Extensive Burns in an Elderly Man Found in a Brush Fire

Abstract

This past spring, a flight team was activated by a rural advanced life support ground service for a scene call approximately 30 minutes from their base for an 80-year-old man found lying in the middle of a brush fire. The ground paramedics did not know how the patient came to this position. During the initial call to the flight service, ground emergency medical services (EMS) reported that the patient had 100% burns that varied in severity from superficial to full thickness. The intercept was requested for emergent transport to a burn center, analgesia, and advanced airway management. On arrival, the flight crew saw that a bag valve mask was being used to ventilate the patient. EMS had placed the patient on a spine board for extrication from the scene. His initial Glasgow Coma Score was noted to be 6 (E1, V1, M4). The flight team noted that the patient occasionally moved his upper extremities and his head. Immediately, there was concern for a compromised airway in the setting, with soot and edema noted in the nares and oropharynx. The ground EMS crew was able to ventilate the patient with difficulty. However, given the severity of the burns and noted trismus, an oral airway could not be placed. Stridor was noted, with obvious swelling of the neck.