So, how did I spend my Thanksgiving afternoon?
I and my partner, Mandie, spent it at a fire standby. Any time there’s a structure fire an ambulance gets dispatched to stand by in case someone is injured — either a person trapped in a house, or a firefighter. Nasty scenes, fires.
We’re the Medical Branch, working for the Incident Commander. (See Wheel, Re-invention of for more on ICS.) When we aren’t fixing up the injured (thankfully injuries aren’t that common), we run the rehab zone. That means, as the firefighters come out from working on the fire, pretty much when the bells ring on their air packs, they come over to us. We give ‘em a bottle of water and check their vital signs: heart rate, respiration rate, blood pressure, pulse oximetry. After they’ve cooled down for a bit, they suit up and go back in.
So, there we were. The smoke was visible from about half a mile away (nice blue-sky clear New Hampshire afternoon). When we arrived we found a garage that had pretty-much collapsed. It looked like a big bonfire. I wish I’d taken a camera with me to show you.
Our friends at the Consumer Product Safety Commission have these recommendations for using turkey fryers:
For safest operation, CPSC staff recommends that consumers follow these guidelines as they prepare to use a turkey fryer:
- Keep fryer in FULL VIEW while burner is on.
- Place fryer in an open area AWAY from all walls, fences, or other structures.
- Never use IN, ON, or UNDER a garage, breezeway, carport, porch, or any structure that can catch fire.
- Raise and lower food SLOWLY to reduce splatter and avoid burns.
- COVER bare skin when adding or removing food.
- Check the oil temperature frequently.
- If oil begins to smoke, immediately turn gas supply OFF.
- If a fire occurs, immediately call 911. DO NOT attempt to extinguish fire with water.
- Make sure there is at least 2 feet of space between the liquid propane tank and fryer burner.
- Place the liquid propane gas tank and fryer so that any wind blows the heat of the fryer away from the gas tank.
- Center the pot over the burner on the cooker.
- Completely thaw (USDA says 24 hours for every 4 to 5 pounds) and dry turkey before cooking. Partially frozen and/or wet turkeys can produce excessive hot oil splatter when added to the oil.
- Follow the manufacturer’s instructions to determine the proper amount of oil to add. If those are not available:
- Place turkey in pot
- Fill with water until the turkey is covered by about 1/2 inch of water
- Remove and dry turkey
- Mark water level. Dump water, dry the pot, and fill with oil to the marked level.
Try not to catch yourself on fire, guys.
If you do happen to catch on fire, remember: Stop, drop, and roll. What that does for you: You are no longer fanning the flames, you aren’t drawing a lot of air (and hot gasses, and smoke) into your lungs, and you’ve got a chance of putting out the fire. (I promise you can’t run fast enough to extinguish flames.) If you see someone else on fire and running, yell at them to stop, drop, and roll. A heavy wool blanket is good for putting out flaming people.
Burns come in three categories: Superficial, partial thickness, and full thickness. (The old names for those are first degree, second degree, and third degree. We don’t use that terminology any more.)
The “thickness” being spoken of is the thickness of the skin. Your skin is the largest organ in your body. For our purposes here it has three functions: It provides thermal regulation, it protects against bacteria, and it’s water-tight, which keeps the fluids inside you.
A superficial burn only affects the top layer of the epidermis. This is like a sunburn. It’s painful, but (unless it’s extensive) not too serious. The surface of the skin is dry and reddened. The burn is painful and sensitive to touch.
A partial-thickness burn involves the epidermis and the dermis. These are generally moist due to the loss of waterproofing. In a superficial partial-thickness burn, thin-walled blisters form. The skin is reddened, and area blanches when pressed, but regains color rapidly. In deeper partial-thickness burns the skin is red or waxy, and moist, but may not blister. It still blanches when pressed, but recolors only slowly or not at all. Partial-thickness burns are intensely painful.
A full-thickness burn extends all the way through the dermis and may affect underlying organs. These injuries can appear to be blackened, waxy, or leathery. Capillary refill is absent, and the surface is dry. Oddly enough, full-thickness burns aren’t painful; the nerves are destroyed. Areas of partial-thickness burns and superficial burns surrounding the full-thickness burn are, however, exquisitely painful.
