First Aid Refreshers, part 5: Serious Burns

In the last installment of the First Aid Refreshers, I covered minor burns.  This time, I want to look at the more serious ones that will require very careful attention.

Types of Burns, continued

These go beyond the top layer of skin and destroy tissue.  They may leave exposed raw areas or even charred flesh.  These are always serious.

Protect Yourself

Before administering first aid, it is important in all circumstances to evaluate the entire situation.  Is the source of the victim’s burn still an ongoing danger?  You must consider your own safety.  Be sure you are not unknowingly stepping into a hazard. This is especially a possibility in the case of an electrical or chemical burn. As with drownings, would-be rescuers often become victims themselves if they are not very careful.

If you suspect an electrical burn (for example, a power line is down), you must proceed with extreme caution.  Electricity is carried easily through water and other materials like metals.  Dealing with high voltage is outside the scope of this posting, but make sure you don’t become another victim.  Identify the power source and turn it off if at all possible before attempting a rescue and first aid.

Chemical burns can be another very dangerous situation.  These burns can not only injure the exterior flesh, but also the airway by inhalation.  And speaking of inhalation risks, fires often produce carbon monoxide which is harmful to everyone exposed.  Try to move a good distance away from any flames or smoke before beginning first aid.   Anyone experiencing headaches, nausea, weakness, numbness, or chest pain should be checked out.

A last possibility for a third degree injury is a steam burn.  Usually, the source in that circumstance would be evident, but proceed with caution anyway.

First Aid for Serious Burns

Once the victim is in a safe area for you both, try to determine how serious the burn is.  If the worst part appears to be a third degree burn, go ahead and treat the entire burn as if it is serious.  If in doubt, err on the side of caution.  A burn may not look very serious at first glance.  Over time, it may develop blisters or show more damage hours later, the same way a sunburn may not hurt much initially but sting terribly the next day.

The young and the old have more delicate skin than others.  You  may need to treat their burns as serious.  Children under age 4 and those over age 60 are more likely to experience complications (or death) from serious burns.  Consider the “rule of 9’s” to determine the approximate percentage of the body affected.  The larger the percentage, the more serious the burn is.  Also keep in mind that the amount of pain associated with the burn may not be reflective of its severity.  A deep third degree burn may have damaged the nerves so much that there is surprisingly little pain.

Remember from the first installment, you should remove all the clothing, watches, rings, etc. near the injury.  (A ring not removed quickly may begin to cut into swelling tissue causing further pain and possible infection, for instance).  You want to stop the burn and let heat escape.  The exception to removing the clothing is if it is attached to the skin.  In that case, cool the fabric with water and cut around it gently.  You want to preserve as much tissue as possible, but you don’t want to further damage the burned area by creating an open wound.  Of course, seek professional medical attention if possible.

In cases of serious burns, especially those covering large areas of skin, expect the victim to go into shock and treat accordingly.  Make sure the person is breathing and begin rescue breathing or CPR if necessary.

Do not immerse a serious burn, especially affecting a large area, in cold water–  this could cause shock by drastically lowering body temperature.  Loosely cover the affected area with a clean bandage (or sheet if the area is large).  Take care not to break blisters or further injure the skin with pressure or friction.  Do not apply any ointments or creams to the burns.  If the fingers or toes have been affected, carefully separate them with clean non-adhesive bandages.  If possible, elevate the burned parts above the level of the heart.  Do not do this if it causes greater discomfort.

Chemical burns are a little different.  Exposure to a strong irritant may cause burning to the skin or airway.  These irritants are either acids or bases.  Acids damage and kill cells by coagulating them.  Bases destroy cells by liquefying them.  The amount of time the tissues are exposed often determines the severity of the burn.  It is imperative to get the chemical off the skin and the victim away from any airborne source.  If the chemical is in a dry or powdered form, be sure to brush as much off as possible before flushing thoroughly with water.  Give special care to the eyes and face.

Do not give any burn victim anything to eat or drink initially.  If 911 or other transport to a hospital is available, fluids can be given by IV later.  Assume that surgery or other advanced medical care will be necessary and giving food or liquids could cause vomiting later.

Sometimes burns are not obvious.  In the case of airway burns, damage to the trachea and lungs could have been caused by inhaling smoke, steam, superheated air, or toxic fumes.  Since you may not be able to see interior damage much from the outside, symptoms to watch for include:

• Charred mouth; burned lips
• Burns on the head, face, or neck
• Wheezing
• Change in voice
• Difficulty breathing; coughing
• Singed nose hairs or eyebrows
• Dark, carbon-stained mucus

In these cases, maintaining an open airway is of the utmost importance.  Continuously monitor the breathing of the victim.

The long-term care of serious burns will be difficult without modern medicine and facilities.  There will likely be scarring and possible infection, so diligent ongoing care will be needed.  I have no personal experience with that, so I will conclude the posting here.

I feel as if the coverage of this important topic is too cursory, but I also do not want to give more advice than I am qualified to do.  If you have not taken at least one course in advanced first aid, I urge you to do so. Recently, we became aware that some REI retail stores are offering Wilderness First Aid classes put on by the NOLS group.  We have taken the Medical Corps class in OH, and have had Red Cross training through various organizations, but Joe and I would both like to take one of the REI courses also.

Any other good medical training programs you’d recommend?  Please share them in the comments section.

Related Posts

• First Aid Refreshers, part 4:  Minor Burns
• First Aid Refreshers, part 3:  Shock
• First Aid Refreshers, part 2: Wound Care
• First Aid Refreshers, part 1:  Fever