# Liquid Asphalt



## whtrngr (Jul 20, 2011)

Hello,

I am an EMT-B in a vary rural area of MN, on the SD border. I run with one ambulance garage, respond with another when in the area (I live on the line between 3 service areas) and also respond with a fire department as a fireman (went through the FF1 & 2 classes) and a first responder. I will hopefully be starting my Paramedic classes this fall.

So the other night, or early morning, a page goes out for my FR unit and the second ambulance service I respond with. It is to a gravel pit, PT has been hit by asphalt on head and back. I was thinking blunt trauma as I drove to the scene. Boy was I wrong. 

I was first on scene, barely, and the PT, a 59yr old male, was covered in LIQUID asphalt. It is over 300 degrees in the tanker truck it spilled out of. And it was NOT something to wipe off. Never felt so helpless, but all we could do until the ambulance arrived was pour tepid water over his head to try to cool him off. It looked like he was wearing a bike helmet made from tar, it was all the way down his back and arms. Once the ambulance arrived we tried to get vitals, but I ruined a BP cuff on him, as it was glued to his arm afterward. I know they had to cut him out of the blankets once they got to the hospital, and the ambulance was out of service for a day and a half afterward. When we arrived he was very coherent, but was going downhill VERY rapidly, and barely made it to the ER awake. He couldn't feel his head, and kept trying to touch it to make sure it was there.

My questions is, was there ANYTHING else we could have done? I know we did a good job, but in a critical burn situation like this, I felt like I was missing something. But with the tar all over him, we could barely touch him or we'd be stuck, and be pulling more of his skin off. We debated cutting his shirt off to try to get the tar off his back, but decided against it, as we were pretty sure skin was coming with it. We were right, as the ER doctor did it once he arrived an the PT was on painkillers.

Anyone else have similar experience? I'm guessing I will never see a case like this again, but I was wondering your thoughts...

~Nick


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## bigbaldguy (Jul 20, 2011)

The only thing I would maybe have done was to get the temperature of the asphalt down as quickly as possible. Asphalt retains heat for quite a while so getting as much cold water on it asap would seem like a good idea. Obviously u run into the possibility of hypothermia but I think getting the temp of the asphalt  down so it doesn't keep burning him would be a priority. Keep his eyes ears nose and mouth as clear as possible would be a Good idea as well. I remember a roofer who had a pot if hot tar dumped over him a few years back (second hand story from a friend who was working with him) they tossed him in a pool asap and he made a nearly full recovery. This was a tough call you had and you did what you could.


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## whtrngr (Jul 20, 2011)

Yeah, all we had was a bunch of water bottles in our FR rig for firemen so we used as much of them as we could. I'm glad we didn't have ice water for the hypothermia reasons. We just kept dumping water on his head and back and kept him talking to us.

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## Handsome Robb (Jul 20, 2011)

Thats an insane situation. Like BBG said, the first thing you need to do is remove the heat source. But with my limited asphalt experience, cold water would harden the outside layer and leave the inner layer hot, and possibly creating an insulation barrier. Just a BLS truck?

If ILS/ALS were available this guy needed fluids, pain management, and a rapid trip to a hospital. From your description he is looking at around 31.5% BSA according to the rule of 9s I would have considered a HEMS intercept to transport him to a burn center.

It sounds like you did everything you could have done in this situation.


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## whtrngr (Jul 20, 2011)

Yeah, only BLS in the immediate area. My service is planning on ALS in less than 5 years... But I know he was transferred to a burn unit by a nearby ALS service within an hour of getting stabilized in the ER.

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## lightsandsirens5 (Jul 20, 2011)

Oh that is terrible! Burns are my single most personally hated call. 

Just as a side note, HEMS might not take him if he is covered in NAZMAT like that. I know our local air amb would not. 

As for what you did, sounds good to me, but this guy needed ALS and fast if nothing else for pain management. 

