Burns are a complex injury, as there are varying degrees of burns, different sizes, and different locations that can present unique challenges. And there are also different types of burns – thermal, chemical, and electrical.
In this lesson, when we talk about treating a burn, assume we're referring to treating thermal burns.
There are basically three degrees of burn – 1st, 2nd, and 3rd. To determine the degree of burn, look for the following signs:
- 1st degree – usually presents itself as a pink outer ring; characterized by redness and pain
- 2nd degree – will present itself with blistering skin and is usually very painful
- 3rd degree – dark, charred areas; can include life-threatening complications
Pro Tip #1: There are many things to consider beyond the burn itself, especially the larger or more severe the burn is. Severe burns include more severe complications, like respiratory arrest if the victim inhaled some heat. While larger burns increase the chances for hypothermia, fluid loss, and the innate ability of the body to heat and cool itself.
The Cliff's Notes version of treatment is threefold:
- Remove the victim from the burn source.
- Cool the burn with water.
- Cover the burn (preferably with a dry, sterile pad) and transport the victim to the hospital.
The burn source can be many things, like burning clothing, burning embers, or a chemical agent. Remember, don't become a victim yourself. And in the absence of a dry, sterile pad, use something that's clean, as infection is perhaps the biggest risk in most burn cases.
Pro Tip #2: Most 1st and 2nd degree burns won't warrant a 911 call. (They'll still warrant a visit with a doctor, though.) However, a 3rd degree burn is an automatic 911 call, as the complications can turn life-threatening quickly.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm going to help you."
- Check for life-threatening complications – airway or breathing troubles, a decreased level of consciousness, etc.
- Cool the burn. Pour cool to cold potable, clean water over the burn for five to 10 minutes. Your goal is to cool the full thickness of the tissue that's been burned and to stop the burning process.
- Apply loose, dry, sterile dressing over the wound. Begin wrapping above the burn and wrap particularly lightly over the burn. With 3rd degree burns, the nerve endings become damaged, so there is less pain. However, 1st and 2nd degree burns can be quite painful.
Pro Tip #3: Observe the victim for signs of shock or dizziness. If they begin losing their balance, help them into a seated or lying position, whichever is more comfortable. At the first sign of shock, call 911 and activate EMS immediately.
- Get the victim to a hospital where a medical professional can help with infection control and pain management. If it's a 3rd degree burn and you activated EMS, wait for them to arrive. Minimal agitation is the goal, as is not popping any burn blisters.
Pro Tip #4: The biggest threats or complications when it comes to burns, even severe burns, usually don't kick in for several hours – hypothermia, fluid loss, infection, etc. That should help alleviate some concern when treating a burn and also impart how important it is to get follow-up care, even when the burn doesn't appear bad.
A Few Common Questions About Burns
How will I know if the victim inhaled some heat, which may lead to respiratory distress?
Look for inhalation burns. Is the victim wheezing? Is there some swelling or burns around the face? Have the eyebrows been burned? Is there soot on the inside of the victim's mouth? All of these could signal possible future complications in the form of respiratory issues.
Why do we run cold water over a burn for so long?
When we cook foods with heat, even though we remove the food from the source of the heat, it will continue to cook on the inside for some time. The same is true with burns.
Don't think of it as trying to cool the surface. The reason you're pouring water over the burn for so long are all those layers beneath the surface that you can't see. Layers that may still be burning, especially with more severe and deeper burns. You need to cool those tissues until all burning has stopped.
Keep in mind that the cold water has an anesthetizing effect on burns. But as soon as you remove the burn from the cold water, the pain will come rushing back.
What if the victim suffered from a chemical burn?
You're likely going to encounter two types of chemical burns – those from dry chemicals and those from wet.
When you're dealing with dry chemicals, you first want to brush off as much of the loose, dry chemical as you safely can. Safety is key. You don't want to become the next victim. After brushing off the loose chemical, rinse the burn for a minimum of 15 minutes, again using cool to cold potable, clean water.
When dealing with wet chemicals, go right into rinsing them off using cool, clean water.
Remember, dilution is the solution to pollution. When dealing with chemical burns, rinsing them off with cool, clean water will have a weakening effect, as the chemicals are diluted again and again with every dousing of clean water.