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• You are attending a local weekend camping event. It s Saturday evening and the weekend has been wonderfully uneventful from the first-aid point-of-view. There
Message 1 of 9 , Dec 1 11:02 AM
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You are attending a local weekend camping event. It's Saturday evening and the weekend has been wonderfully uneventful from the first-aid point-of-view. There are some minor activities scheduled for tomorrow morning but tonight there is the traditional campfire parties. Being the only chirugeon on-site, you've been sticking to soft-drinks unlike a number of the other campers but have been enjoying the parties anyway. While you are wandering around you notice that one of the campfires gets a brief but sudden increase in flame. Shortly after that you hear someone yelling for help.

Arriving at the campsite you see a bunch of people milling about a single male (about 20ish) sitting on the ground a few feet from the campfire (now normal sized) clutching his right arm to his chest. You're told that the person (who name is James) had thrown something on the fire but was too close. The witness says it appears that he got his hand caught in the fire and then he fell backwards over some pieces of wood, possibly hurting his left ankle.

Discuss.

(Feel free to discuss this however you would like. You can explain what you think has happened, what you are going to do, what you'd expect to see or any other question/topic that comes across your mind as you read the scenario).
• Scenario 3 Response Brian the Green Check: Approaching the scene look for: = is the fire now behaving normally (which is mentioned in the scenario that it is)?
Message 1 of 9 , Dec 2 8:24 AM
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Scenario 3 Response

Brian the Green

Check:
Approaching the scene look for:
= is the fire now behaving normally (which is mentioned in the scenario that it is)?
= is there signs of sparks or smouldering on things nearby, such as hot ash on the top of tents?
= Is there the glittering of broken glass?
= Is the patient talking? (I will assume for the rest of this that he is)
= Note the amount of wood and where it is.

Call:
= Ask if someone here has a cell phone in case we need 911. If none here task someone to find one and return with it.

Care:
= Instruct the people to give ground so the patient can be safely examined.
= Ask for who in the camp is looking after the fire. Advise them for safety reasons to check on the fire and also to see if hot ash landed on tents or other things nearby.

= Approaching the patient ask where are the injuries.
= Instruct the patient to move farther back from the fire. Observe if they are able to do so safely.
= Assessment showing that he is awake (as the arm is being clutched) and talking (assumed for this response). This signals the ABC are okay.
= Beginning the secondary assessment the patient is found as (assumed for this response) to have light burns on his right hand. The hair on the arm is singed and the skin appears discoloured. No blistering has occurred.
= The left ankle is also hurting him significantly. Asking him to try moving it finds he is unwilling due to pain.

= When the cell phone becomes available call 911. Instructing them that we need an ambulance. There appears to be first degree burns to the right hand and forearm. There is also an injured ankle. Give directions to the event include the fire number/address of the site. Advise them it is a camping site.
= Discuss with the operator if they wish us to leave the patient in the camp or whether we should move them to the parking lot.
= If they are not sure it is better to leave the patient in the camp.
= If relocation is agreed a camp chair should be easily found which several people could use to carry him out without needing to use his leg.
= In either case task someone to go to the end of the driveway with a flashlight to guide the ambulance into the site and if need be to the patient.

Prepare for transport:
= Counsel the patient that it is best for the burns to be checked out professionally at the hospital. For safety the ambulance should do the transport so that they can care for the hand.
= Ask the patient if there is someone who can drive to the hospital to bring them back.
= Also ask the patient if there is someone he would like us to contact for him.

Very Important:
= When the ambulance comes ask them which hospital they are going to!

= Prepare notes to send the Kingdom Chirugeon regarding emergency services being on site. Relay this information ASAP by email, phone etc.