I would defiantly go for TONS of water. He needs to be cooled the heck down and fast. I would consider the fact that he could get hypothermic, but that is (much) less of a factor in my mind  than stopping the burning tar.


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## Handsome Robb (Jul 20, 2011)

If the tar was cooled adequately I don't see why HEMS wouldn't transport him. It is not a DOT HAZMAT rated material...I'm also assuming you meant HAZMAT, I have never heard of NAZMAT 
Not trying to start an argument, just wondering about your thought process on this.


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## lightsandsirens5 (Jul 20, 2011)

NVRob said:


> If the tar was cooled adequately I don't see why HEMS wouldn't transport him. It is not a DOT HAZMAT rated material...I'm also assuming you meant HAZMAT, I have never heard of NAZMAT
> Not trying to start an argument, just wondering about your thought process on this.



Gosh darn. That is what happens when you are very tired, very angry and trying to type. :-S

Our air amb has a strict policy against transporting any pt contaminated with flammable or other substances that could off gas and possibly impair the flight crew. I dunno if tar falls under that now that we are talking about it. We had a pt from a factory accident once covered in used lubricating oil. He was deconned fairly well, but HEMS refused him because the stated the oil on him was too dangerous for the flight crew. It would have taken GOJO and a scrub brush to remove the rest.


Now look, I'm going to have to go and find out about tar from the NEMS people.


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## firetender (Jul 20, 2011)

*Flow of the call*

I'm really curious about the poor guy's reaction to the pain, his characterizations of it on a one to ten basis over the course of your experience with him. Was he calm? Freaked out? Barely conscious? In and out? How did he react to the trauma, and what did you learn about working with a person affected by something very few of us would ever encounter, yet, it would be great to know.

How it was for you would be equally instructive. In the moments that you felt helpless, what kicked in that helped you get beyond that?

If you had the opportunity it would be very cool to have you report to us about follow up and what more the experts suggest could have been done. Everyone involved in this call will be learning something new...

Thanks for taking one for the team, and good work in a really unique situation!


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## Handsome Robb (Jul 20, 2011)

Lights, didn't mean to make you angry!  That makes sense with fumes in the Helo I didn't think about that. I personally wouldn't say asphalt is an impairing fume but, then again, I worked construction for a while in HS so I am used to it.

I agree with Firetender. I hope one of the medical students or MDs on here will add their two cents or more like two dollars to this thread haha.


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## JPINFV (Jul 20, 2011)

I really, unfortunately, have nothing extra to add past what has already been said (reduce temp, pain management, get to burn unit ASAP), but all I can picture is the tar and feathering scene from HBO's John Adams miniseries or the golden crown scene (maybe NSFW) from HBO's Game of Thrones miniseries.


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## fortsmithman (Jul 20, 2011)

This could very well happen in my area.  Because we are having major road work being done for the next few years.  As well my service is BLS only.  Here in the Northwest Territories we have no ground ALS only our air medevac provider is the only ALS provider.


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## MrBrown (Jul 20, 2011)

Yeah there is one thing that can be done - overdose him on pain meds 

Brown's friend the Consultant Anaesthetist, Browns other friend the locum Senior Intensive Care Registrar and Brown's uncle, the HEMS Doctor all agree.

Poor bugger:, prayers to him.


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## ArcticKat (Jul 20, 2011)

Just wondering, was there ETOH on board?  I don't know of any paving companies that do their work at 3 in the morning.  Around here that would have likely been some drunk idiot playing around with something he knows nothing about.


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## crazycajun (Jul 20, 2011)

ArcticKat said:


> Just wondering, was there ETOH on board?  I don't know of any paving companies that do their work at 3 in the morning.  Around here that would have likely been some drunk idiot playing around with something he knows nothing about.



Many places in the US do road construction at night. It allows busy daytime traffic to flow regularly without the hassles of road construction crews. It is also safer for the crews at night due to less traffic volume.


