First Responder EMS Curriculum for Training Centers in Eurasia

c. EviscerationsEviscerations are extensive injuries that involve an open wound that has internal organsprotruding from the wound. These injuries must be cared for surgically. To managethese injuries, cover the protruding organs with a thick, moist dressing. Do not attemptto replace the organs inside the body.d. AmputationsAmputation of extremities or other body parts requires special management as well.These injuries may produce massive or limited bleeding. The primary goal, as in all theabove special considerations, remains the stabilization of the patient’s airway,breathing, and circulation first. The amputated body part should be located andpreserved for potential reattachment. Place the body part in a plastic bag. Then placethis bag inside another plastic bag or container with ice and water. This step willlengthen the time the body part remains viable. Do not use ice alone or dry ice. Thesecan cause direct injury to the amputated part and reduce viability.6. BurnsBurns can result from direct exposure to heat, steam, fire, chemicals, or electricity. Theclassification of burns is according to the depth of skin and underlying tissue involvement.Burns are classified as superficial, partial thickness, and full thickness. Superficial burnsinvolve the outer layer of skin. The underlying tissue is not involved. These burns, alsoknown as first-degree burns, result in reddening and swelling of the skin. Partial-thickness,or second-degree, burns produce redness, swelling, and blister formation. These burns canbe very painful and involve the outer and middle layers of the skin. Full-thickness, or thirddegree,burns extend through all layers of skin. These burns result in destruction of nervoustissue and underlying structures that provide blood and nutrients to the skin. The skin,therefore, may appear charred or white and feel leathery. The patient may experience littleto no pain after the injury, because the area no longer has sensation. Full-thickness burnscan result in significant scarring and disfigurement.a. Role of the First ResponderComplete the First Responder assessment. Complete a scene size-up before initiatingemergency medical care. Complete an initial assessment on all patients. Complete aphysical exam as needed. Complete ongoing assessments. Comfort, calm, and reassurethe patient until additional EMS personnel arrive.b. ManagementWhen caring for a patient who has sustained a burn injury, take the following steps:1. Stop the burning process initially with water or saline.2. Remove smoldering clothing and jewelry. Be aware that some clothing may havemelted onto the skin. If you meet resistance when removing the clothing, leave it inplace.3. Observe appropriate body substance isolation to prevent transmission of disease.4. Continually monitor the patient’s airway for compromise or closure.5. Prevent further contamination by covering the burned area with a dry, steriledressing.6. Do not use any type of lotion, ointment, or antiseptic.7. Do not break blisters, if possible.First Responder EMS Curriculum/AIHA, July 2002 161