Case Study: Structure Fire with Two Patients

Dispatch time: 0435

Dispatched as a structure fire with possible entrapment.

A rescue crew responded at 0435 from the main station. While en route central advised that the house was fully involved; patient status unknown. The fire department on scene advised EMS that both occupants were out of the structure and to continue response with 10-18 traffic, reference severe burns to a female patient. Rescue arrived on scene to find a 62 year old female patient lying in the front yard. Rescue immediately loaded the patient onto their stretcher and placed the patient in the ambulance. Rescue began assessing the patient and noted that she had first, second, and third degree burns to over 50% of her body. Patient had a large full thickness burn on her back right shoulder; necrosis had set in. The burns included: full rotation from the bottom of both feet to the top of both knees, full rotation of both arms from fingertips to the upper shoulder, back right shoulder, top of head, as well as a burned airway. Rescue began dressing the wounds and immediately called for a life flight helicopter. The patient was placed on high flow oxygen by non re-breather at 15 lpm. Rescue dressed the patients wounds with sterile water and cling. Rescue maintained control of the patient until the arrival of ALS. With the arrival of ALS, Rescue transferred control to the paramedic units and assisted with IV setup and medication administration. When paramedics arrived central advised the life flight helicopter had an eta of eight minutes. Paramedics attempted to start an IV in the patients left arm. The paramedics were unsuccessful due to the degree of the burns. Rescue and paramedics were unable to locate another site to start an IV because of the burns. Veins in the feet, legs, arms, and neck were unable to be located. Life flight arrived and began care. In the back of the ambulance the life flight crew used an intraosseous gun to gain direct access to the bone marrow for the administration of medication. Patient was conscious during the use of the IO gun. After use, the patient was immediately sedated and her airway was taken by county paramedics by the use of an ET tube. Patient was then transported to the helicopter by Rescue and paramedics with the direction of the flight crew. Patient was then loaded into the helicopter and secured. The flight crew made their final checks and Rescue and paramedics cleared the landing zone. Life flight departed; time on ground 12 minutes.