Emergency Medical Treatment for Burns
Burns are a hazard of everyday life. From scalding coffee to curling irons, hot frying pans and space heaters, we’ve all had an accidental burn or two. Children are even more at risk from household burns, and due to thinner skin, may take more damage; hot water an adult can tolerate can dangerously scald a child. Summer is a particularly dangerous time for burns, as barbecues, campfires, fireworks and even sunburns can attest, and chemical and electrical burns can happen at any time. Most people try to minimize the danger of burns in their home and environment, but accidents can happen.
Unfortunately, few people know how to properly care for burn injuries. Several common folk remedies can make burns worse. Proper care of even the most minor of burns will help you heal faster, and avoid skin damage and scars.
Basic Burn Safety
Safety around fires is very important. Summer bonfires, barbecues, fire pits and so on are usually part of a party – and it’s hard to remember safety at parties. But try to remember to keep a safe distance from fires and hot metal, and make sure that folks who are drinking don’t play with fire. Drunks and flames are a very dangerous combination! Have someone sober feed the flames, tend the grill, and so on, and don’t encourage dangerous games with fireworks, jumping over fires, or anything of the sort. If there are children present, make doubly sure they’re kept away from sources of flame and heat, and supervise them closely if they’re old enough to wave a sparkler or toast a marshmallow. Remember that loose hair and clothing are dangerous around flames – tie hair back, and wear close-fitting clothes rather than loose ones. Don’t wear meltable or highly flammable material around open flame – nylon, PVC and similar materials can melt to the skin and cause a lot of damage. Be careful of stray strings on the hems of cutoff jeans.
If you catch fire, stop, drop and roll. (If it’s a minor spark to clothing, and you can do so safely, smother it with water or heavy fabric.) If there’s fire on a person, put it out. If there’s something still causing the burn (a flaming hot dog fallen on someone’s lap, for instance), remove it right away if you can. If the burn is bigger than your hand, shows blisters, or is chemical or electrically caused, get help right away.
As with any emergency, keep calm, and make sure you and anyone else is safe before beginning first aid. Don’t be so busy treating a burned hand that you step in the firepit or knock over the grill!
When you burn, damage continues to occur even after the burn source is removed. What looked minor at first may blister in a few minutes. That’s why it’s important to treat even minor burns right away – your skin’s still ‘cooking’ until you cool it off. Don’t wait to soak that burned hand until you’re done cooking dinner; run your hand under the cold tap for a few minutes right away. Otherwise you could find yourself with blisters before dessert.
Know Your Burns
Burns are classified in two ways: degree, and depth (and also how much area they affect). Most people are familiar with the terms “first-degree” up to “third-degree” burns, but most people don’t know what they mean. I recently heard a friend saying “Well, it wasn’t even a first-degree burn” about an incident that left him with red and peeling skin for a week afterwards. When I told him he had a second-degree burn, he was astonished.
What type of burn you have will affect your burn care, and whether or not you need to seek medical attention. A quick rule of thumb is that if it blisters – or looks too crispy to blister – you need an ambulance.
A first-degree burn means that only the upper layer of the skin is damaged (the “epidermis”). The skin is often reddened at first, and turns lighter when light pressure is applied. It’s also very sensitive, so applying that light pressure will probably smart. These often cause slight swelling. A good example of a first-degree burn is a sunburn – yes, that’s a first-degree burn.
Second-degree burns involve blisters; they do damage to the top two layers of skin, the epidermis and the thicker dermis. These are the sorts of burns you usually get if you pick up a hot metal thing in your kitchen without hot pads. Second-degree burns can affect hair follicles and sweat glands.
Third-degree burns go all the way to the hypodermis (the third, final layer of your skin), and even below. In these cases the skin may be charred, gray, whitish or translucent, and coagulated (cooked – yuck!) blood vessels may be visible. The area may go numb, but pain may still be felt from the upper layers of burns. These burns cause extensive nerve and tissue damage, and require immediate medical attention.
Some doctors also list fourth degree burns, which are even more severe and affect internal structures such as internal organs and bones. These very deep burns are most often due to electricity, and are often more severe than they appear. Very little ‘surface’ burn damage can be done by a fatal electric shock, so it’s always wise to seek medical attention in electrical burn cases. However, it’s impossible to visually distinguish a fourth degree burn from a third by looking at the skin, so most first-aid manuals stop there.
First-Degree Burn Care
Care for first-degree burns is pretty simple, and nothing too bad is likely to happen even if you don’t do all the things you should. Soak the burn area in cold, but not icy, water for about five minutes. (Ice can damage the injured skin further, but an ice cube is better than no treatment.) A wet towel or even a cold drink with condensation on the sides will do in a pinch. The important thing is to get the burn cooled as soon as possible. Really. Unless you soak the burn in cool water, what seemed minor can actually get worse if not immediately treated. And if you wait too long, that cool towel won’t really help at all; the damage will be done.
It’s a good idea to cover a first-degree burn with something sterile, or at least clean and soft. Do bear in mind that friction or pressure will make the burn worse; tight clothes over a sunburn, or a watch band over a cooking burn, will irritate the damaged skin.
