You can follow the smoke and flames to the scene. On arrival you see the entire A-frame structure is fully involved and fire crews are already working on the initial attack. The fire chief directs you to their command vehicle and tells you there is one female patient being attended to by firefighters. A second victim is believed to still be in the structure and fire crews are working to gain access.

In the command vehicle you see a 35-year-old female sitting on a bench seat. She is crying hysterically and has obvious burns to her face and chest. Her hair and eyebrows are singed, her face black with soot. The skin is peeling off her face, chest and arms. Firefighters are attempting to pour water on her arms and chest. She is holding a wet cloth to her face. Her clothes are burnt to the skin on her legs and chest.

The firefighters report the female told them her and her husband had awakened early this morning chilled from the cold night. Her husband had gone to the back room to light the pilot light and start the furnace which is powered by natural gas. After a few minutes she had gone to check on him and had just entered the doorway when there was a tremendous blast and immediate engulfing flames. She was thrown across the room. Dazed, she struggled to crawl to the door of the cabin but was unable to assist her husband due to theflames. A neighbor covered her with a blanket extinguishing her burning clothes, called the fire department, and attempted to run into the cabin to rescue the male but was unable to due to heat and fire.Primary survey of the female reveals carotid and radial pulses present and equal, airway open, patient awake, alert orientated to person, place, time and situation. Lung sounds reveal clear equal lung sounds with slight wheezing in the bases on expiration only. The patient’s burns are: entire face is reddened, hair is singed, eyebrows burnt off, blisters and peeling skin on chest and both lower arms. Vitals as above. Patient reports no pertinent past medical history, is on birth control pills and reports no allergies. She is hysterical due to pain and the situation and is being restrained by a firefighter. Secondary survey reveals burns to the chest and upper extremities. Her abdomen is non-rigid, non-distended and non-tender. There is a large piece of glass impaled in her right lower leg with approximately one-inch piece of glass protrud­ing. The area is not actively bleeding. No other trauma is noted.

35 year-old-female	80 kg
B/P	140/80
Pulse	120 regular
Respiration	24 non-laboured
E.C.G. Reveals:

Basic Level Questions

1.The first thing you should do on arrival is: A. Call for backup B. Report to the command post C.  Hazard check D. Inform hospital of potential MCI. 

2.Patients can sustain burns from: A. Heat B.  Electricity C.  Chemicals D. All of the above E. A only 

3.The goal(s) of burn treatment is/are: A. Stop the burning B.  Ease or relieve the pain C.  Maintain body temperature D. All of the above E.  None of the above  

4.The female patient has sustained: A. 9% 1st degree, and 23% second degree burns B. 5% 1st degree, and 18% second degree burns  C. 9% second degree and 18% third degree burns D. 18% second degree and 9% third degree burns 

5.A second degree burn involves epidermis, dermis, and sometimes subcutaneous tissue. A. True B.  False 

6.This patient should be: A. Transported to a major burn center B.  Transported to the nearest medical facility C.  Not transported until the outcome of her husband is known 

7.The impaled glass in this patient’s leg should be treated by: A. Bulky dressing surrounding glass and secured with bandage B.  Removing the glass and applying pressure dressing C. Leaving it alone as this is not her primary problem D. All of the above are acceptable treatment options 

8.The best treatment for this patient’s burns would be: A. Dry sterile dressings B.  Medicated ointment C.  Wet sterile dressings D. WaterJel blanket or dressings 

9.The disadvantage of continually applying saline soaked dressings to large burn areas is the danger of lowering body temperature and causing hypothermia. A. True B.  False 

10.The disadvantage(s) of applying dry sterile dressings to large burn areas is/are: A. Material may stick to the wound B.   Does not help relieve pain C.   Does not help stop the burning process D.  All of the above 

11. The product WaterJel: A.  Works by transference of heat not evaporation B.   Has a 5-year shelf life for prehospital use C.   Does not require a water source for cooling D.  Is water soluble E. All of the above 

12.The female burn patient: A.  Should receive oxygen via non-rebreather mask B. Should receive oxygen via a nasal canula C.   Should receive oxygen via a bag valve mask D.  Does not require oxygen supplementation  

