Liquid Asphalt

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.
 
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.
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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.
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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.)
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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?
 
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.
 
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.
 
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.
 
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.


Now look, I'm going to have to go and find out about tar from the NEMS people.
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Are the NEMS people those who transport NAZMAT pts?? :rofl:
 
Nazmat! Nazmat!

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