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340Re: [E-Chir] Re: Scenario 3

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  • sheldon@pipcom.com
    Dec 2, 2009
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      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.)
      > ------------------------------------
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