Related Discussion:

Big fires and tents:
There was a flashing surge from the fire. Tall flames can carry ash up high enough that the wind can scatter it. Might be a few feet or a few tens of feet. It is not unusual for camps have tents within 30ft of their firepit and most have tents within 60ft.
I recall one event when to many pallets where burned at once. This is when this important lesson was learned. One person did spot the smouldering happening on their tent's awning. Those with tents nearby did a check and shaking off smouldering bits.
While there are safety requirements in some parts of the world for fire resistant tents those coatings can become worn with age. A large enough heat could overcome the coating and set the tent on fire.
A particular danger for smouldering is that they might produce heat for hours. Usually this is not going to happen with light ash from a flashing fire. Still it is important to check. Thus it is possible for the tent to have people sleeping in it when it catches fire hours later.
The ash can also burn a small hole in a tent without starting a fire. Holes do not keep out rain very well at all.

Dealing with too much fuel on a fire:

a) Put out some of the fire
b) Put the whole fire out
c) Remove the fuel

The safest way to deal with excessive wood (fuel) on a fire is to put the whole fire out. Camps should have some means of putting the fire out nearby. Water or dirt are usually available. A challenge with the excessive fuel scenario is that the people who do that generally did not think ahead thus if, big if, they have something it likely isn't enough for the now oversized fire.
With the big fire that had happened the excessive fuel was removed by myself. Im trying to recall if we doused at least part of the fire first and/or whether they simply didn't have enough water to put out the fire.
It wasn't obvious to those nearby in the darkness but the gloves I had on are actually welder's gloves with a heat resistance. A stick/board was used to get a pallet close to the edge. From there, with the known to be heat resistant welding gloves, I could lift the pallet clear of the fire. Once in a clear spot the pallet could be safely doused, patted down etc. Great care was taken while doing this including make sure the space behind me was clear.
Putting the gloves in water also gives you some protection. The water evaporation pulls away some of the heat. Recharge the water on the gloves regularly. When the gloves feel hot stop to let the gloves cool (preferably with more water).
Why not use the water directly a mug of water will give you several soakings on gloves compared to maybe dousing one log on the fire.
Reminder this was with done with welding gloves to stop the high flying ash starting secondary fires on tents.
I did this knowing for certain they where welding gloved. Do not trust non-welding nor period nor "unknown" gloves to do this.
Nor is this something to be as a regular activity. Rather it was a way of keeping of the rest of the camp safe when an emergency developed.
The far better situation is for those having fires to plan ahead and have sufficient fire fighting gear (water, dirt, extinguishers) on hand in the first place.
(Yes, there is of course some question as to whether the gloves should have been used at all. The real problem was to much wood on the fire AND insufficient proper resources leading to the other tents starting to smoulder. No it was not my camp I wandered in to join the party.)
• I d like ideas on getting appropriate light for reviewing the injuries. I find flashlights make it difficult to see slight colour variations, especially in
Message 1 of 9 , Dec 2 8:41 AM
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I'd like ideas on getting appropriate light for reviewing the
injuries. I find flashlights make it difficult to see slight colour
variations, especially in the pink colours of natural skin and sun
burned or first degree burns. Bouncing the flashlight off a surface
often makes it easier. What would you (every you) want? Do you think
multiple flashlights would be better? Are LED lights better? If
possible, I'd like to move the injured person to a tent that could be
brightly and in-directly lit, but the injured ankle would make this
difficult.

Eyrny
• Greetings, Don t take this the wrong way, your very thorough, but you d call for an Ambulance for first degree burns and a sprained ankle? As a former
Message 1 of 9 , Dec 2 8:45 AM
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Greetings,

Don't take this the wrong way, your very thorough, but you'd call for an
Ambulance for first degree burns and a sprained ankle? As a former
ambulance driver, I'd be a little turned off about that and would the
person hurt really want to get saddled with the ambulance bill?

