Objectives Clinical Assessments and Interventions Follow-up Actions 181 Treat major burn im- mediately, while preparing for hospi- tal transport via EMS. Treat and provide symptom relief for minor burn (usually mild to moderate). ● Cool burned area with tap water to no more than 20 percent of BSA for 10 min- utes. Do not apply ice. ● Do not remove adherent clothing. ● Remove non-adherent burned clothing that is smoldering and retaining heat and jewelry. ● Cover burned area with dry, sterile material. ● Check for signs of smoke inhalation (e.g., soot in nostrils, singed hair, hoarseness, drooling, stridor, cough, mouth burns). ● Prevent shock (see Guideline 113, Shock, page 226). ● Initiate intravenous Lactated Ringer’s solu- tion per standing order, if needed. ● Elevate burned extremity to decrease fluid loss and swelling. ● Do not break blisters or apply ointments, creams, or topical anesthetics. ● Transport to hospital via EMS. ● Remove smoldering material. ● Initiate cooling efforts (saline-soaked dressings). ● Minimize local sensitivity depending on the degree and extent of the burn (may require medical treatment). ● Leave blisters intact. ● Administer medications (i.e., antimicrobial agents, analgesics) per standing order. ● Apply dry, sterile dressing. ● Keep affected part elevated to reduce edema. ● Assess tetanus immunization status per Guideline 15, Tetanus Prophylaxis, page 40. Administer immunization accordingly. Guideline continues on next page For mild to moderate burns: ● Advise employee about signs and symptoms of infection. ● Advise to keep burned site ele- vated for at least 24 hours. ● Counsel regarding safety pre- cautions. ● Change dressing as needed. ● Observe wound for infection. ● Evaluate worksite for thermal haz- ard and associated risk assign job accommodations as needed. ● Evaluate worker to remove work restrictions/accommodations as appropriate. For extensive or severe burns: ● Implement case management procedures. ● Consult with treating physician regarding plan of care. ● Assist with return-to-work transition. ● Assess job requirements and necessary medical restrictions/job accommodations.