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## Simusid (Jul 20, 2011)

As I was reading the narrative, and knowing I'm a basic, all I could think of was "cool him off!  cool him off!" and obviously that's been covered already. One issue I thought of was patient packaging and transport.  I assume he was just placed supine on the stretcher?   Knowing that the injury is on his back, is there any creative way to transport him that could reduce further damage?


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## LucidResq (Jul 20, 2011)

I may be imagining this but I think I remember seeing in a medical text that mayonnaise can help remove tar from skin. Obviously this wouldn't be done prehospitally and I may be wrong. I'll try to look it up again when I get home.

Sent from my telefono


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## jjesusfreak01 (Jul 20, 2011)

Simusid said:


> As I was reading the narrative, and knowing I'm a basic, all I could think of was "cool him off!  cool him off!" and obviously that's been covered already. One issue I thought of was patient packaging and transport.  I assume he was just placed supine on the stretcher?   Knowing that the injury is on his back, is there any creative way to transport him that could reduce further damage?



Lube up the backboard before you put him on so they can get him off at the hospital. I know oils and lotions are a no-no on burn injuries, but in this situation, every burned area is already covered in asphalt, so it doesn't seem like it would hurt. Thoughts on this?


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## lightsandsirens5 (Jul 20, 2011)

NVRob said:


> Lights, didn't mean to make you angry!  That makes sense with fumes in the Helo I didn't think about that. I personally wouldn't say asphalt is an impairing fume but, then again, I worked construction for a while in HS so I am used to it.
> 
> I agree with Firetender. I hope one of the medical students or MDs on here will add their two cents or more like two dollars to this thread haha.



Ah ha ha ha! I'm not angry at you! Ha ha ha ha!!! I see how it sounds like I was. Not at all man. I'm angry at NREMT.  

Oh my gosh I must have been more tired than I thought when I wrote that. Lol! 


Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.


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## lightsandsirens5 (Jul 20, 2011)

jjesusfreak01 said:


> Lube up the backboard before you put him on so they can get him off at the hospital. I know oils and lotions are a no-no on burn injuries, but in this situation, every burned area is already covered in asphalt, so it doesn't seem like it would hurt. Thoughts on this?



Speaking strictly BLS here now. I doubt I'd be placing him supine. As long as I had a patent airway with no apparent compromise I'd probably let him lay prone if he was most comfortable that way and could support himself/maintain his own airway. 

I doubt with a BLS transport he is going to want to bounce down the road supine owing to the complete lack of any kind of pain management. 

To directly answer you question, first I'll ask one of my own. What exactly do you plan on using to lube the backboard up with? Motor oil? I see your reasoning, but I just don't know if I want to place the burden of that decision on my back as it'll be my neck that gets the big, ugly ax. I'd call med control and get advice. 

Oh yea, and if HEMS is the only ALS available, call them anyhow, commandeer the crew and take them to the ER with you. (Assuming HEMS won't let the pt on board their craft.)


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## whtrngr (Jul 20, 2011)

Wow, I never thought I would get SO many responses. 

Not sure what happened to the PT after the hospital, and what happened at the hospital was relayed to my by the other EMT's, but for what we did, we just cooled him off as best we could with the water we had. On the cot we had him in blankets as he was shaking he was so cold (as to be expected), and the blankets were just counted as a loss. He was on high flow O2, and we tried to make him as comfortable as possible while trying to keep him conscious. 

As for why he was out so early, we are in a bit of a heat wave here, and the crew were authorized to work nights as it was slightly cooler. 100 degrees with 90% humidity makes a hot day. It was 88 degrees when this happened. Driving was terrible with the humidity condensation. Eyeglasses were pretty useless too.

As for getting over feeling useless, well, that was quick. We JUST had a refresher on burn victims on my service, but nothing covering this. We just saw another workers water bottle, took it, and used it. Shortly after that the first responder rig showed up with cases of bottled water, and we continued unit the ambulance arrived. We had the ABC's covered. But the rest of it was petty hands off... BP wasn't possible as mentioned before, but we did everything we could think of. Mainly, LOTS of water.