Russ / Dafydd

> Scenario 3 Response
>
> Brian the Green
>
> Check:
> Approaching the scene look for:
> = is the fire now behaving normally (which is mentioned in the scenario
> that it is)?
> = is there signs of sparks or smouldering on things nearby, such as hot
> ash on the top of tents?
> = Is there the glittering of broken glass?
> = Is the patient talking? (I will assume for the rest of this that he is)
> = Note the amount of wood and where it is.
>
> Call:
> = Ask if someone here has a cell phone in case we need 911. If none here
> task someone to find one and return with it.
>
> Care:
> = Instruct the people to give ground so the patient can be safely
> examined.
> = Ask for who in the camp is looking after the fire. Advise them for
> safety reasons to check on the fire and also to see if hot ash landed on
> tents or other things nearby.
>
> = Approaching the patient ask where are the injuries.
> = Instruct the patient to move farther back from the fire. Observe if they
> are able to do so safely.
> = Assessment showing that he is awake (as the arm is being clutched) and
> talking (assumed for this response). This signals the ABC are okay.
> = Beginning the secondary assessment the patient is found as (assumed for
> this response) to have light burns on his right hand. The hair on the arm
> is singed and the skin appears discoloured. No blistering has occurred.
> = The left ankle is also hurting him significantly. Asking him to try
> moving it finds he is unwilling due to pain.
>
>
> = When the cell phone becomes available call 911. Instructing them that we
> need an ambulance. There appears to be first degree burns to the right
> hand and forearm. There is also an injured ankle. Give directions to the
> event include the fire number/address of the site. Advise them it is a
> camping site.
> = Discuss with the operator if they wish us to leave the patient in the
> camp or whether we should move them to the parking lot.
> = If they are not sure it is better to leave the patient in the camp.
> = If relocation is agreed a camp chair should be easily found which
> several people could use to carry him out without needing to use his leg.
> = In either case task someone to go to the end of the driveway with a
> flashlight to guide the ambulance into the site and if need be to the
> patient.
>
> Prepare for transport:
> = Counsel the patient that it is best for the burns to be checked out
> professionally at the hospital. For safety the ambulance should do the
> transport so that they can care for the hand.
> = Ask the patient if there is someone who can drive to the hospital to
> bring them back.
> = Also ask the patient if there is someone he would like us to contact for
> him.
>
> Very Important:
> = When the ambulance comes ask them which hospital they are going to!
>
> = Prepare notes to send the Kingdom Chirugeon regarding emergency services
> being on site. Relay this information ASAP by email, phone etc.
>
>
> Related Discussion:
>
> Big fires and tents:
> There was a flashing surge from the fire. Tall flames can carry ash up
> high enough that the wind can scatter it. Might be a few feet or a few
> tens of feet. It is not unusual for camps have tents within 30ft of their
> firepit and most have tents within 60ft.
> I recall one event when to many pallets where burned at once. This is when
> this important lesson was learned. One person did spot the smouldering
> happening on their tent's awning. Those with tents nearby did a check and
> shaking off smouldering bits.
> While there are safety requirements in some parts of the world for fire
> resistant tents those coatings can become worn with age. A large enough
> heat could overcome the coating and set the tent on fire.
> A particular danger for smouldering is that they might produce heat for
> hours. Usually this is not going to happen with light ash from a flashing
> fire. Still it is important to check. Thus it is possible for the tent to
> have people sleeping in it when it catches fire hours later.
> The ash can also burn a small hole in a tent without starting a fire.
> Holes do not keep out rain very well at all.
>
> Dealing with too much fuel on a fire:
>
> a) Put out some of the fire
> b) Put the whole fire out
> c) Remove the fuel
>
> The safest way to deal with excessive wood (fuel) on a fire is to put the
> whole fire out. Camps should have some means of putting the fire out
> nearby. Water or dirt are usually available. A challenge with the
> excessive fuel scenario is that the people who do that generally did not
> think ahead thus if, big if, they have something it likely isn't enough
> for the now oversized fire.
> With the big fire that had happened the excessive fuel was removed by
> myself. Im trying to recall if we doused at least part of the fire first
> and/or whether they simply didn't have enough water to put out the fire.
> It wasn't obvious to those nearby in the darkness but the gloves I had on
> are actually welder's gloves with a heat resistance. A stick/board was
> used to get a pallet close to the edge. From there, with the known to be
> heat resistant welding gloves, I could lift the pallet clear of the fire.
> Once in a clear spot the pallet could be safely doused, patted down etc.
> Great care was taken while doing this including make sure the space behind
> me was clear.
> Putting the gloves in water also gives you some protection. The water
> evaporation pulls away some of the heat. Recharge the water on the gloves
> regularly. When the gloves feel hot stop to let the gloves cool
> (preferably with more water).
> Why not use the water directly a mug of water will give you several
> soakings on gloves compared to maybe dousing one log on the fire.
> Reminder this was with done with welding gloves to stop the high flying
> ash starting secondary fires on tents.
> I did this knowing for certain they where welding gloved. Do not trust
> non-welding nor period nor "unknown" gloves to do this.
> Nor is this something to be as a regular activity. Rather it was a way of
> keeping of the rest of the camp safe when an emergency developed.
> The far better situation is for those having fires to plan ahead and have
> sufficient fire fighting gear (water, dirt, extinguishers) on hand in the
> first place.
> (Yes, there is of course some question as to whether the gloves should
> have been used at all. The real problem was to much wood on the fire AND
> insufficient proper resources leading to the other tents starting to
> smoulder. No it was not my camp I wandered in to join the party.)
>
>
>
>
>
>
> ------------------------------------
>
>
>
>
>
• ... I have a Coleman lantern that is run on batteries and has more of a white light- something like that would make viewing the injuries easier than with a
Message 1 of 9 , Dec 2 9:26 AM
View Source
>I'd like ideas on getting appropriate light for reviewing the injuries.

