Burns management (Demo)

A gas explosion  in Ravenshoe in Queensland a few years back, gives some insight into how quickly events can unfold.

Allegedly a car collided with some gas cylinders at the back of a cafe, this is said to have caused a massive explosion.

The explosion was supposedly felt 100m away so by those accounts it was a substantial event.

The people in the cafe had no warning of what was about to transpire. People fled the cafe with horrific burns while others weren’t able to escape so easily. The response from bystanders however was immediate and effective.

From the footage it can clearly be seen that people race into the building after the explosion, no doubt to assist those that could not get out with some of the rescuers carrying others to safety. This is obviously fraught with danger but it is a normal reaction. But was this reaction a conscious thought? The danger has passed so I’m going to help…or was it not thought about at all?

Either way the result was to get everyone clear and then treat them. Watching the vision, and in hindsight, I’m sure that authorities would like to have moved people a little further away initially. Again with confusion and people in pain and in need of treatment some things get overlooked

So what is the best course of action you should take should you be witness to such an incident?

We can bang on about how best to implement triage, but it is the basic first aid treatment with which we should really concentrate.

We would normally follow the DRSABCD action plan…which is a very good idea considering that the explosion may have damaged electrical wires, caused further gas leaks and certainly thrown debris many meters, so glass and other sharp objects all come into play.

We would want to remove people from the immediate vicinity and organise a safe place to perform first aid.

On arrival, ambulance crews would organise a Triage Officer and a Transport Officer, both roles have different functions but communication is paramount.

In this case there would be varying degrees of burns and possibly blast injury.

Blast injury occurs by over pressure waves that affect various areas of the body. Ears, lungs and hollow organs are the main concerns. The chief cause of death is lung bruising (contusion) and subsequent swelling and bleeding into the alveoli which interferes with gas exchange. Don’t forget that a patient may have sustained spinal injuries in a blast too.

Burns are a given in this situation. All areas of the body may be affected, but as with blast injury the airway is the main concern initially. The inhalation of gas over 150 degrees C can cause airway swelling with fluid moving into the airways and alveoli interfering with gas exchange. The degree of burns to the face and body also can vary from superficial to full thickness burns.

OK so you are the first aider that has taken charge of the scene, you have moved all the injured to one area and have started to provide first aid treatment.

Treatment

• Rest and reassure the patient – sitting if possible for those short of breath from airway involvement or smoke inhalation

• Assess airway and breathing – noisy breathing, hoarse voice, facial burns

• Cool the burns – To reduce further injury and pain

• Remove any watches, rings and bracelets early before swelling occurs

• Remove any material that is not stuck to the skin

• Elevate burned limbs if possible to reduce swelling

• Elevate burned limbs if possible to reduce swelling

• Wrap the burns in sterile dressings (Cling Wrap is good*)

• Keep the patient warm

• Reassess airway and breathing

NB: It is best to apply cling wrap over the burn and not wrap it around the limb. A clean plastic bag would work too.

It is important to ensure that the patient maintains normal temperature. It is easy to over cool burns and place the patient at risk of hypothermia.

Hydrogel products work very well and can be used if there is no suitable running water but be aware that they will cool the patient to the point of hypothermia if used to cover large areas.

It probably goes without saying but burns are extremely painful. Anyone that has burned themselves on a hot pan or had a splash of oil on their skin will attest to this. This gas explosion would have felt like a blow torch to the people in the cafe. Our thoughts and feelings go out to all the victims and the rescuers from this terrible incident.

Leave a comment