The prehospital burn protocol for NYC is an interesting combination of scene safety, resuscitation, analgesia, and specialty care systems, making it a nice example of all the interplay between the operational and medical aspects of EMS.
First step at the CFR level is to “stop the burning process,” which, remembering that CFRs are FDNY firefighters, is very funny to me. Beyond that, they’ll remove any clothing, accessories, etc. that may be contributing to injury, start to dress some wounds, initiate eye irrigation, and divert to procedures for carbon monoxide exposure, if indicated. BLS will continue with local wound care and initiate transport.
At the ALS level, paramedics will secure an advanced airway if necessary, obtain IV access, and begin fluid resuscitation. For patients in severe pain, they will administer weight-based morphine or fentanyl by Standing Order in up to 2 doses, to a maximum total of 10mg morphine or 200mcg fentanyl. Importantly, even though those medications are Standing Order, the paramedics require OLMC approval for their use if there is any burn that involves the airway, so be sure to discuss this with crews that call. Other ALS considerations include cardiac monitoring for electrical burns, and topical analgesics for chemical eye exposures.
The Key Points/Considerations section, while probably not directly impactful to OLMC, nevertheless contains some interesting tidbits, ranging from decontamination guidance, to burn center criteria, to references to Burn MCIs, which invoke citywide disaster plans in case of a sudden surge of patients requiring burn center beds. Worth a quick read for a little bit of insight.
Keep it up, OLMC pros! You’re all…on…fire! Ha ha ha, do you get it?
Anyway, www.nycremsco.org or the protocol binder for more protocols (and less jokes).
Dave