Burns to the hands and feet, to the face (and especially the airway) , that involve the groin or buttocks, are over a major joint, or are circumferential (all the way around a limb or your chest), raise the seriousness of the injury. Burns to those areas, or to persons under five years old or over 65 years old, raise the seriousness one level. A burn plus another injury (e.g. fracture, laceration) raises the seriousness of the burn one level. You go from minor to serious, or from serious to critical. If your burn started out critical, you’re in trouble anyway.
First aid for burns: First, stop the burning process. Copious water is usually the best method. Then, loosely wrap the affected area in sterile, dry bandages. Don’t pull off anything that’s charred to the skin. Don’t break blisters. (If someone’s wearing a watch or a ring — cut it off. The injured area will swell and circulation may be lost.)
Start looking for pulse points beyond the burned area. If you find a pulse, mark it with a Sharpie marker. That’s good meat. Later on, when the burned areas start to swell, you may lose those pulses. Knowing that they were there, and where they were, will help your ED doctors.
Speaking of swelling — that’s why circumferential burns are so dangerous. They can form a sort of tourniquet and stop circulation in a limb, or stop the chest from expanding in order to breath.
You aren’t going to put on wet dressings, because that could induce hypothermia. You are going to use sterile dressings because the skin’s ability to protect against bacteria is gone. You don’t want to use creams or ointments, because they can hold in the heat, and because the first thing we’re going to have to do in the ED is remove them — and that hurts.
Like anything else, treat for shock. Start treating for shock before shock develops — after you’ve gone into shock getting back can be tough. (To treat for shock — wrap the patient in blankets for warmth, lay him on his back with his feet elevated. Provide oxygen if you have it.) While bacteria aren’t really your concern on-scene, do your best to keep the wound clean. That’ll simplify things down the road. Of more immediate concern are hypothermia and dehydration. Losing skin compromises the body’s ability to maintain heat and water.
If you note charring, blistering, or blanching around the nose or mouth, or singed nose-hair, or sooty phlegm, expect airway problems. The air passages will swell and the situation will get dire fast. That person needs to be in a hospital (or, better, burn center), right now.
Any full-thickness burn is severe. Any partial-thickness burn greater than three inches in diameter is severe.
As long as we’re talking about fires and such, direct burns aren’t the only way they can kill you. Carbon monoxide, or cyanide gas, for example, can nail you long before the flames reach you.
Carbon monoxide is a colorless, odorless gas that binds more firmly to hemoglobin than oxygen does. Carbon monoxide is created by incomplete combustion. Hydrogen cyanide, a byproduct of combustion of some materials, destroys the ability of the mitochondria in your cells to function. This tends to paralyse the muscles, including heart and diaphragm. Small concentrations of hydrogen cyanide reaching the brain can cause unconsiousness.
What do you want to do about those? Get smoke detectors and carbon monoxide detectors. If you heat or cook with gas, add an explosive gas detector to your home. (You can get combined CO/explosive gas detectors). Test them regularly; change the batteries every six months. (If your alarms keep going off for no apparent reason, find out why. Don’t just take the battery out of the alarm.)
As long as we’re here, shall we talk about fires in general?
There are four classes of fires. Class-A is combustible solids (like wood or paper). It’s characterized by white smoke and red flames. You extinguish ‘em with solid stream or high-velocity fog water. Class-B is combustible liquids like oil. It’s characterized by orange flames and black smoke. You extinquish it with low-velocity fog or foam. Class-C is electrical fres. It’s characterized by thin bluish smoke and a smell of ozone. It’s extinguished with dry chemical or carbon dioxide. Class-D is combustible metals like magnesium. It’s characterized by brilliant white light. It’s extinguished with dry powder (don’t use water — water just makes it angry).
Pick extinguishers for your home rated for the kinds of fires you’re likely to see. If you have a dry chemical extinguisher, go around and turn it upside down once a month. That’ll keep the powder loose, so when you need it the chemical isn’t all caked in the bottom of the cylinder. If you’re going to extinguish a fire yourself, first, don’t let the fire get between you and the door. Next, test the extinguisher before you get close to the fire. Then, use low sweeping motions of the extinguisher aimed at the base of the flame. After the fire is out, set a reflash watch. Call your friends at 9-1-1. They want to hear from you. (Send someone to call, or call yourself, before you go attack the fire.)
Copyright © 2006 by James D. Macdonald
I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.
Stop, Drop, and Roll by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.
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