First Aid treatment for Burns
Dealing with a casualty who has burnt or scalded themselves can be very alarming. Quick positive action can save the casualty a vast amount of pain and scarring. If you can recognise a burn and understand the dangers and consequences if action is delayed, then you are more likely to give the prompt action needed and not panic.
How burns are caused
Sometimes it is not always obvious that the injury is a burn and so time could be wasted if you are not sure. For this reason, it is worth quickly looking at the causes:
Type of Burn
Type of Burn
- Hot Objects
- Hot fat
- Low Voltage (Domestic/Office)
- High Voltage
- Freezing metal
- Liquid gases
- Radio-active Sources
Assessing a Burn
There are various factors to take into consideration when assessing a burn, this will help you decide the severity and the appropriate treatment.
The factors to consider are the cause, the depth and the area that the burn covers. In addition, consider where the burn is, i.e. the location. For example, a burn on the abdomen is likely to be more painful than on the palm of the hand.
If a burn involves only the surface of the skin, that is the outer layer, it is said to be a superficial burn. Examples include tea and coffee scalds, touching an iron or oven slightly.
Should the burn blister, making it look raw, this is said to be a partial thickness burn, as the burn has damaged the part of the skin.
A full thickness burn, however, means that the skin has been damaged all the way through the layers and may have affected the nerves and muscles.
Adding this information to the extent of the burn will give you an idea as to the overall severity and the amount of shock that could be involved. For example, a partial thickness burn of 50% of the body can be fatal, especially if the casualty is a young child or elderly person.
Assess airway, breathing, circulation, disability, exposure (prevent hypothermia) and the need for fluid resuscitation. Also, assess severity of burns and conscious level
- Establish the cause: consider non-accidental injury
- Assess for associated injuries: associated injuries may be sustained while the victim attempts to escape the fire. Explosions may throw the patient some distance and result in internal injuries or fractures
- It is essential that the time of the burn injury be established
- Burns sustained within an enclosed space suggest possible inhalation injury
- Pre-existing illnesses, drug therapy, allergies and drug sensitivities are also important
- Establish the patient’s tetanus immunisation status
Body surface area – Rule of Nines:
- The adult body is divided into anatomical regions that represent 9%, or multiples of 9%, of the total body surface. Therefore 9% each for the head and each upper limb; 18% each for each lower limb, front of trunk and back of trunk
- The palmar surface of the patient’s hand, including the fingers, represents approximately 1% of the patient’s body surface
- Body surface area differs considerably for children – the Lund and Browder chart takes into account changes in body surface area with age and growth
If not available:
- For children <1 year: head = 18%, leg = 14%
- For children >1 year: add 0.5% to leg, subtract 1% from head, for each additional year until adult values are attained
First Aid approach to Burns
1. S.A.F.E approach: as for all pre-hospital emergencies.
- Shout/call for help – ensure someone has called an ambulance
- Assess the scene
- Free from danger
- Evaluate the casualty
2. Stop the burning process (for example: stop, drop and roll); remove the burning source.
- Remove all burnt/burning clothing (unless stuck to the patient), jewellery (bring bagged clothing to hospital for examination)
- Chemicals – need longer period of irrigation and specific information about the chemical concerned should be obtained.
3. Cool the burn wound
- Ambulance control despatch system will advise the 999 caller to cool the burn area for up to 10 minutes
- If this has been done, Pre-hospital carers should cool for another 10 minutes during package and transfer
- Water should not be ice cold - If the burn area is small (
< 5%)then a cold wet towel can be placed on the burn area, on top of the Clingfilm dressing but before wrapping up the whole patient to maintain body warmth beneath the blankets.
- Be aware of the risk of hypothermia, especially in children and the elderly
- Cool the burn wound but warm the patient
- Cover burnt area with Clingfilm
- Be aware of possible constricting effect of wrapping!
- Wrap the patient up in blankets or duvet (Cool the burn wound but warm the patient)
- In chemical burns after irrigation / cooling. Clingfilm theoretically may worsen chemical burn effect, irrigate thoroughly until pain or burning has decreased. Go for wet dressings only but beware of powder injuries, which may be worsened with water. Bring data sheet on likely chemical if available with the patient to hospital.
5. Assessment and management of immediately or imminently life threatening problems:
A.c.B.C (Airway with cervical spine stabilisation, breathing, circulation)
Management of minor burns
- Clean burns with soap and water, or a dilute water-based disinfectant to remove loose skin
- All blisters should be left intact to minimise the risk of infection
- Larger blisters or those in an awkward position (in danger of bursting) should be aspirated under aseptic technique
- Non-adhesive dressing, with gauze padding is usually effective, but biological dressings are better, especially for children
- Dressings should be examined at 48 hours to reassess the burn, including depth
- Dressings on superficial partial-thickness burns can be changed after 3-5 days in the absence of infection
Management of Major Burns
The main aims of burn care are to restore form, function, and feeling, and burn management can be divided up into seven phases rescue, resuscitate, retrieve, resurface, rehabilitate, reconstruct, and review.
- Rescue – The aim is to get the individual away from the source of the injury and provide first aid. This is often done by non-professionals—friends, relatives, bystanders, etc.
- Resuscitate – Immediate support must be provided for any failing organ system. This usually involves administering fluid to maintain the circulatory system but may also involve supporting the cardiac, renal, and respiratory systems
- Retrieve – After initial evacuation to an accident and emergency department, patients with serious burns may need transfer to a specialist burns unit for further care
- Resurface – The skin and tissues that have been damaged by the burn must be repaired. This can be achieved by various means, from simple dressings to aggressive surgical debridement and skin grafting
- Rehabilitate – This begins on the day a patient enters hospital and continues for years after he or she has left. The aim is to return patients, as far as is possible, to their pre-injury level of physical, emotional, and psychological wellbeing
- Reconstruct – The scarring that results from burns often leads to functional impairment that must be addressed. The operations needed to do this are often complex and may need repeating as a patient grows or the scars re-form
- Review – Burn patients, especially children, require regular review for many years so that problems can be identified early and solutions provided.
The complexity of the injury and the chronic nature of the sequelae of burns require an integrated multidisciplinary approach with long follow up. Only such management can lead to the best outcomes for burn patients.
First aid treatment for burns and scalds – GK First Aid Training offer a number of First Aid Courses that deal with first aid treatment for burns and scalds. We offer both the 1 Day Emergency First Aid at Work and the 3 Day First Aid at Work Course. Both of these courses can be delivered directly to you in your workplace. Call us directly on 0800 774 7034 to discuss your requirements.