I have a Coleman lantern that is run on batteries and has more of a white light- something like that would make viewing the injuries easier than with a standard flashlight (for that matter, I think one of my flashlights is an LED one as well).

I have to agree about not calling 911 for first degree burns and a sprained ankle- I'd be more likely to suggest that one of the patient's friends take him to a hospital to get checked out.

Medb

• A and B are ok, don t forget C. I would do a quick check for the quality of the pulse and of the skin colour and condition. I d be interested in assessing the
Message 1 of 9 , Dec 2 10:29 AM
View Source
A and B are ok, don't forget C. I would do a quick check for the quality of the pulse and of the skin colour and condition.

I'd be interested in assessing the ankle more closely while keeping it immobile. For example how is the circulation? Palpate the area very carefully. Crepitus? Deformities? Discolouration? How are the strength, sensation and mobility?

Perhaps a moist cool sterile dressing lightly over the burned areas would help with the pain. Burns HURT! :) ok, I'm a wuss. But would also help treat for shock.

Sprains also can hurt sometimes worse than breaks. Again, I'm a wuss. Did I mention that earlier?

Given the results of the assessment of the ankle and the area covered by the burns and the possibility that the arm may be 2nd degree, I would probably call 911 as well. Daffyd you make a good very good point, but I'm a fan of erring on the side of caution. If the ankle assessment turns out well though, and there are no signs of shock, POV could also be an option.

Kaellyn

-----Original Message-----
From: sheldon@...
Date: Wed, 2 Dec 2009 11:45:41
To: <E-Chir@yahoogroups.com>
Subject: Re: [E-Chir] Re: Scenario 3

Greetings,

Don't take this the wrong way, your very thorough, but you'd call for an
Ambulance for first degree burns and a sprained ankle? As a former
ambulance driver, I'd be a little turned off about that and would the
person hurt really want to get saddled with the ambulance bill?

