So we had a call to a burn victim that was grossly charred, but was breathing. He started to deteriorate in transport but we made it to the hospital. I was wondering if he were to arrest if that would be a traumatic VSA, I know it's not a blunt or penetrating trauma but it doesn't make much sense as a medical cardiac arrest either. Also could a patient meet the standards for an obvious death after patient contact?
This is a very complex case. We will answer your question in two parts.
A trauma is an injury from a physical force, which can include burns. The Advanced Trauma Life Support (ATLS) program states: burns are a significant type of injury that can occur alone or be coupled with blunt or penetrating trauma.
A burn in isolation may not seem to meet the indications of the Traumatic Cardiac Arrest Medical Directive and consideration for TOR - cardiac arrest secondary to blunt or penetrating trauma. SWORBHP Medical Council would endorse treating burn patients as traumatic injuries and thus be treated under the Trauma Medical Arrest Medical Directive, if applicable. This will result in an early patch consultation which may assist with further direction (continue on scene resuscitation, transport or terminate)
If the patient is initially alive on contact but becomes vital signs absent during care with clinical features consistent with the obviously dead criteria of the Deceased Patient Standard, the most pertinent action would be to continue management per the ALS-PCS. As per the Preface of the BLS, when providing patient care as per the Standards, a paramedic shall ensure that the patient simultaneously receives care in accordance with the Advanced Life Support Patient Care Standards (ALS-PCS). In the situation you detail, a patch to the BHP for consideration of Trauma TOR would be recommended.
It is important to remember that all of these cases of traumatic death, and fires will be Coroner's cases, and involve Fire Marshal investigations. During transport this could result in the ambulance being taken off the road for an extended period of time, and not being able to attend 911 calls. In many cases obtaining a TOR could be challenging as fires can attract hundreds of people to the scene and become very public events with media. It is important to relay the location of the patient and the team's recommendations when speaking to the BHP so we are best able to support you.