Editor_s Note:This is a bonus article to theJanuary 2010 JEMSCall to Action,"Critical Burn Patient."It includes additional scene, care and transport information.
At about 7:30 p.m. on June 9, a man was smoking a cigarette while pumping gasoline into plastic, 1-gallon gas can at a gas station in the southwestern Houston suburb of Alief. The gas or vapors ignited, catching him and part of the pump on fire. Bystanders and the store clerk tried to help by grabbing a portable sodium phosphate fire extinguisher and putting the fire out. No other injuries were reported, and there was no major structural damage.
When the first responders arrived, they found the man barely conscious, but breathing. He was covered in a grayish-white powder from the extinguisher. He had partial-thickness and full-thickness burns (between 80Ï90%) over most of his body. The bottoms of his feet were the only surface areas unburned. A strong, pungent smell of burnt flesh and plastic filled the air. The patient had also inhaled a substantial amount of the chemical residue from the extinguisher, resulting in additional respiratory issues.
Community Volunteer Fire Department responders made sure the fire and all hot areas were extinguished, covered him with a sterile burn sheet, treated him with oxygen via a non-rebreather mask and administered morphine for pain control. Even though the crews handled the patient with great care, every time he was moved or touched, flakes of skin and powder came off.
Memorial Hermann_s Life Flight helicopter was called to transport the patient to Memorial Hermann Hospital, a Level I trauma center. Upon their arrival, the man tried to speak but was disoriented. With the IVs already in place, emergency personnel lifted the backboarded patient onto their stretcher and prepared to intubate him. The flight paramedic intubated the patient while the flight nurse administered narcotics to diminish his pain. The flight nurse noted that the patient's wrist felt tight and hard, like a rubber ball.
During flight, the crew continued giving the patient pain medication and sedated him to place him in a pharmacological coma so that they could ventilate him without difficulty. The patient did well during the short transport to the hospital.
Once the helicopter arrived at the hospital, he was taken to the decontamination shower where the fire extinguisher residue was removed before he was taken into the emergency department. Once in the ED, critical care procedures were continued and a fasciotomy was immediately performed to relieve the pressure caused by his circumferential burns. Despite the significant care rendered by the prehospital, aeromedical and hospital personnel, the patient later succumbed to his injuries.
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