Protocol 2-176

Protocol 2-176 - Burns

CMH EMS & MIH Protocols

EMD:

Dispatch a non-dedicated standby ambulance to the following incident types:

1st alarm commercial structure fire,
2nd alarm residential structure fire,
2nd alarm natural cover fire, OR
2nd alarm vehicle fire.
Alarm definitions:

1st alarm = Initial dispatch.
2nd alarm = Mutual aid dispatched.

EMR:

Hazardous atmosphere standby: Refer to Guideline 1-300 - Ambulance Operations.

Stop the burning process.

Chemical burn:

Decontaminate the patient according to Protocol 2-924 - Universal Patient Care.
Contact MEDICAL CONTROL and/or POISON CONTROL (888-268-4195).
Fluorine or Hydrofluoric Acid contact: Calcium Chloride and KY Jelly Mixture applied to exposed contact area.

Assist Ventilations as needed.

Consider Oxygen 100%.

Consider Saran Wrap (or similar) to prevent heat loss.

Consider applying Cardiac Monitor limb leads.

Remove all jewelry.

Keep patient warm.

AEMT:

Ensure completion of applicable items above.

Refer to Protocol 2-176-50 - Burns - Rule of Nines.

Consider IV LR fluid bolus:

Greater than 20% BSA of 2nd° & 3rd°:

Modified Parkland Formula (first 8 hours): (2 ml/kg) * (% BSA).

Click "calculate" to get dose.

Goal is for the calculated volume to be administered within 8 hours of the burn.

Less than 20% BSA of 2nd° & 3rd°:

Adult:	Pediatric:
500 ml/hr.	6-13 yr old: 250 ml/hr. 0-6 yr old: 125 ml/hr.

Medic:

Ensure completion of all applicable items above.

Consider Protocol 2-044 - Airway: RSI if any of the following:

Brassy cough,
Carbonaceous sputum,
Deep facial burns,
Hoarse voice, OR
Rhonchi / rales / crackles.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914085 - Injury-Burns-Thermal

Citations:

Protocol 9-010 - References
Boland, Satterlee, & Jansen, 2014
Cox Paramedics, 2014
Cyanokit, 2012
Finn, et al., 2004
Mercy Burn Center, 2014
NASEMSO Medical Directors Council, 2017
National Association of Emergency Medical Technicians, 2019

Change Log:

Date	Link to previous version	Description of change
01/29/14	pdf	Added consider saran wrap. Replaced Parkland formulas with new ABLS fluid guidelines. Added consider direct transport to burn center guidelines. Added contraindication for King Airway and 7.5 ET tube desired.
12/12/14	pdf	Added stop the burning process. Added remove all jewelry. Added keep patient warm. Detailed fluid bolus dose for pediatrics greater than 6 yr and less than 6 yr. Added weight-based dose for greater than 65yr for Fentanyl. Added reference to Poisoning for smoke inhalation.
12/12/14	pdf	Made Intubation and RSI DELIBERATE ACTIONS. Added indications for RSI.
03/02/15		Removed DELIBERATE ACTIONS.
04/14/15		Added consider to limb leads.
02/03/16	pdf	Added EMD section.
07/22/16	pdf	Moved fluid bolus to AEMT section.
09/22/17	pdf	Removed medical control for calcium chloride jelly for HF exposure.
08/24/18	pdf	Added link to poisoning protocol. Removed comment to titrate LR to SBP. Added rule of nine graphic.
08/24/18		Per Dr. Kramer, added bolded DECON to every step and every level. Added comment that any Fluorine exposure can be treated as HF exposure.
07/23/19		Added link to new hemorrhage protocol.
04/12/20	pdf	Added HF acid content (without substantive modification) from old Protocol 4-140 - PoisoningOverdose. Added content (without substantive modification) from old Protocol 5-030 - Burns. Added link to Protocol 1-300 - Ambulance Operations for hazardous atmosphere standby.
11/13/20	pdf	Added modified Parkland formula based on new recommendations from PHTLS version 9.
06/06/21	pdf	Moved to emsprotocols.online
10/14/21	pdf	Changed 2-176-01 to 2-176-50 link.
03/15/23	pdf	Clarified RN and medic roles. Added CP.
03/19/23		Changed links for LR.
03/20/23		Changed link for Calcium

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