Burns can be one of the most painful and traumatizing injuries received by a casualty. In this week’s DD First Aid, Aiden Thompson of Donegal Training Safety Solutions deals with all aspects of burns.
In most of the literature that we read, they tell us how to treat the burn as if it was a simple injury, however, these texts seldom prepare us for the actual trauma the casualty experiences as a result of their injuries.
So in this article, I would like to identify the differing degrees of burns, the treatment for these serious injuries, and the preventative measures we can take to avoid them.
Degrees of burns
We have all, at some point burnt our finger when lifting a hot plate or dish out of the oven. Your natural and instinctive response is to cool the area by either sticking your finger in your mouth and proclaiming a few expletives or running it under cold water for a period. That’s a perfectly normal response and often requires little first aid intervention.
But when we burn a large area of our body we need to be able to treat this injury fast and effectively. We need to know what a large area is, relative to the size of the casualty, and we need to know when to seek medical advice.
When we refer to burns, we often talk about 1st, 2nd, and 3rd-degree burns which refer to our layers of skin.
A first-degree burn, which burns the outer layer of skin, will often be red, slightly swollen, and tender to touch. A classic example of this is a mild sunburn, which we can generally manage ourselves with some after sun lotion and by covering up and learning from our mistakes.
A second-degree burn will present with blisters, the presence of blisters means the burn is now more serious because an infection can occur if a blister is burst. There are many “Old Wives Tales” about how to treat these burns but do not put ointments, gels, or other “cures” on these burns because they may require medical attention. If this is the case the doctors will need to remove the remedy to examine the burn, which can be excruciating for the casualty and are often a potential risk of infection themselves.
A third-degree burn, the most serious, will often appear waxy white because of poor blood flow through the area or have charred edges to the burn, sometimes the casualty will be in excruciating pain, and in other circumstances, they may say they have no pain at all. This is a sign of nerve damage and all third-degree burns must be taken very seriously.
When is a burn considered serious?
It depends on the depth, size, and location of the burn. We now know how to recognize the degree of burns. We must now understand what size a burn is, proportionate to the casualty’s body. A simple rule of thumb is that the size of the palm of the casualty’s hand is equal to 1% of their body. 1% doesn’t sound like much really, but when you look at the size of your hand while reading this article you will realize that it’s a relatively large area. When we consider larger burns, we break the body into areas of 9% or multiples of 9%. For example, a burn to the chest and abdomen equals 18% of the body, a full-circumference burn to the arm, which is smaller in size is 9%. A full-circumference burn to a leg is 18% per leg and the head area is also 9%. These are very serious injuries so when I teach first aid my simple rule is as follows; if a casualty has a second-degree burn (a burn that blisters) that is larger than 1% we need to seek medical advice. This burn will require pain relief, antibiotics to prevent infection, and professional assessment and dressing to reduce the effect of the injury.
There are also some areas of the body that we don’t want to burn if possible.
1. The palms of the hands and the souls of our feet. These very sensitive areas are used every day by the casualty and the recovery from these injuries can be very long and difficult requiring physiotherapy and multiple surgeries and skin grafts.
2. The neck or face. When we burn, we swell. We don’t want the airway to swell and potentially close over causing another major emergency, breathing problems.
3. The groin or perineum. This is where we get rid of our bodies’ waste products, we defecate, urinate, procreate and give birth from this area. If we suffer a bad burn in this area it can affect us for life resulting in the use of colostomy bags and alternative birthing methods.
4. The airway. Sometimes, if we are lucky we might rescue or retrieve a casualty from a burning building or car. We might see soot or char marks around their nose or mouth and then realize that they have inhaled hot gases that have burned their airway internally. These casualties may appear fine at first but begin to show signs of breathing difficulties as their airway is affected. Any internal burn, or risk of internal burn, is serious and needs to be investigated by a professional medic.
