It’s been a long night, you’ve ran non-stop except for the little break you got to sleep maybe 2 or 3 hours during what is considered a truce period. You’ve just backed into the station coming off a call for an elderly woman who has fallen ill at 0430, interrupting your truce sleep. You’re greeted by the watchman as you narrate your tale while finishing up a morning bathroom break. Your story is interrupted again…

“Respond to a report of man on fire…”

“What is this? A Denzel Washington movie..” you grumble as you take your seat in the ambulance.

The MDT is no less helpful. “On fire…… 30yom…..” it reads.

Pulling up to the scene, you see no fewer than 3 police officers running around, and the engine sent to help you has stopped in front of a house, that is still smoking. The police officer stops you. “Yeah, he’s in there. It’s… uh, pretty bad. He’s burned all over.”

The open door shows the scene out into the street. A charred body lies in the front room of a house. “Oh great,” mumbling as your partner pulls the ambulance out of the way of the soon to be arriving full response. You both grab on the cot as you roll it up to the house to find half of the engine crew already working on your patient.

The smell of burnt flesh permeates the air. The paramedic on the engine looks vainfully for an IV while his assistant secures a non-rebreather to the burned face of your victim.

Visually, the rest of the scene is about as unappealing as the odor. The patients face is burned, and soot is visible inside the airway. The patient is completely naked, presumably the clothes have been burned away. The skin over the hands and feet has burned and flaked away, revealing the bleeding under layer of skin. Looking down to the ground, bloody tracks are noted where the patient had walked. The skin on the shoulders and arms has also burned away, revealing the freshly exposed ink of tattoos. Surprisingly, your patient is still breathing.

The crew covers the patient in a burn sheet. You decide to lift the patient on a backboard because using any other method would cause more pain and more irritation of the skin layers. The backboard is covered in a burn sheet, and the patient is lifted on to the cot and taken back to the ambulance.

In a better environment, the vain hunt for IV access continues, and is abandoned due to the lack of any landmarks. IO access is considered, but the swelling has progressed so quickly that now even the IO landmarks are not palpable. You continue the high flow oxygen and dismiss the engine crew to go back to firefighting duties.

You gather as much information as you can before the airway becomes unmanageable, but, to your surprise, it’s in great shape. The patient gives you an address not consistent with where the scene was, and mentions something about gas.

Your monitor manages to catch some vitals on the quick ride to the burn center:

BP: 150/86
HR: 138, sinus tachycardia
RR: 22, inspiratory wheezes noted with slight crackles

Stay tuned for Part 2


Category: Case Studies
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About the Author

Russell Stine is a firefighter/paramedic in a large urban system. He has been employed for 6 years as a street level provider and has delivered care as an EMT and a paramedic across the urban, suburban, and rural settings. He has been in emergency services for 15 years.


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