Russ / Dafydd

> Scenario 3 Response
>
> Brian the Green
>
> Check:
> Approaching the scene look for:
> = is the fire now behaving normally (which is mentioned in the scenario
> that it is)?
> = is there signs of sparks or smouldering on things nearby, such as hot
> ash on the top of tents?
> = Is there the glittering of broken glass?
> = Is the patient talking? (I will assume for the rest of this that he is)
> = Note the amount of wood and where it is.
>
> Call:
> = Ask if someone here has a cell phone in case we need 911. If none here
> task someone to find one and return with it.
>
> Care:
> = Instruct the people to give ground so the patient can be safely
> examined.
> = Ask for who in the camp is looking after the fire. Advise them for
> safety reasons to check on the fire and also to see if hot ash landed on
> tents or other things nearby.
>
> = Approaching the patient ask where are the injuries.
> = Instruct the patient to move farther back from the fire. Observe if they
> are able to do so safely.
> = Assessment showing that he is awake (as the arm is being clutched) and
> talking (assumed for this response). This signals the ABC are okay.
> = Beginning the secondary assessment the patient is found as (assumed for
> this response) to have light burns on his right hand. The hair on the arm
> is singed and the skin appears discoloured. No blistering has occurred.
> = The left ankle is also hurting him significantly. Asking him to try
> moving it finds he is unwilling due to pain.
>
>
> = When the cell phone becomes available call 911. Instructing them that we
> need an ambulance. There appears to be first degree burns to the right
> hand and forearm. There is also an injured ankle. Give directions to the
> event include the fire number/address of the site. Advise them it is a
> camping site.
> = Discuss with the operator if they wish us to leave the patient in the
> camp or whether we should move them to the parking lot.
> = If they are not sure it is better to leave the patient in the camp.
> = If relocation is agreed a camp chair should be easily found which
> several people could use to carry him out without needing to use his leg.
> = In either case task someone to go to the end of the driveway with a
> flashlight to guide the ambulance into the site and if need be to the
> patient.
>
> Prepare for transport:
> = Counsel the patient that it is best for the burns to be checked out
> professionally at the hospital. For safety the ambulance should do the
> transport so that they can care for the hand.
> = Ask the patient if there is someone who can drive to the hospital to
> bring them back.
> = Also ask the patient if there is someone he would like us to contact for
> him.
>
> Very Important:
> = When the ambulance comes ask them which hospital they are going to!
>
> = Prepare notes to send the Kingdom Chirugeon regarding emergency services
> being on site. Relay this information ASAP by email, phone etc.
>
>
> Related Discussion:
>
> Big fires and tents:
> There was a flashing surge from the fire. Tall flames can carry ash up
> high enough that the wind can scatter it. Might be a few feet or a few
> tens of feet. It is not unusual for camps have tents within 30ft of their
> firepit and most have tents within 60ft.
> I recall one event when to many pallets where burned at once. This is when
> this important lesson was learned. One person did spot the smouldering
> happening on their tent's awning. Those with tents nearby did a check and
> shaking off smouldering bits.
> While there are safety requirements in some parts of the world for fire
> resistant tents those coatings can become worn with age. A large enough
> heat could overcome the coating and set the tent on fire.
> A particular danger for smouldering is that they might produce heat for
> hours. Usually this is not going to happen with light ash from a flashing
> fire. Still it is important to check. Thus it is possible for the tent to
> have people sleeping in it when it catches fire hours later.
> The ash can also burn a small hole in a tent without starting a fire.
> Holes do not keep out rain very well at all.
>
> Dealing with too much fuel on a fire:
>
> a) Put out some of the fire
> b) Put the whole fire out
> c) Remove the fuel
>
> The safest way to deal with excessive wood (fuel) on a fire is to put the
> whole fire out. Camps should have some means of putting the fire out
> nearby. Water or dirt are usually available. A challenge with the
> excessive fuel scenario is that the people who do that generally did not
> think ahead… thus if, big if, they have something it likely isn't enough
> for the now oversized fire.
> With the big fire that had happened the excessive fuel was removed by
> myself. Im trying to recall if we doused at least part of the fire first
> and/or whether they simply didn't have enough water to put out the fire.
> It wasn't obvious to those nearby in the darkness but the gloves I had on
> are actually welder's gloves with a heat resistance. A stick/board was
> used to get a pallet close to the edge. From there, with the known to be
> heat resistant welding gloves, I could lift the pallet clear of the fire.
> Once in a clear spot the pallet could be safely doused, patted down etc.
> Great care was taken while doing this including make sure the space behind
> me was clear.
> Putting the gloves in water also gives you some protection. The water
> evaporation pulls away some of the heat. Recharge the water on the gloves
> regularly. When the gloves feel hot stop to let the gloves cool
> (preferably with more water).
> Why not use the water directly… a mug of water will give you several
> soakings on gloves compared to maybe dousing one log on the fire.
> Reminder this was with done with welding gloves to stop the high flying
> ash starting secondary fires on tents.
> I did this knowing for certain they where welding gloved. Do not trust
> non-welding nor period nor "unknown" gloves to do this.
> Nor is this something to be as a regular activity. Rather it was a way of
> keeping of the rest of the camp safe when an emergency developed.
> The far better situation is for those having fires to plan ahead and have
> sufficient fire fighting gear (water, dirt, extinguishers) on hand in the
> first place.
> (Yes, there is of course some question as to whether the gloves should
> have been used at all. The real problem was to much wood on the fire AND
> insufficient proper resources leading to the other tents starting to
> smoulder. No it was not my camp… I wandered in to join the party.)
>
>
>
>
>
>
> ------------------------------------
>
>
>
>
>

