Kit Buildup - Burn Pack

[K.L. Davis]

This is part of this post (https://www.m4carbine.net/showthread.php?p=393845#post393845).

Within the scope of what the orginal idea, feel free to make some suggestions for this kit -- please copy the list before your post and add, subtract or make changes to the existing list. Please give your reason for the changes.

Just to throw some ideas out... I like the small kit from Water Jel and have basically that kit with cold packs and Silver Sulfadiazine as a burn pack now.

So...
One 12X16 Face Dressing
Two 4X16 Burn Dressing
Two 4X4 Burn Dressing
Six Burn Jel Packets
Two Rolls of 3" Gauze
Two small Cold Packs
One Tube of Silver Sulfa
One Tube of Bacitracin
Scissors
Tape

This makes for a pretty small pack, about the size of a hardback book -- way more than one would want for a wilderness, or hiking kit... but then the probability of burn treatment is reduced in that setting anyway?

[FMF_Doc]

I like the idea of a small kit, one thing I would add would be a small bottle of sterile water.

I would vacuum seal it together to further reduce the size and help keep contamination out of the sterile supplies.

[K.L. Davis]

So how's this?


One 12X16 Water-Jel Face Dressing
Two 4X16 Water-Jel Burn Dressing
Two 4X4 Water-Jel Burn Dressing
Six Water-Jel Burn Jel Packets
Two Rolls of 3" Gauze
One Small Cold Packs
One 250ml Bottle of Sterile Water
One Tube of Bacitracin
Scissors
Tape

*Changed the cold pack from 2 to 1, took out the SSD (Rx item and Sulfa drug) and added 250ml of Sterile Water.

I am not not even close to an expert on this stuff... so feel free to comment, I can put some stuff together to show what size package we are talking.

[RESQDOC]

That's a nice little burn kit. You won't get tape to stick to Water-Jel, so devise alternate means to hold it in place, such as your gauze rolls, ACE wraps, Kerlix, Kling, etc. + large safety pins. Personally, I would change at least one gauze roll to 3" Kling (vet wrap) & toss in some diaper pins, to have some versatility.

Lidocaine impregnated wound cleaning pads (over the counter) can offer some relief to unroofed second degree, and to a lesser extent, intact burned tissue. Lidocaine toxicity is always a possibility, but a few pads (6 or less) won't get you in trouble.

[K.L. Davis]

How's this?

One 12X16 Water-Jel Face Dressing
Two 4X16 Water-Jel Burn Dressing
Two 4X4 Water-Jel Burn Dressing
Six Water-Jel Burn Jel Packets
Six Wound Cleansing Pads w/Lidocaine
One Roll of 3" Gauze
One Roll of 3" Kling
One Small Cold Packs
One 250ml Bottle of Sterile Water
One Tube of Bacitracin
Six Safety Pins, Four Large and Two Small
Scissors

[FMF_Doc]

Looks good to me, I can't think of anything else off the top of my head.

[peepee]

Wet dressings are great and are the gold standard for treating burns but this is only if you are near a burn treatment facility/sustained treatment facility. One of your biggest concerns with burns and trauma is hypothermia(lg burns-defined below)and for soldiers who are isolated from these facilities dry dressings may be an option. This is our protocol in SF/Spec Ops from our schoolhouse/committees.
Liquids in contact with the skin pull body heat away 30% faster than if dry, not to mention your skin is no longer exist(not to get into the weeds! ;)). Anyway, just food for thought. :dirol:

Straight from the 18D-SFMS(Spec Forces Med School)/SOCM(Special Ops Combat Medic Course) schoolhouse.

MGMT of Thermal Burns
Moderate to Severe Burns
-Dry sterile dressings
-Partial Thickness: >15%BSA
-Full Thickness: >5%BSA
-Maintain warmth
-Prevent Hypothermia
-Consider aggressive fluid therapy(Parklands Formula)
-Moderate to sever burns
-Burns over IV sites
-Place an IV in partial thickness burn site

[dvdmacdaddy]

I work in EMS with a burn center at my back door. The new "gold standard" for burn care is dry non-adheraing sterile dressings, gel wise you can use triple antibiotic ointment (Neosporin). Keep the patient warm, dry, and hydrated. Biggest cause of death in burn patients is infection. If you happen to have antibiotics around and the burn is severe and your days away from a burn center you can administer a broad spectrum antibiotic.

I have seen what it is like when a burn patient arrives in the burn center and when they clean off the gels/ointments/etc that has been placed on the burn it takes twice as long to clean and is very very very very painful.

[AFGuy1227]

I work in EMS with a burn center at my back door. The new "gold standard" for burn care is dry non-adheraing sterile dressings, gel wise you can use triple antibiotic ointment (Neosporin). Keep the patient warm, dry, and hydrated. Biggest cause of death in burn patients is infection. If you happen to have antibiotics around and the burn is severe and your days away from a burn center you can administer a broad spectrum antibiotic.

