RomeViking09 Posted February 20, 2008 Share Posted February 20, 2008 Scenario setting: Resident Overnight Scout Camp in the Blue Ridge Mountains in North GA Time: 2216 Local Time Call Info: A staff member calls into over the radio reporting a campfire accident in a campsite with 1 camper with "major" injuries, and 2 campers with "minor" injuries at 2219 you, your partner, and the camp ranger (with ability to transport to the camp health lodge) are on scene with a BLS Jump bag and a Burn kit. You find the scene is safe and start to check out each of your 3 PTs. You find the following: PT #1 - 43 y/o Male PT with Partial thickness burns to hands and forearms A/Ox4 HR: 112/Reg/Strong RR: 16/Reg/Unlabored BP: 145/75 STCM: Pink/Warm/Dry (except areas burned) P: PERRL PT #2 - 46 y/o Male PT with Partial thickness burns to hands and forearms A/Ox4 HR: 130/Reg/Bounding RR: 26/Reg/Labored BP: 160/92 STCM: Red/Hot/Moist P: PERRL PT #3 - 10 y/o Male PT with Partial Thickness burns to his chest, neck, left arm, & left leg below the knee A/Ox4 RR:36/Reg/Labored HR: 128/ Reg/Bounding BP: 120/60 STCM: Red/Hot/Dry P: PERRL ALS can be on scene in 1 hour the camp heath lodge is stocked with almost everything that would be on a BLS ambulance with access the the following Drugs: Acetaminophen Ibuprofen Naproxen Diphenhydramine HCL Pseudoephedrine HCL Epinephrine 1:1000 (5x 0.3ml EpiPen, 5x 0.15ml EpiPen) You team is yourself, a 2nd Medic of equal skill, and the Camp Ranger (who is a retired FF/Paramedic). You are operating under BLS ONLY Protocols (no IVs or Drugs unless listed above) Post how you would treat and when you would transport each patient (you have the ability to transport non-emergent in a camp van to a level 2 Trauma Center within 45 mins or Call for ALS Transport to the same Trauma Center, No Air Evac) Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 20, 2008 Share Posted February 20, 2008 Stop the burning process all the mnemonics that you have - do them cover with clean dry dressings oxygen - high flow for the 10 year old ALS to come get the 10 year old - Transport the two minor burns in the camp van. This can't be this simple can it? Link to comment Share on other sites More sharing options...
dahlio Posted February 20, 2008 Share Posted February 20, 2008 Seems to be that simple. Ruff seems to sum it up. Triage: ALS the 10 yr. old, and BLS the other two. Link to comment Share on other sites More sharing options...
Eydawn Posted February 20, 2008 Share Posted February 20, 2008 ALS is WAY out in this scenario if I remember Viking's previous ones. Like, 45 minutes by air far out. So, you have to be able to stabilize and treat to the best of your ability as a BLS provider until your EASY button quits glitching and the Paramedics get there. You can't sit there in the campsite for an hour waiting for ALS... especially in the dark, with the kiddo's troop freaked out and 2 of their adult leaders out of commission. As a camp medic, here's how I'd run it. First, you stop the burning process on the kid and make sure there's no airway compromise especially since we have injuries to the neck. Clean dry burn sheet, get the kiddo on the backboard and in the camp response vehicle (I had a Chevy Suburban... put it in a ditch at one point too! Never lived that down...) so you can get him back to the health lodge ASAP. It's probably getting colder out there since it's dark, and hypothermia is a big concern with this kid especially since he has a large amount of surface area compromised and is only 10 years old. Get the ranger or whoever is authorized to contact ALS via landline to get them going immediately. Viking, is this a hefty 10 year old or a skinny arse Webelo type? Is he a new crossover, or a sibling? If the scoutmasters are OK to walk, I would leave my partner with them to guide them back to the health lodge after doing a quick bandage job- just to keep them dry and clean until we get to the lodge. This is where those wonderful non-stick gauze pads with Telfa would be your friend... I would also have the ranger get on the radio to find some staff to babysit the troop if we're taking all of their 2-deep leadership with us. (You must have at least 2 adult leaders present at any one time with a troop... helps to keep the likeliehood of a pervo getting alone time with the kids at a minimum.) If the scoutmasters are NOT ok to walk, I would have someone else with a camp vehicle swing out to their campsite to go get them. They're lower priority patients no matter how you look at it. Get the kid inside, get the kid nekkid if we didn't do that already, reassess vitals, look for hidden injuries and get the camp director up to the lodge. High flow O2, get as good a history as we can from this poor kid, and get the camp director or otherwise handy staff member to pull the health forms for all three individuals, starting with the kid's. Double check the kid's history against the form, and have the camp director call his parents if he doesn't have a parent up at the camp with him. Let his parents know what's going on and what we're doing for him. Depending on what my next vitals are and how stable we're able to keep the kid, I want ALS by heligoflopter to be kept in mind. If we can get them there quicker than the ground guys, by all means let's get them in the air. If we have no air access, consider a rendezvous with ALS- meet them halfway if possible. If a rendezvous is not possible due to lack of ability to safely transport for any lengthy distance, then I guess we're stuck in the health lodge. If we're stuck for at least an hour, I want to get some pain control onboard in this kid if possible, so I'm getting on the phone with my physician advisor (who has graciously provided me with authorization to use the drug list mentioned before) and asking him or her if acetaminophen would be appropriate given the situation. I don't want to give anything that would interact with the stronger meds the ALS might be wanting to get on board, but I certainly don't want to let this kid suffer for an hour. I'm not just giving the meds because I'm *not* a doc, and at my camp I could only give the comfort meds to an adult or to a kid who had it authorized on his health form. For the adults, I'd be arranging a POV transport and giving them the acetaminophen if that is what they wanted, and I'd be asking a LOT of questions about how the fire funnies occured. How did TWO scoutmasters end up burned? Was it that they both dove for the kid who fell in the fire? How'd the kid fall? Was there roughhousing? So, given my thought process... how stable did the kid stay, did you rendezvous or do air transport, and what'd you do for the adult leaders? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted February 20, 2008 Share Posted February 20, 2008 Good sum up Wendy but in the scenario there's no ALS Air transport. You have an ambulance coming but no heligoflopter available. Link to comment Share on other sites More sharing options...