Don’t put anything adhesive on a burn (like standard band-aids); you could take skin off with it. (If you’re using a band-aid, make sure the adhesive parts are off the burn, on undamaged skin.) If it hurts, an anti-inflammatory (like aspirin or ibuprofen) is a good idea; most of the pain will be from swelling unless you’re chafing the burn. Burns also dehydrate you, so wash those pills down with a healthy amount of water.
Over the next few days, your skin may feel tight and dry, or even peel; use lots of burn cream, aloe, or moisturizer to help the skin heal. It will probably peel within a few days, no matter how much moisturizer you use; the damaged skin has to come off sometime. The burn should be completely healed within a week, or two at the most. If not, see a doctor.
Severe Burn Care
Second- and third-degree burns are much more serious, and you should seek trained medical assistance for them as soon as possible. But proper immediate action can prevent a lot of damage. At the very least, you don’t want to make things worse with some common mistakes.
If a burn blisters much at all, or was of extended duration, or covers a large area or a highly sensitive one like the face, treat it as a serious burn. A second degree burn can turn into a third-degree if you don’t treat it and cool it down immediately.
Make sure the burn victim is breathing and has a pulse. If not, perform CPR or scream for somebody who can, and call 911 as soon as possible. Keep the victim calm and collected; get them to sit or lie down while moving the burn area as little as possible so as not to damage the skin further.
If it’s a burn with clothing involved, do NOT try to remove the burnt clothes if they’re stuck to the skin – you can peel off skin or underlying tissue that way. Cut the clothing off around the burn it off if you have to.
A serious burn will be blistering. Do NOT break the blisters; do NOT apply any kind of ointment, not even “burn cream”. These will all cause more damage. (Particularly don’t use butter! This old folk remedy really makes things worse – paramedics and emergency room folks hate this one.) Find a smooth, clean fabric – a sheet is great, a T-shirt will do in a pinch – soak it with COOL water, and GENTLY lay that on the burned area. If there’s nothing suitable, just pour cool water (or even juice or soda, just not strong alcohol) very gently over the area. If you can, pour the liquid just above the burn and let it trickle down. Do NOT use ice or ice-cold water; that will cause more damage, burst the blisters, and can put the burn victim into shock. (Don’t put that barbecued hand into the cooler full of ice.) The idea is to cool the burn down without doing any more damage. Do NOT blow on it. You might break the blisters just by breathing hard on them. Broken blisters often lead to infections, and on burned skin, that can cause complications or scarring. Just cover it with that smooth, damp cloth and leave it alone.
If it’s a face burn, be especially careful – you could do permanent scarring damage with a careless touch. If the burn victim is having trouble opening an eye or mouth, tell them to move it as little as possible and to stay calm. If it’s fingers and toes, or something like an armpit, get a layer of cloth (ideally a sterile, non-adhesive dressing, but that sheet will do) between the flesh so the fingers or whatever don’t stick together.
Once you’ve covered the burn, don’t touch it. Mist it or soak it lightly if it seems necessary (but hopefully help is on the way). Elevate the burned area if possible; prop the burned area up on something (if you can do so without damaging the burned skin) so it’s higher than the burn victim’s heart. If it’s a neck burn, do not elevate the head; their airway might collapse. Do elevate the feet if they’re lying down and you can do so; this will help prevent shock. If they’ve got to stay sitting up, put their head between their knees if they feel faint or dizzy.
Keep the rest of their body warm; even in warm summer nights, a chill can make things much worse. Cover the unburned areas with a coat or blanket. Keep the victim talking to you; monitor them for signs of shock, losing consciousness, or dropping pulse until medical help arrives. (Signs of shock are: pale, clammy skin; weakness; bluish lips and/or fingernails. Also ask the victim if their eyes are focusing okay.)
If there isn’t damage to the head, it’s okay to let them sip some water. Don’t give them anything else (like medicines) unless real medical care is hours away. If the victim is clear-headed, ask them if they’ve got any medical conditions, allergies, et cetera that someone should tell the medics about, in case they lose consciousness before help arrives. (And maybe their ID and any health care plan information they can remember.) Be prepared to tell the medics what happened. Don’t ever lie to the medics; it’s your health they’re trying to save. If that firework was illegal, it’s not their job to arrest you – it’s their job to make sure you keep your skin on. If Bob was drinking underage and set off an illegal firework, the medics need to know not to give him painkillers that react with alcohol, and firework burns cause deeper damage than “a spark from the campfire”.
A serious burn does require proper after care, and your doctor will give you better advice.
If you plan to barbecue or camp a lot, it’s a good idea to know fire and burn safety, and make sure your first aid kit is also prepared. A standard first aid kit is not really equipped for burns. It’s a good idea to make sure you’ve got a roll of non-fluffy, non-adhesive bandaging, a big bottle of water, and an old, clean bedsheet or pillowcase around. (Cotton or other lightweight material, please; satin sheets or anything fancy may make things worse.) Have a pair of medic shears to cut clothes off of a burn victim with, and they’re also handy to cut bandages and for other first-aid uses. A flashlight may come in handy; trying to treat a burn by the light of the dying campfire isn’t easy! A pamphlet or instructions on burn care won’t hurt either.
Obviously, the best way to treat burns is to prevent them from happening – but proper first aid and treatment will keep an accidental burn from becoming worse. Don’t put anything on a burn except smooth fabric and cool water; don’t break the blisters; don’t touch the burn. Remember that, and you’ll save yourself or a friend from serious scarring or damage if the worst occurs.