I have seen what it is like when a burn patient arrives in the burn center and when they clean off the gels/ointments/etc that has been placed on the burn it takes twice as long to clean and is very very very very painful.

So would the best thing to do be cover w/Kerlix and treat for shock while waiting for ambo or other means of transport? This assuming you're not in a disaster or some other SHTF event.

[dvdmacdaddy]

Thats correct if the patient is critical, also if you have IVs and training you can start to large bore IVs with rapid infusion (Parkland Burn Formula).

If not critical cover with kerlex, hydrate/IV (if trained and have it) watch for shock and infection, transport to the closest burn center ASAP.

Critical is any inhalation injury; > 20% TBSA 2nd Degree/Partial Thickness; > 5% TBSA 3rd Degree/Full Thickness; any 2nd-3rd degree burn to the head, neck, face, feet/hands, genitalia; any electrical burn; or any 2nd-3rd degree burn with other underlying trauma.

TBSA- Total Body Surface Area

Quick way to figure % is take the size of the patients hand and that is 1%, or you can use the Rule of Nines (easy just have to remember your charts).

Parkland Burn Formula - 4cc/kg/% burn with 1/2 given in 1st 8hrs

[AFGuy1227]

Would you want to clean the burnt area with water, sterile or not, before applying gauze?

[dvdmacdaddy]

If possible you would want to flush the burn area with as much sterile water as you can, especially if it is a chemical burn.

[AFGuy1227]

This seems like it would be a good burn kit based on all the recommendations from others. Maybe break up the one big bottle of sterile water into two smaller just to make kit a little smaller.

One Roll of Kerlix Gauze
One Roll of 3" Kling
One Small Cold Packs
Six Wound Cleansing Pads w/Lidocaine
One 250ml Bottle of Sterile Water
One Tube of Bacitracin
Six Safety Pins, Four Large and Two Small
Scissors

[dvdmacdaddy]

That sounds like a good burn kit. I would add a burn sheet and mylar blanket. If you cant get a burn sheet you can use a mylar blanket. Just make sure all burns are covered before using just the Mylar blanket.

When you have burns you loose the ability to regulate body temperature the burn sheet and Mylar blanket can be used to wrap the patient in to keep warm. Also a burn sheet can be placed directly on the burns, so if the patient is burnt head to toe you can just wrap in the sheet instead of trying to wrap the body with gauze.

Cold packs aren't necessary as a patient with burns is more likely to be hypothermic.

[chuckman]

I have seen what it is like when a burn patient arrives in the burn center and when they clean off the gels/ointments/etc that has been placed on the burn it takes twice as long to clean and is very very very very painful.

I worked in a burn center and you should see what we do in the days and weeks after they arrive! The cleaning and debridement is a never-ending process, and is quite painful.

This is a good thread, and my two cents is that in a pre-hospital arena "sterile" sheets really need not be sterile, but any sheet as long it does the job and is warm, and do not irrigate burns unless they are relatively small as burn patients get hypothermic very quickly (exception is chemical burns, you gotta get the chemicals off).

[AFGuy1227]

So based on the inputs provided I think this will be my major burn kit:

2 x rolls Kerlix AMD
4 x 30mL SalJet Rinse
2 x Burn Sheet
1 x Mylar Blanket
8 x Safety Pins, 4 large and 4 small

My med kit would already have scissors, tape, and coban so I didn't include in list. Kit would most likely be in a Ziploc or vacuum sealed for grab and go ease. I will be adding some Lidocaine wipes to my first aid kit for small burns that can be handled with 4x4 and most likely no trip to the ER.

What you guys think?

[chuckman]

So based on the inputs provided I think this will be my major burn kit:

2 x rolls Kerlix AMD
4 x 30mL SalJet Rinse
2 x Burn Sheet
1 x Mylar Blanket
8 x Safety Pins, 4 large and 4 small

My med kit would already have scissors, tape, and coban so I didn't include in list. Kit would most likely be in a Ziploc or vacuum sealed for grab and go ease. I will be adding some Lidocaine wipes to my first aid kit for small burns that can be handled with 4x4 and most likely no trip to the ER.

What you guys think?

If you want the burn sheet, go with the burn sheet, but once it's open it is inherently unsterile. Also think about replacing them when the sterility goes out of date. Also, just because a burn is small don't think it isn't serious. Technically, any burn to the hand and foot should be referred to a burn center (but as many stupid burns as I have had on my hand being stupid I have never been to a burn center as a patient and I turned out OK).

[AFGuy1227]

If you want the burn sheet, go with the burn sheet, but once it's open it is inherently unsterile. Also think about replacing them when the sterility goes out of date. Also, just because a burn is small don't think it isn't serious. Technically, any burn to the hand and foot should be referred to a burn center (but as many stupid burns as I have had on my hand being stupid I have never been to a burn center as a patient and I turned out OK).