Eydawn Posted February 20, 2008 Share Posted February 20, 2008 Well damn. If the camp van is equipped to properly hold a supine patient, (aka GOOD restraints) then off we go for intercept. Other than that... pray? Lol... this is a really good example of the joys of camp medicine... Wendy CO EMT-B Link to comment Share on other sites More sharing options...
RomeViking09 Posted February 20, 2008 Author Share Posted February 20, 2008 Here is my Answer: PT #1 - Given Rule of Nines he has maybe a max total of 9% surface burns, and has stable Vitals so he gets 2x 500mg Acetaminophen for Pain (pre Off-Line Direction), 2nd Skin Dressings on the Burns, or moist gauze. This leader get to make up his own mind about going to the ER and how he wants to go, given that he only has minor 2nd degree burns that can heal on their own. PT #2 - I am going to take him to the health lodge, and he going to get O2, and a trip to the ER, look at his Vitals and his age you have Tachycardia, Labored breatheing, and high blood pressure so I am thinking treat for Shock then the burns. As soon as I get to the Health Lodge I am getting the AED out just in case and he is getting a full physical exam and watching his Vitals PT #3 - Here is the tricky one, you need to treat for shock and get this kid inside ASAP, O2, and Burn dressings, I would have the kid on a backboard and we have a jeep that can transport 1 PT supine, 1 PT seated and 2 Medics. So I am taking this kid in to the health lodge to warm him up and then it is off to the ER with PT #2, I notify ALS in route but my plan is to get this kid into a ER asap so he can be sent off to a burn center, given Rule of Nines he has 36% surface burns and possible airway issues. The change of survival (Given COS= 100- (age + surface burn%) for this PT is 54%. This was not a real Scenario but one we used in staff training week. In the training Scenario the camper trips into the fire and the adults are burned in the process of putting the kid out. the 2nd adult is a curve ball we throw so that Medics remember not top focus just on the kid, in Bad Camp and/or Wilderness scenarios you all most always have more than one patients that need your care at the same time, this a bit easier b/c you have two EMTs, but what if it is just you? what can you have others around you doing for so you you can focus on treatment's they can't do. In street EMS I don't see a lot of Use of ByStanders on Scene except maybe to hold an IV bag, or keep doing CPR, but here you may need them to do real patient care while you attend to another patient. Link to comment Share on other sites More sharing options...
RomeViking09 Posted February 20, 2008 Author Share Posted February 20, 2008 Viking, is this a hefty 10 year old or a skinny arse Webelo type? Is he a new crossover, or a sibling? Lets Say a "normal" 10 year old, new crossover in good physical shape If we're stuck for at least an hour, I want to get some pain control onboard in this kid if possible, so I'm getting on the phone with my physician advisor (who has graciously provided me with authorization to use the drug list mentioned before) and asking him or her if acetaminophen would be appropriate given the situation. I don't want to give anything that would interact with the stronger meds the ALS might be wanting to get on board, but I certainly don't want to let this kid suffer for an hour. I'm not just giving the meds because I'm *not* a doc, and at my camp I could only give the comfort meds to an adult or to a kid who had it authorized on his health form. Given our off-line direction we can give the drug then and their, If I am sending the kid off to the ER in our van, I am giving him 1000mg of acetaminophen (the is the pain med listed in our protocols) I might consider asking for Ibuprofen depending on the amount of swelling. Link to comment Share on other sites More sharing options...
Eydawn Posted February 20, 2008 Share Posted February 20, 2008 Misread Adult #2's pulse rate. I'd expect his HR, RR and BP to be up from the emotional and physical stress of the incident; but he still is much lower priority than the kid with the potentially compromised airway and large surface area burns. He'd be riding shotgun in the van, unless he wanted to stay with Adult #1. So you have capability to transport long distances? No waiting. Call the doc, ask for tylenol for the kiddo, get going to the ER and if ALS meets us enroute, all the better. Wendy CO EMT-B Link to comment Share on other sites More sharing options...
Eydawn Posted February 20, 2008 Share Posted February 20, 2008 I'm not comfortable, off line medical direction or no, administering *any* dose of acetaminophen to a pediatric patient in this severe a condition without on-line medical direction. I simply do NOT know enough as a basic to make that decision solo, and refuse to do so. The adults are another story. They can choose to take it if it is available under their own cognizance. Kids are tricky. Now, I'm operating here under *my* camp protocol in my head... since I haven't had a chance to read yours. But I'll give you good odds I still call the doc before giving the kiddo any meds at all. Wendy CO EMT-B Link to comment Share on other sites More sharing options...
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