If you consider a child being scalded with boiling water or soup, for example, they often burn their chest, legs, groin, and feet. Added to this is the fact they often wear nappies that are designed to soak up liquids. It is not hard to conclude that these can be very serious injuries that need immediate first aid while we wait for help to arrive.
So, how do we treat burns?
Similar to every other emergency, our priority is to ensure we are safe first. If you run into a kitchen and slip on a wet floor there is a chance you could injure yourself badly by slipping on a wet surface and not be able to render first aid effectively. We need to cool the burnt area by placing it under cold running water as soon as possible. This sounds simple enough, but in reality, the burns casualty is often trying to withdraw from the water because of the immense pain they are in. As cruel as it may seem, we need to restrain the casualty and continue to cool the burn. If it’s a large burn we must place the casualty into the shower or bath, but remember to turn your shower to cold.
If we can, we remove any clothing that may be saturated by cutting them away from the body. Never pull clothes away from the skin, lots of modern garments are synthetic and they react to heat and can melt into the skin. Instead, cut away any affected clothing and if there is an area affected cut around it and let the medical team deal with this in the hospital. If the casualty is wearing jewelry, remove it if possible because the burnt area will swell and could cause a blood supply problem. We cool the area for at least ten minutes or until the pain has eased.
It is very important to note that if you are on your own and an accident occurs, treat the burn first and then activate the emergency services. If, however, there is more than one adult present, one treats the injury while the second one calls for help. In serious injuries, no matter what the cause, the sooner we call for help, the better.
What should we do after we cool the burn?
In an ideal world, we would have proper medicated burns dressings which can prevent infection from causing complications and are designed to cool the burn because they are foil wrapped and stored in a fridge making them cold and soothing. We can buy these from our local pharmacy or online.
If you don’t have these though, Clingfilm is a great burn dressing because it doesn’t react to heat and traps the fluid that may escape from a burst blister. Be careful not to wrap the Clingfilm around a burned area though as swelling may become an issue.
As strange as it may seem, we must also keep the casualty warm because they will go into shock as a result of the injury. Place a coat or blanket over the casualty after we have treated and dressed the injury, and while we await the emergency services arrival. If at any stage the casualty complains of pain, simply place the injured area back under cold running water. Remember, when we phone for help always place our phone on the loudspeaker and follow the advice of the operator who can keep us focused and calm in an emergency.
There are so many different chemicals in our homes and workplace that there is no one simple answer to a chemical burn, we need professional medical advice. Like a scald injury though we need to irrigate the wound, but because the skin is porous and can absorb the chemical, we irrigate it for at least 20 minutes. All chemical burns are serious regardless of their size or location so medical advice is encouraged. If a chemical burns the eye, be careful to irrigate the injured eye low in a basin or sink. Do not irrigate an injured eye and allow the water to enter an uninjured eye causing further damage. A chemical can also scar the face, which we don’t want to happen if we can avoid it.
Prevention is always better than the cure
As ever, when we deal with injuries and accidents, prevention is always better than the cure. Make your home as child-safe as possible and be alert to your child’s ability to climb and access cupboards and presses. Ensure you use a fireguard and stair guard. Keep the handles of all pots and pans away from the edge of cookers, ensure they are facing inwards to prevent a child from being tempted to reach up to support themselves, and don’t let the flexes of kettles or irons hang over the edges of kitchen surfaces. Chemicals such as dishwasher tablets, bleaches, or cleaning products need to be stored safely, away from your children’s reach, and always in their original container.
Thank you for taking the time to read this article and please feel free to contact me at any point to discuss any concerns you may have or to book a first aid course with me.
In next week’s article, we will discuss poisoning and the steps we can take if we suspect this has occurred.
Aiden Thompson is a PHECC registered paramedic
and former Search And Rescue winchman with the Irish Coastguard helicopter, R118, based in Sligo. As a PHECC registered first aid instructor and an Irish Heart Foundation training site coordinator Aiden delivers the highest standard of training to members of the public.
If you would like any further information on courses available in your area, please contact Aiden on 0863111661 or visit his website www.dsts.ie for further details.