should be available for all rescue personnelpersonnel


Personal Protection from RadiationPersonal Protection from Radiation

FactorsFactorsTimeTimeDistanceDistanceShieldingShieldingQuantityQuantity



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Emergency Care for Victims of Emergency Care for Victims of Radiation AccidentsRadiation Accidents

Patients who have been irradiated are not radioactivePatients who have been irradiated are not radioactiveFollow protocol for removing radioactive material from a Follow protocol for removing radioactive material from a patient's clothing, skin, or open woundspatient's clothing, skin, or open woundsTreat patients in normal fashionTreat patients in normal fashionMove patient away from radiation sourceMove patient away from radiation sourceDo not delay lifesaving care for patient transfer or Do not delay lifesaving care for patient transfer or decontaminationdecontaminationIV fluid replacement should be initiated if indicated using striIV fluid replacement should be initiated if indicated using strict ct aseptic techniqueaseptic technique


Radiation DecontaminationRadiation DecontaminationRadiation emergencies may be defined as:Radiation emergencies may be defined as:

CleanClean•• Patient exposed but not contaminatedPatient exposed but not contaminated

DirtyDirty•• Patient contaminatedPatient contaminated•• Only properly trained personnel should attempt to Only properly trained personnel should attempt to

decontaminate radiation victimsdecontaminate radiation victims

Patients who are transported should be isolated from Patients who are transported should be isolated from the environmentthe environmentTransport all patientTransport all patient’’s effects with patients effects with patient


ConclusionConclusionUnderstanding the consequences of burn Understanding the consequences of burn

injuries and appropriate prehospital injuries and appropriate prehospital management can reduce morbidity and management can reduce morbidity and mortality in this complex patient group.mortality in this complex patient group.



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Questions?Questions?



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