------------------------------------

• ... What does POV stand for in this case? (presumably not Point-Of-View used in my computer games). Also... When calling 911... a) Will they discuss with you
Message 1 of 9 , Dec 7 4:07 PM
View Source
--- In E-Chir@yahoogroups.com, viscountessk@... wrote:
> Given the results of the assessment of the ankle and the area covered by the burns and the possibility that the arm may be 2nd degree, I would probably call 911 as well. Daffyd you make a good very good point, but I'm a fan of erring on the side of caution. If the ankle assessment turns out well though, and there are no signs of shock, POV could also be an option.
>
> Kaellyn
>

What does POV stand for in this case? (presumably not Point-Of-View used in my computer games).

Also...

When calling 911...

a) Will they discuss with you if the ambulance is really needed? Though I believe they kinda have to once you ask because if something goes wrong after that they are in a bad legal situation.

b) If they come and passenger refuses to come (after their mucho influence) is there no charge?

c) I posted prior to the injury details so was treating as serious enough. I have had some one go on about a sprained ankle only to find out later that they had actually snapped 2 of 3 tendons and if the last one had gone there foot would have been Kaput.
• ... A good question and answer. Most probably know that LED lights cast a blue-tinged light which will affect the colours your see. LED ones can cast alot more
Message 1 of 9 , Dec 7 4:14 PM
View Source
--- In E-Chir@yahoogroups.com, Jackie Wyatt <jkwyatt@...> wrote:
>
> >I'd like ideas on getting appropriate light for reviewing the injuries.
>
> I have a Coleman lantern that is run on batteries and has more of a white light- something like that would make viewing the injuries easier than with a standard flashlight (for that matter, I think one of my flashlights is an LED one as well).
>

Most probably know that LED lights cast a blue-tinged light which will affect the colours your see. LED ones can cast alot more light as they consume far less power so are generally made with dozens of emittors.

Hmmm... dont carry a flashlight in the chirugeon belt pouch but I do have one in another belt pouch. Had enough of having fun at camping events only to realize I was well away from my camp when it was dark.

Brian the Green
• POV is privately owned vehicle ... Although my first reaction is usually point of view too. Kaellyn Sent from my BlackBerry® powered by Virgin Mobile. ...
Message 1 of 9 , Dec 8 2:45 PM
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POV is privately owned vehicle ... Although my first reaction is usually point of view too.

Kaellyn

-----Original Message-----
From: "b1laxson" <b1laxson@...>
Date: Tue, 08 Dec 2009 00:07:28
To: <E-Chir@yahoogroups.com>
Subject: [E-Chir] Re: Scenario 3

--- In E-Chir@yahoogroups.com, viscountessk@... wrote:
> Given the results of the assessment of the ankle and the area covered by the burns and the possibility that the arm may be 2nd degree, I would probably call 911 as well. Daffyd you make a good very good point, but I'm a fan of erring on the side of caution. If the ankle assessment turns out well though, and there are no signs of shock, POV could also be an option.
>
> Kaellyn
>

What does POV stand for in this case? (presumably not Point-Of-View used in my computer games).

Also...

When calling 911...

a) Will they discuss with you if the ambulance is really needed? Though I believe they kinda have to once you ask because if something goes wrong after that they are in a bad legal situation.

b) If they come and passenger refuses to come (after their mucho influence) is there no charge?

c) I posted prior to the injury details so was treating as serious enough. I have had some one go on about a sprained ankle only to find out later that they had actually snapped 2 of 3 tendons and if the last one had gone there foot would have been Kaput.

------------------------------------