Dealing with Burns and Scalds

Burn injuries can happen at any time and are very common, as a first aider, our treatment of a burn remains simple and straight forward, however, you must be aware of when a burn requires either a Dr’s check or a hospital visit.

How to treat a burn or scald

Do not put yourself in danger.
Ensure that Airway and Breathing are maintained.
Cool the burn immediately with cold (preferably running) water, for at least 10 minutes. If water is not available, any cold harmless liquid (e.g. milk) is better than no cooling at all. Do this first then move quickly to a water supply if you can. Take care not to cool large areas of burns so much that you induce hypothermia.

Remove watches, rings etc. during cooling, as burned areas will swell. Clothing that has not stuck to the burn may be removed very carefully.

Dress the burn with a sterile dressing that won’t stick. Cling film is one of the best dressings for a burn – discard the first two turns from the roll and apply it lengthways (don’t wrap it tightly around a limb). Secure with a bandage.

Alternative dressings could be a new, unused plastic bag, low-adherent dressings, or specialised burns dressings (do not rely on burns dressings to cool a burn, use cold water).
Dial 999 for an ambulance if the burn appears severe, or the casualty has breathed in smoke or fumes.

When would a burn or scald need hospital treatment?

Estimating the Severity of a Burn

There are 5 factors that combine to affect the severity of a burn

Size

The larger the area of the burn, the more severe. The size of the burn is given as a percentage of the body’s surface area. An easy way to work this out is to compare the size of the burn with the patient’s hand. An area equal to the size of the palm of the patient’s opened hand (including fingers) is equal to 1% of their body area.

Cause

The cause of the burn, as previously described in this chapter, will influence the overall severity – for example, electrical burns may leave a patient with deep internal burns. Some chemicals (such as hydrofluoric acid) could cause poisoning in addition to burns.

Age

The age of the patient will affect the recovery rate and severity. Babies and young children will burn at lower temperatures than adults. Elderly patients’ burns take longer to heal, and they may be more susceptible to infection.

Location

The location of the burn can affect the severity – in particular, burns to the airway of a patient by inhaling hot gasses can be an instant killer. Burns to the eye may result in blindness.

Depth

The deeper the burn, the more severe. See the depth of burns below.

Depth of burns

The skin consists of 3 layers – the ‘epidermis’ on the outside, and the ‘dermis’ beneath, which lies on a layer of ‘subcutaneous’ fat.

The depth of burns can be defined as:

Superficial

This involves only the outer epidermis layer, and most commonly occurs from scalds. The burn looks red, sore, and swollen.

Intermediate

This affects both the epidermis and the dermis layers of skin. The burn looks raw, and blisters will form.

Full Thickness

The layers of skin are burned away to the subcutaneous fat layer or beyond. The burn may look pale, charred, or waxy. The nerve endings will be burned away, so pain in this area may be absent, misleading both you and the patient.

The different causes of burn can be separated into 5 areas. The treatment for the burn can differ slightly depending on the cause

Electric Burns

Caused by heat that is generated by an electrical current flowing through the tissues of the body. You may be able to see a burn where the current entered the body and at the point of exit. There may be deep internal burns that are not visible along the path of the current flow. The extent of the internal burns can be estimated by the severity of the entry and exit wounds.

An electric shock may cause cardiac arrest. In this case, Airway and Breathing become the priority.

Ensure your own safety – make sure contact with the electricity is broken.
Ensure Airway and Breathing are maintained.
Irrigate the area of the burns, including the path between entry and exit, for at least 10 minutes.
Dial 999 for an ambulance.
Continue treatment as you would for a ‘dry heat’ burn.

Dry heat burns

Any direct contact with a dry heat source or friction.

Wet heat burns (scalds)

Scalds are most commonly from hot water but may be from hot fats or other liquids that can reach higher temperatures than water.

Treat a wet burn the same as s a dry heat burn.

Chemical burns

Caused by chemicals that either corrode the skin or create heat (or both).
It is important to learn the correct first aid treatments for any chemicals used in your workplace – different chemicals can have different first aid treatments.
Make the area safe – contain the chemical if possible and protect yourself from encountering it.
Dry powder chemicals can be carefully brushed off the skin before irrigating. Take care to protect yourself.
Irrigate the burn with lots of running water to wash the chemical away. This should be done for longer than a thermal burn – at least 20 minutes. Take care not to wash the chemical onto unaffected areas of the body. Ensure pools of contaminated water do not collect underneath the casualty.
Dial 999 for an ambulance. Make a note of the chemical and give this information to the ambulance operator if possible.
Remove contaminated clothing carefully whilst irrigating the burn.
If an eye is contaminated, I irrigate as above, and ensure that the water runs away from the unaffected eye.
Some chemicals in the workplace cannot be safely diluted with water – health and safety regulations require an ‘antidote’ to be available in an emergency. You should be trained in the use of the antidote.

Radiation burns (sunburn)

Most commonly seen as sunburn.
Remove the casualty from exposure to the sun; indoors if possible.
Give the casualty frequent sips of water to ensure that heat exhaustion does not take effect.
Cool the burn with cold water.
If the area affected is extensive, cool the burn under a gentle cold shower or in a bath of cold water for 10 minutes.
If there is extensive blistering, or you are not sure, seek medical advice.
If the sunburn is mild, after-sun cream or calamine lotion may soothe the area.

Seek Medical Advice If

The burn is larger than 1 inch square
The patient is a child
The burn goes all the way around a limb.
Any part of the burn appears to be full thickness.
The burn involves hands, feet, genitals or the face.
You are not sure.

Never Do Any Of The Following

NEVER burst blisters (the layer of skin is protecting against infection).
NEVER touch the burn.
NEVER apply lotions, ointments or fats, they might introduce infection and would need to be removed in hospital.
NEVER apply adhesive tape or dressings, the burn may be larger than it first appears.
NEVER remove clothing that has stuck to the burn.

First Aid Lessons and Help

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These lessons and information do not replace actual attendance on a first aid course, getting hands on practice with your first aid skills is the best way to ensure you are a competant and capable first aider.

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We provide workplace onsite training for Emergency First Aid, First Aid at Work and Paediatric First Aid but a range of other First Aid Courses across the North East, our first aid training centre is based in South Shields.

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