25. Fires. Disaster Medical Support Management

essay 25

Define fire

• A fire is an uncontrolled process of burning.

• The three elements a fire needs to ignite are: heat, fuel and an oxidizing agent (usually oxygen)

• AOD is ALWAYS combines

Classification of fires depending on…

• origin

  • Man-made: explosions, motor vehicle collisions, industrial accidents, negligence of cigarettes, camp fires, burning garden debris, faulty machinery, military actions

  • Natural: thunderstorms, volcanoes, sparks from rockfalls, spontaneous combustion of hay, oil seeds, coal

Damaging factors present in case of fires?

• Thermal

• Toxic (caused by fumes)

• Overpressure (caused by collapsing buildings)

• Blast wave

• Psychological (caused by sight of injured people)

• Chemical

• Radiological

Zones of the AOD

• Zone of smoke

• Zone of thermal damage

• Zone of burning

Risk factors of fires

• Meteorological:

  • wind- guides the propagation of the AOD, thus determines location of FMS.

  • Wind also related to time and size of preventative measures implementation.

  • Stronger winds enlarge AOD.

• Landscape: dry weather and forests promote fire spreading. Water basins stop the fire but obstruct evacuation

• Industrial sites dealing with flammable, explosive, toxic or radioactive substances

• Gas/petrol stations

• Preparedness of reaction forces

• Density of populations

• Density and distance between buildings in the area

• Time of the day: night or day. Disasters during the night are recorded to have more severe complications

• Structural safety/construction’s fire resistance

  • e.g. Grenfell, extremely flammable so more damage occurred

Describe the preparedness of fire based disasters

• Creation and implementation of important alarming systems

• Planning and training for appropriate responses

• Building infrastructure designed to lessen the impacts

• Management of forest resources

Main types of injuries

• Burns

• Inhalation of toxic chemicals (fumes)

• Psychological damage

• Fractures (if buildings collapse)

• Crush syndrome

Classification of burns (degree)

1st, 2nd, 3rd and 4th

1st degree burn

• 1st degree: partial thickness of skin with damaged epidermis.

  • Wound is superficial, red, painful

  • has a wet appearance

  • Not taken into account when calculating total body surface area burned

2nd degree

2nd degree: partial thickness with damaged epidermis and dermis.

• Wound is red, swollen, painful

• blisters present (specific)

• 3rd degree

• 3rd degree: full thickness.

  • Subcutaneous fat is damaged.

  • Epidermis and dermis destroyed.

  • Wound is red at first

  • but then becomes whitish, charred, translucent

  • lacking sensation.

  • There is no pain in the area because receptors for pain are destroyed

4th degree

4th degree: full thickness.

• Dermis, epidermis and subcutaneous tissue destroyed.

• Muscle, bone, tendon can be seen.

• Charred tissues and unfeelingareas.

Burns can cause 2 types of?

shock:

• hypovolemic shock

  • from extravasation of fluids

  • a life-threatening condition

  • caused by a significant loss of blood or other fluids in the body

  • Extravasation- refers to the leakage of fluid or medication from a blood vessel into surrounding tissues.

• traumatic shock from pain and cell damage

Ambulatory victims

Ambulatory victims often complain of

• respiratory problems due to inhalation of fumes

• plus or minus burns

Classifications of burns

according to surface area affected

• Major burns- injury affects more than 20% of body surface area

• Moderate burn- affects 10-20% of body surface area

• Minor burns- affects less than 10% of body surface area

How to calculate body surface area affected

• Palm and fingers is 1% of persons body surface area

• Imagine how many times palm fits into the area of injury on the body

• Rule of the nines- many parts of body are covered by 9% of human skin

  • Head and neck is covered 9%

  • Each arm is covered by 9%

  • Chest is covered by 9%

  • Abdomen is covered by 9%

  • Lumbar region is covered by 9%

  • Each leg is covered by 18% (9% anterior and posterior)

  • Genital area is 1%

What is the first activity to be performed in AOD?

• in the AOD is Medical intelligence.

• First step to disaster medical support to casualties is triage

SOP

Standard operating procedure

• Search and rescue teams enter AOD and find casualties and rescue them

• Primary triage is performed

• First aid is provided

• Casualties are evacuated to FMS

• In front of FMS is a physician who performs primary Medical triage

• Casualties then Directed to area of medical station according to patients condition

• In FMS, first Medical aid, wound cleaning, application of septic dressings dressings is performed

A P F M D M

Arson Plan For Disaster Medicine

First Aid in AOD

E S A C E F

Escape Safely And Calmy, Extinguish Fire

Key Steps in Burn Patient Management during Fire Disasters:

1. Casualty Extraction:

   • Search and Rescue (S&R) t eams locate and extract casualties from the fire zone.

2. Immediate Priority:

   • Stop the burning process by extinguishing flames:

     • Use blankets, wet clothes, or any safe means to smother the fire.

3. Systematic Patient Assessment:

   • After addressing immediate threats, perform a systematic assessment of the patient to identify and prioritize life-threatening injuries.

4. On-Scene Burn Care:

   • Wound Coverage: Cover burns with sterile gauze to protect against infection.

   • Hypothermia Prevention: Implement measures to counteract hypothermia, as damaged skin cannot regulate body temperature effectively.

5. Evacuation to FMS:

   • Organize transport of casualties to the Field Medical Station (FMS).

   • Medical triage and decontamination occur at the FMS, including:

     • Removal of contaminated clothing.

     • Partial decontamination of the face to reduce exposure to harmful agents.

6. FMS Location Considerations:

   • Positioned outside the combined AOD to ensure safety.

   • Placement should be downwind from the fire zone and distant from other potential risk objects.

This approach ensures both immediate and systematic care for burn patients while maintaining safety for responders and minimizing further harm to casualties.

First pre-physician aid

• Administration of high flow of oxygen as may mitigate effects of airway edema and addresses poisoning by chemicals e.g. CO, hydrogen cyanide

• Wet tissue covering for cooling of the body

• Rehydration with fluids orally

• Pain relief and antibiotics per os (not IV)

• Immobilization of injured body part to reduce pain

• Nurses don’t deal with the burns, they only apply wet dressing

First Physician aid

• Swift airway management is provided to those with signs of airway burn injury

• Fluid resuscitation with crystalloid solutions

• Wound management: initially involves covering with greasy and sterile dressings, Deflamol or Panthenol if available

  • type of Topical Agents

• Clinicians should assess and treat adequately burn-related pain with opioids

• Most severe injuries are treated first-

  • burns and intoxication

• Evacuation to hospitals which are well-equipped for surgical and intensive care treatment

• 3rd and 4th degree burn casualties may require transfer to burn centres.

• Need

  • emergency medicine physicians

  • GP’s

  • burn specialists

  • anesthesiologists