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## abckidsmom (Jul 20, 2011)

lightsandsirens5 said:


> Speaking strictly BLS here now. I doubt I'd be placing him supine. As long as I had a patent airway with no apparent compromise I'd probably let him lay prone if he was most comfortable that way and could support himself/maintain his own airway.
> 
> I doubt with a BLS transport he is going to want to bounce down the road supine owing to the complete lack of any kind of pain management.



Yep.  Doesn't sound like a backboard is needed in this case, unless it's just for movement purposes.  Once he's on the cot, I'd want him upright, so he'd have the most effective breathing.



> To directly answer you question, first I'll ask one of my own. What exactly do you plan on using to lube the backboard up with? Motor oil? I see your reasoning, but I just don't know if I want to place the burden of that decision on my back as it'll be my neck that gets the big, ugly ax. I'd call med control and get advice.



I totally agree.  I'd put a sheet between him and anything he touched, so that he would come loose from stuff.  They'll chip away at this in the OR, and the sheet will just come off then.



> Oh yea, and if HEMS is the only ALS available, call them anyhow, commandeer the crew and take them to the ER with you. (Assuming HEMS won't let the pt on board their craft.)



An often overlooked option.

And my question:  I was thinking that I'd want to hose this guy down one time, pretty well, and then move to the hospital.  Seems like bottles of water are too little.  Would you put him under a hose for a minute or two?


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## mycrofft (Jul 20, 2011)

*Consider the flesh-asphalt interface*

The likelihood is that there are some *actual* full thickness burns here because there is no escape for the heat except inwards, maybe carried off by fluid circulation, but mostly just stuck under the tar carapace. Decon/initial debridement would need to be done under general anestheisa with special attention to airway, electrolytes and fluids. Then I wonder about the absorption of petroleum compunds through the skin, muscle, vessels, maybe even periosteum and bone.

Here's hoping his case goes optimally.


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## ArcticKat (Jul 20, 2011)

Sounds like a job well done.  You treated it as a Hazmat situation as well as a burn.  Treated as best you could while considering treatment options at the same time during a difficult call.

It might be a good idea to consider purchasing a BP cuff for the thigh for situations like this.  

Kudos.


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## Cup of Joe (Jul 21, 2011)

Another thing, more for the hospital to consider, would be core body temp.  Since tar and asphalt can clog the pores in the skin, he will be unable to sweat from the covered areas to cool himself down.


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## Anjel (Jul 21, 2011)

lightsandsirens5 said:


> Gosh darn. That is what happens when you are very tired, very angry and trying to type. :-S
> 
> Our air amb has a strict policy against transporting any pt contaminated with flammable or other substances that could off gas and possibly impair the flight crew. I dunno if tar falls under that now that we are talking about it. We had a pt from a factory accident once covered in used lubricating oil. He was deconned fairly well, but HEMS refused him because the stated the oil on him was too dangerous for the flight crew. It would have taken GOJO and a scrub brush to remove the rest.
> 
> ...



Are the NEMS people those who transport NAZMAT pts?? :rofl:


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## lightsandsirens5 (Jul 21, 2011)

Anjel1030 said:


> Are the NEMS people those who transport NAZMAT pts?? :rofl:



Gosh dang it. -_-


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## mycrofft (Jul 21, 2011)

*Nazmat! Nazmat!*

"Nasty-Azz Material"? 
Sorta like "methyl-ethyl-badstuff"?


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## mycrofft (Jul 21, 2011)

*jcalNYC, a long term issue. Good thinking.*

Even if he survives past debridement, the remaining scar will not sweat. I am not sure how well skin grafts' nerves reattach to allow sweating from them.

At 300 degrees F., sweat doesn't help anyway.


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