I would use the burn sheet just for the fact that I get them relatively cheap and they are prepackaged in a compact manor. I'm not that worried about them being sterile just b/c the date has passed and besides you mentioned a couple post back that sterile or not didn't matter. I include 2 burn sheets and a mylar blanket b/c I live in Interior AK and it can get -50 in winter; sheet under, sheet over, then mylar blanket hope we don't all freeze to death before Fire Rescue shows up. Not trying to pick a fight just explaining my choices and why.

[chuckman]

Not trying to pick a fight just explaining my choices and why.

No worries, and where you live it's a valid point to layer. Hypothermia kills trauma patients quickly, moreso for burn patients. Let's hope you never have to use the stuff...I worked in a burn center and burns still give me the heebie-jeebies.

[AFGuy1227]

I've never seen a burn first hand, hope not to ever, but I've seen the after affects of a guy that got burnt by an electrical arc when a secondary distribution cabinet blew. Guy was lucky that he was wearing the appropriate PPE or it probably would've been a lot worse.

[dvdmacdaddy]

No worries, and where you live it's a valid point to layer. Hypothermia kills trauma patients quickly, moreso for burn patients. Let's hope you never have to use the stuff...I worked in a burn center and burns still give me the heebie-jeebies.

Agreed, burns are horrific, I don't wish them upon my worst enemies.

[dvdmacdaddy]

I worked in a burn center and you should see what we do in the days and weeks after they arrive! The cleaning and debridement is a never-ending process, and is quite painful.

This is a good thread, and my two cents is that in a pre-hospital arena "sterile" sheets really need not be sterile, but any sheet as long it does the job and is warm, and do not irrigate burns unless they are relatively small as burn patients get hypothermic very quickly (exception is chemical burns, you gotta get the chemicals off).


For my paramedic training because the hospital here is a teaching hospital I opted to spend an extra 24 hrs in the burn unit on top of our required 48 hrs, I really enjoyed it and learned alot.

[ftbear]

IMHO if you have access to them, a very large pair of sterile gloves ( 8.5 or 9) would be of great benefit. Hand burns are very common. I find in treating hand burns, using typical gauze around a hand wound will eat up alot of supplies and very quickly if changing the dressings at any interval. Placing silvadene ointment into a sterile glove and then placing the hand in them covers the hand while keeping it clean and covered. Also, the right/left hand can be turned inside out if 2 left/right hand wounds occur.

If you have access to it, additional silvadene (You will find you will never have enough) and a sterile tongue depressor for easy application would be my choice for additions to your great kit.

Nice thread

[DevilDoc1138]

Definitely flush the burn with the sterile water, and kerlix is my favorite securing wrap. Hypothermia blankets are real cheap and very small packaged so they are easy to fit. Solid burn pack.

[USAFPararescueDoc66]

Having versatility is good, especially as described above using diaper safety pins. These have many uses in trauma (Finger splints, and if needed you can hold a large wound together by going apex to apex) In my expirience with burns you might also want to add an airway device. I only say this due to the thermal sensativity of the throat most notably the Larynx and vocal cords if a flash burn has occured in these areas breathing will be severly impeaded. We always carried an OPA , you might want to consider throwing one of those in your burn kit. If you have been trained and have access to them, obviously a high dose steroid push would be ideal to mitigate swelling, however if this is not possible you might want to consider an airway intervention. Just my opinion.

Stay Safe

[Sincitymx]

I cooked the skin off of the top of my left hand up to my mid forearm total 3rd degree.. I got very lucky. But while I was being treated the nurse gave me a small jar of GENERIC NAME: SILVER SULFADIAZINE - TOPICAL (SIL-ver SIL-fa-DYE-a-zeen) to keep in my first aid kit for future use when and if severe burns occur. They used that stuff every day for 3 months as a type of antibiotic ointment on my hand after they scrubbed away the scar tissue daily. I guess the silver in it acts like an antibiotic and kills germs. Now I'm not a medic or any expert on burns. So please dont shoot the messenger. But I still keep a fresh supply in my backpacking first aid kit. I hope this helps someone out there if they happen upon a severe victim.

[Caduceus]

I cooked the skin off of the top of my left hand up to my mid forearm total 3rd degree.. I got very lucky. But while I was being treated the nurse gave me a small jar of GENERIC NAME: SILVER SULFADIAZINE - TOPICAL (SIL-ver SIL-fa-DYE-a-zeen) to keep in my first aid kit for future use when and if severe burns occur. They used that stuff every day for 3 months as a type of antibiotic ointment on my hand after they scrubbed away the scar tissue daily. I guess the silver in it acts like an antibiotic and kills germs. Now I'm not a medic or any expert on burns. So please dont shoot the messenger. But I still keep a fresh supply in my backpacking first aid kit. I hope this helps someone out there if they happen upon a severe victim.

Yeah, silvadene is the same as Silver Sulfadiazine. I think it's prescription only, which sucks. In a pinch bacitracin or neosporin work, once the "heat" is removed (vaseline bases can retain heat and worsen thermal burns, in theory). BTW, if you're using it, you still need to clean the burn first.

Don't work so well on chemical burns, AFAIK.