Introduction – Most people have suffered a burn or scald at least once in their lives, usually sunburn. Thankfully, instinct correctly tells us to cool it using cold water, but there’s much more to treating a burn than this basic step.
What is a burn? – The World Health Organisation define a burn as:
…an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals.”
What is a scald? – People often refer to scalds when talking about burns – the difference between them is that burns are caused by a dry source (for example, a flame or the sun) and scalds, a wet source (like hot liquids and oils).
Understanding the Depth of Burns – Burns are categorised as follows:
Superficial (Previously named 1st degree burns)
How to Identify a Superficial Burn:
Superficial burns are identified by redness, discomfort and pain, swelling may be present.
Partial thickness (Previously named 2nd degree burns)
How to Identify a Partial Thickness Burn:
Partial Thickness burns are identified by blistering, redness, pain, swelling, may ooze and have evidence of superficial burn around the partial thickness burn.
Full thickness (Previously named 3rd degree burns)
How to Identify a Full Thickness Burn:
Full Thickness burns are identified by deep, significant destruction of skin layers, charred, waxy, smells burnt, unlikely to be painful at injury site due to nerve damage, evidence of partial and superficial thickness burn around the full thickness burn.Causes of Burns
The cause of burns can be separated into three different categories:
- THERMAL – Fire; radiation including sunburn and exposure to radioactive sources like X-ray; friction, and cold; for example, frostbite and exposure to substances like liquid nitrogen.
- ELECTRICAL – Low and high voltage, lightning strikes.
- CHEMICAL – Domestic and industrial chemicals.
General Treatment of Burns
The principles of burns first aid treatment are:
- Ensure you are not putting yourself in danger.
- Cool the burn, preferably with running cold water – do not apply ice.
- If water is not available, consider using water-gel dressings to remove the heat from the burn.
- Manage the risk of infection.
There are also a few clear Do NOT’s when treating burns:
- Do not apply lotions or creams.
- Do not apply butter or other fats.
- Do not burst any blisters.
How To Treat Non-Chemical Burns
- Generally, non-chemical burns should be cooled for at least 10 minutes.
- Blisters should not be intentionally burst as this can introduce infection and delay healing.
- Any restrictive clothing or jewellery in the burn area or vicinity should be carefully removed, as if swelling occurs it can restrict blood flow, cause pain and make it much harder to remove these items later on.
- Clothing that has adhered to a burn should be left alone as removing it can cause further damage to the skin/tissues.
- Any burn that is bigger than the affected patient’s hand should receive medical attention.
- Consider treating the patient for medical shock.
Some burns are more specialist and therefore require specific or varied treatment. Examples of specialist burns include:
- Facial burns and burns to the airway, which quickly swell and cause airway obstruction.
- Chemical burns – some chemicals will react violently with the application of water.
- Electrical burns.
- Burns to the hands, feet, face and genital area.
- Burns that extend all the way around a limb, the chest or neck (circumferential burns).
- All full thickness burns.
- Consideration of the physiological differences for children and the elderly and the higher risk burns present to these patients.
- Be mindful that burn injuries may not always be accidental.
How to Treat Chemical Burns
The treatment for chemical burns differs from that of non-chemical burns with the key differences being that you should:
- Identify the chemical and any specific treatment.
- Cool the burn for at least 20 minutes, usually with cool running water (unless the manufacturer instructions say otherwise).
- Gently remove any adherent clothing, while flushing the area with water (if appropriate).
- Ensure you do not cause the chemicals to splash onto other areas of the patient or onto you.
How to Treat Electrical Burns
Electrical burns broadly sit into two categories based on origin:
- Low voltage supply – domestic electricity supply.
- High voltage supply – overhead power cables, railway power lines and cables, lightning.
In all such cases it is important to ensure you do not place yourself in any danger when providing assistance and first aid and to ensure medical attention is sought. In the case of high voltage burns it may be necessary to stay a set distance away from a patient, keep bystanders away and you will need to seek help from the emergency services.
Use of clingfilm and specialist burn dressings
Both first aid and pre-hospital care by ambulance staff advocates the use of clingfilm as part of the treatment for burns. It is important to be aware of the following when using clingfilm:
- It is vital that the burn is sufficiently cooled first.
- The first two complete turns of the clingfilm roll should be disposed of before application.
- Clingfilm should be applied length ways over a burn in layers. It must not be wrapped around an area as this will cause constriction, aggravate any swelling and cause additional pain to the patient.
- Clingfilm should not be applied to chemical burns.