13.Information received on the history of the event that is pertinent to pass on to the receiving center includes: A.  Fact that there was an initial blast B.   Fact that neighbour phoned for emergency response C.   Fact that patient has no allergies D.  Fact that patient is on birth control medication 

14.Third degree burns are characterized by: A.  Dry skin B.   Blistered skin C.   Edema D.  All of the above F.  A and B 

Advanced Level Questions 

15.An E.C.G. Recording: A.  Should not be attempted on this patient due to the chest burns B.   Should be attempted with the usual chest lead placement C.   Should be obtained by placing the ground and negative electrodes on the left and right arms, positive on abdomen D.  Will not be accurate due to damage to skin 

16. The E.C.G. indicates: 

17.An I.V. for this patient: A.  Is inappropriate due to the burns on the arms B.   Is appropriate in case vol­ume replacement is required C. Should be large bore NaCl or Ringers lactate D. B and C are correct  

18.Fluid volume loss is a complication of burns due to: A.  Increased capillary permeability B.   Evaporation C.   Decreased capillary permeability D.  A and B F.   None of the above  

19.Thermal injury to the respiratory tract is usually limited to the upper airways. A. True B.   False  

20.This patient’s pain could be appropriately managed by administering: A.  Morphine Sulphate 2mg IV. q 2-5 mm. B.   Meperidine 2mg q 2 mm. C.   A and B are correct D.  None of the above 

21. Nitrous oxide: A.  Should be avoided in this patient due to chest burns B. Should not be used in combination with other analgesics C.   Is appropriate for this patient if self-administered D. B and C are correct 

22.The following burns are considered critical: A.  First degree that cover 25% of the body B.   Third degree involving face, hands, feet or genital areas C.   Second degree covering 5% of total body surface in a child D.  All of the above  

23.Less than 10% of all fire related deaths are caused by smoke inhalation. A.  True B.   False 

24.Causes of inhalation injury include: A.  Heat inhalation B.   Inhalation of toxic chemicals or smoke C.      Inhalation of carbon monoxide D.  All of the above E.   B and C only  

25.Efforts to help prevent and treat this type of incident would include: A.  Community programs on fire safety B.   MCI. and response practice with other agencies including the fire department C. Having a CISD protocol in place D.  Knowledge of new equipment and resources on the market E.   All of the above  

References

Karren Keith J., and Brent Q. Hafen; First Responder A Skills Approach Third Edition; Morton Publishing Company, Colorado: 1990

Basic Trauma Life Support for Paramedics and Advanced EMS Providers Third Edition; Brady, New Jersey 1995.

Caroline, Nancy L. Emergency Care in the Streets Fifth Edition; Little, Brown and Company, Toronto:1995.

Bledsoe, Bryan E., Dwayne E. Clayden and Frank J. Papa, Prehospital Emergency

Pharmacology Fourth Edition; Prentice Hall, New Jersey: 1996.

Jones, Shirley A. et. Al. Advanced Emergency Care For Paramedic Practice; J.B. Lippincott Company, New York: 1992.

Pauling-Shepard, RN., BscN; Prehospital Management of the Adult Burn Victim: Calgary: January, 1995.

WaterJel Technologies, Safety Today Inc. Ontario

The answers to these questions are to industry standards and may not necessarily be correct according to local protocol. If there is any discrepancy between these answers and local protocol, please follow the protocol for your area as set out by your Medical Director.

Heather MacKenzie-Carey is a paramedic who has 15 years of EMS experience in Nova Scotia and Alberta. She is currently teaching in the Paramedic Program at the Southern Alberta Institute of Technology. She has a Bachelor of Science degree in Health Education from Dalhousie University in Nova Scotia and a certificate in Social Work from the University of Waterloo.  She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

Canadian Emergency News and the author of this quiz grant permission for readers to copy it for personal and departmental educational purposes. All other reproduction and re-publication without writ­ten consent is prohibited.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News. It originally appeared in the August - September 1996 issue (volume 19, number 4).