24. Fires. DMS

Define fires

uncontrolled process of burning

What are the 3 elements a fire needs to ignite?

1. Heat

2. fuel

   1. Oxidising agent (usually oxygen)

What does intensity and duration of burning depend on? (2)

O₂ levels and amount of burning matter

When does burning stop?

When O₂ levels in the surrounding air decrease to 14-15%

Classification of fires depending on their origins? (2)

1. Natural

   • caused by thunderstorms, volcanoes, sparks from rockfall, spontaneous combustion of hay, oil seeds, coal

2. Man-made

   • caused by explosions, motor vehicle collision, industrial accidents, negligence - cigarettes, burning garden debris, camp fires

Risk factors of fires (8)

1. Weather and the wind - direction, speed, type

2. Landscape

3. Industrial sites dealing with flammable or explosive materials

4. Gas/petrol stations

5. Structural safety/ constructions’ fire resistance

6. Density of constructions

   • distance between buildings and the width of the streets

7. The density of the population

8. Time of the day

Primary damaging factors of fires? (2)

1. Thermal

2. Toxic (smoke)

Secondary damaging factors of fires? (4)

1. Overpressure (falling buildings)

2. Blast wave (explosion)

3. Radiological (damaged nuclear powerplant)

4. Psychological (stress/ panic due to witnessing damage and suffering in AOD)

What is the type of area of damage when there are fires?

Combined area of damage

• primary damaging factors always present are THERMAL and TOXIC

Zones in the area of damage of fires

1. Zone of burning

   • temperatures highest

   • majority of casualties irreversible losses

2. Zone of thermal damage

   • no fire

   • temps high enough to cause injury or spontaneous combustion of flammable materials

3. Zone of smoke

   • intoxication due to inhaling toxic smoke

Injuries due to fires? (types of casualties we can get) (5)

1. Thermal burns

2. Intoxications

   • inhaled toxic smoke

   • CO poisoning - prevents haemoglobin binding and transporting O₂ to tissues

3. Traumas - explosions, collapsing to destroyed buildings

4. Radiological burns, Acute radiation syndrome

5. Psychological disorders

6. Hypovolaemic/ Traumatic shock

   • burn injury → damaged vessel walls, water leaks out → low blood vol. in vessels

   • sever injuries → severe pain → blood vessels dilate and blood pressure drops → organs shut down

Describe the classification of burn injuries by depth

1. 1st degree

   • superficial

   • only epidermis damaged

   • burnt skin area: red, wet, very painful

2. 2nd degree:

   • a little deeper

   • epidermis + dermis damaged

   • burnt area: red, wet, swollen, v.painful, blisters

3. 3rd degree:

   • deeper

   • epidermis + dermis destroyed + subcutaneous fat tissue damaged

   • burnt area: cherry red/ dark brown/ black (charred) colour, no sensitivity in burnt area (nerve receptors damaged) - whitish/translucent colour if exposed to moderate heat

4. 4th degree:

   • deepest

   • epidermis + dermis + subcutaneous fat tissue destroyed + underlying tissues damaged (muscles, bones, tendons)

   • visually looks just like 3rd degree (difference in depth only)

   • loss of sensitivity in burnt area

*1st and 2nd degree → heal by themselves w/out scarring

*3rd and 4th degree → always need hosp. treatment, leave scars

Classification of burn injuries by size of affected skin area?

1. Major burns - more than 20% of skin burn

2. Moderate burns - btwn 10-20% of skin burnt

3. Minor burns - less than 10% of skin burnt

When burnt surface area calculated, take into account only 2nd, 3rd, 4th degree burns

• 1st degree burns are superficial and don’t change overall prognosis

Methods for determining size of burn skin area?

1. Rule of the nines

   • parts of the body covered by 9% of our skin

     • head and neck ~9% of skin

     • each of arms (shoulder to fingertip) ~9%

     • chest and back - each 9%

     • abdominal region - 9%

     • lumbar region - 9%

     • each of legs - 18% (front= 9%, back= 9%)

     • genital area - 9%

2. Rule of the palm

   • palm covered by ~1% of person’s skin

   • smaller burns - how many times palm fits burnt area

Standard operating procedure in case of fires

1. Search and rescue teams

   • wear autonomous respirators (w/ normal air underpressure) + fire resistant clothing

   • rescue any found casualties to safe place

   • stop burning clothes by pouring water + covering casualties with blankets completely

2. Primary triage

   • First aid

   • evacuate casualties to medical stations

3. Medical stations OUTSIDE of area of damage

   • Nurses and physicians

   • Primary medical triage

   • First medical aid

     • First pre-physician aid

       • high flow oxygen therapy

       • cleaning wounds

       • apply wet dressings - panthenol

       • Painkillers p.o or i.m

       • Antibiotics p.o or i.m

       • Immobilise burnt parts of body

     • First physician aid

       • Aggressive fluid resuscitation i.v

       • treatment of burn-related pain w opiods

       • respiratory resus

       • NO SURGICAL TREATMENT IN FMS (risk of excessive bleeding)

4. Hospitals for definitive treatment

   • necrotic tissues removed

   • gen surg, intensive care, internal disease, toxicology, burn centres