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Burns, and scalds are common types of injuries that a first aid provider will have to deal with. Because they result in tissue damage and in come cases destruction they are also one of the most painful, and difficult injuries to heal. However with prompt, proper treatment when the injury happens this trauma can be reduced.
Types of Burns:
Burns can be caused in numerous ways, but they can essentially be grouped into four classes.
- Heat
As expected this is the most common type of burn and can be caused by any sufficiently hot object. Scalds are a type of heat burn caused by a liquid, steam or conceivably both. For example water at 66 degrees celcius can burn a childs skin in two seconds.
- Chemical
Chemical burns are very serious, as the chemical continues to burn as long as the chemical is on the skin. Acids, alkalis, phenols, and phosphorus can cause them. Most chemical burns are treated as critical burns. Common items around the house that can cause chemical burns are oven cleaner, drain cleaner.
- Electrical
Result from contact with an electric current. While heat is the actual agent that causes the burn, electrical burns are normally treated differently because of the electrical factor. All are treated as critical burns.
- Radiation
Sunburn is likely the most common type of radiation burn that most people are familiar with, but other sources can be x-rays, the flash from an arc-welder, and exposure to radioactive material (although this is rare).
The Description of a Burn:
Most people have heard of 1st, 2nd, and 3rd degree burns, but what does this mean? It simply refers to the severity of the burn, and which of the three layers of tissue is burned. First-degree burns affect only the top layer of skin (the epidermis). Second-degree burns affect the first, and second layer (the dermis), and third degree affects these plus the third layer (fatty tissue). Third degree burns are the most serious.
In addition to the above any burn is considered critical if:
- it was caused by electricity, and most chemicals
- it interferes with breathing (burns on face, throat, or through inhalation)
- it is accompanied by soft tissue damage or a fracture.
- it is located where the skin bends (elbows, knees, etc.)
- the casualty is under two or over fifty years of age.
- the casualty has other medical conditions (diabetes, seizures, mental illness, etc.).
When a person is burned medical personnel will normally also give the percentage of the body that was burned. There are two main ways of estimating the area of a burn. The easiest way is to assume that the size of the casualty's palm is equal to one percent of their body. In general on an average adult this will equate to eighteen percent each for a leg, and the same for either the front or back surfaces of the trunk. Each arm is worth nine percent, as is the head and neck combined; the remaining one percent is allocated to the genitalia.
On a child the head and neck combined equal eighteen percent, each arm is again nine percent, the front and back surfaces of the trunk are eighteen percent each, and each leg is fourteen percent.
What not to do for a burn
All burns are easily susceptible to infection and further injury. In some cases the casualty may not feel pain (as in 3rd degree burns where the nerves have been destroyed). There are some basic precautions you should follow with regard to all burns:
- Don't breathe, cough, or touch a burn.
- Don't break any blisters.
- Don't remove clothing that is stuck.
- Don't use butter, or oily dressings on a burn. The only exception is sunburn lotion on a minor sunburn.
- Don't cover burns with cotton, wool, or adhesive dressings.
- Don't cool the casualty too much. When burn is cooled, wrap casualty to prevent shock.
What to do for a burn
- Inform casualty you are first aid trained, and ask if you can assist them.
Everybody has the right not to be touched by others. When you are offering first aid this must be respected. You should always identify yourself as someone who is first aid trained, and then ask if you can help.
The casualty can say "Yes" or otherwise indicate their consent. They can do nothing, but not prevent you from assisting. If there are relations present they can also give consent. If it is a child, and their parents are not around then you can proceed. In all these cases you have consent or implied consent to assist.
The casualty also has the right to say "No", which may sound odd, but they may have reasons, which you must respect.
- Cool / Wash the burn
Cool the burn with cool clean water, until pain is reduced. If burn was caused by a chemical flush entire area with large amounts of clean water (twenty minutes or more). If chemical is a dry powder brush off any loose chemical before flushing. If eye is involved you may have to hold eye open as casualty may not be able to do this.
- Loosen or remove anything on or around the burned area that is tight.
This is especially important for rings, jewelry, tight clothing, foot wear. Do this as soon as possible before the injury swells. But don't remove anything that is stuck.
- Cover with a clean, lint-free dressing.
When the pain has been reduced, cover the burned area with a clean dressing. Secure it with tape, but make sure no tape touches the burned area. If you have access to specialized burn dressings then use these according to the package directions.
- Give on-going care
Arrange for medical aid, give first aid for shock, make the casualty comfortable, and monitor their condition until medical aid arrives or they are delivered to a medical facility.
Conclusion
Burns are likely to be one of the more serious injuries that a first aider will encounter. But with proper training, preparation, and care they can be usually taken care of.
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