Brian Dale
Dr. Clawson:
We were hoping you could help us out with some questions and issues we are experiencing with MPDS® Protocol 7: Burns (Scalds)/Explosion (Blast).
Our agency has recently experienced a number of calls involving pediatric burn patients where the body area was less than 18%, but the injuries were quite significant. For example, one of the most recent calls was reported as a pediatric scald to the face, which coded to a 7-A-1. However, it was also reported that the skin was peeling from her face. The fire department arrived first on scene, upgraded the ambulance response, and the patient was flown to the nearest burn center. Our EMS agency and other cooperating agencies are looking for a way to upgrade any pediatric burn patient. Protocol 7 does not assign determinants based on the age or severity of the burn (3rd degree, 2nd degree, 1st degree). The only determinant that we identified as relating to severity is the Significant Facial Burns (7-C-4), but by definition this would not apply to a patient who was scalded.
Currently, we prioritize an ALPHA as a code 2 response, and a BLS crew could be sent. EMS has assigned different response priorities to each determinant in the protocols. We are wondering if anyone else has experienced this issue. Is there a good way to upgrade a pediatric response from initial dispatch without lumping in all 7-A-1 patients? Or can you provide us with the reasoning behind Protocol 7 and why it does not address burns by age or severity so we could present this to our cooperating agencies? We have researched the “Principles of EMD,” reached out to other agencies, and tried to solve the problem internally, but we are at a loss. Any assistance would be appreciated.
Thank you so much,
Kasey S. Young
EMD Quality Assurance Coordinator
Alameda County Regional Emergency Communications Center
Livermore, California, USA
Dr. Clawson: I have referred the question to Brian Dale, the Academy’s Associate Director of Medical Control and Quality Processes
Dear Kasey,
I have been asked to respond to your inquiries about Protocol 7 and pediatric patients. Regarding your email question, we do get periodic questions about this, particularly regarding burns to the face. The background on the latest version is that we reached out to a number of pediatric trauma/burn centers including Primary Children’s and the U of U Trauma Center here in SLC (Utah, USA). We were unable to find any quantifiable data to suggest a non-inhalation burn to the face—in adult or peds—altered the patient’s outcome or prehospital mortality. We do agree that burns to areas of the body such as the face, fingers, toes, head, and other areas do necessitate transport to a burn center for specific management, but the data does not support sending ALS units simply due to the area burned. Obviously, when there are inhalation burns, this alters the patient acuity and thereby the determinant coding within the MPDS (Medical Priority Dispatch System™). We know that it is very difficult to manage pain in burn patients, as they are bad candidates for sedation or paralytics, so this usually rules out upgrading the response for pain management, and burns of this size do not necessitate fluid replacement unless the patient is already fluid compromised for some reason.
As a 33-year paramedic, I know the stress that a burned child places on the responders, but we try to focus on the clinical acuity of the patient, especially on known outcome data, and what prehospital interventions did to alter or impact that outcome. We believe the data supports the current coding matrix of the MPDS relating to size and location of the insult. We do know that explosions and burns to the face that result in inhalation injuries create much more sick patients, but with scalding burns as described in your email, this risk is extremely low.
If you have access to any data or research that contradicts our position on burn patients, please send us a link or the research itself so that we can review the updated information or treatment protocols. It is important to remember that burns such as this can be life-altering and can lead to significant scarring and a protracted recovery period, but there is little that we know of that a paramedic can do to alter this unless there is airway compromise, real or suspected, or significant volume deficiencies.
I hope this answers some of your questions, and I would be willing to have a conference call if you think that would assist in improving the answers I have given.
Regards,
Brian Dale
Associate Director of Medical Control and Quality Processes
IAED™
