First Aid for Burns

I. Definition

A burn is an injury that results from heat, chemical agents, or radiation. It may vary in depth, size, and severity, causing injury to the cells in the affected area.

II. Causes and Effects

A. Causes

Burns are caused most commonly by—

1. Carelessness with matches and in cigarette smoking

2. Scalds from hot liquids

3. Defective heating, cooking, and electrical equipment

4. Use of open fires that produce flame burns, especially when flammable clothing is worn

5. Unsafe practices in the home, in the use of flammable liquids for starting fires, for cleaning, and for scrubbing wax off floors

6. Immersion in overheated bath waters.

7. Use of chemicals, such as lye, strong acids, and strong detergents

B. Hazards

In addition to surface burns and the effects of heat on the blood and on body tissues other than the skin, the hazards of fire include the following:

1. Inhaling very hot (superheated) air or irritating or poisonous gases, including carbon monoxide

2. Asphyxia from insufficient oxygen in the air

3. Falls and injures from collapsing walls in burning buildings.

III. Classification

Burns are usually classified according to depth or degree of skin damage. Often the degree will differ in various parts of the same affected area.

A. First degree

First-degree burns are those resulting from overexposure to the sun, light contact with hot objects, or scalding by hot water or steam. The usual signs are—

1. Redness or discoloration

2. Mild swelling and pain

3. Rapid healing

NOTE. Severe sunburn should receive medical care as soon as possible.

B. Second degree

Second-degree burns are those resulting from a very deep sunburn, contact with hot liquids, and flash burns from gasoline, kerosene, and other products. Second-degree burns are usually more painful than deeper burns in which the nerve endings in the skin are destroyed.

The usual are—

1. Greater depth than first-degree burns

2. Red or mottled appearance

3. Development of blisters

4. Considerable swelling over a period of several days

5. Wet appearance of the surface of the skin, due to the loss of plasma through the damaged layers of the skin

C. Third degree

Third-degree burns can be caused by a flame, ignited clothing, immersion in hot water, contact with hot objects, or electricity. Temperature and duration of contact are important factors in determining the extent of tissue destruction.

The usual signs are—

1. Deep tissue destruction

2. White or charred appearance (At first, the burn may resemble a second-degree burn.)

3. Complete loss of all layers of the skin

IV. Extent and Location

In addition to classification of burns according to depth or degree, burns are ordinarily described according to the extent of the total body surface involved.

In general, an adult who has suffered burns of 15 percent of his body surface (a child, 10 percent), wherever located, requires hospitalization. Burns of the face are often associated with injury to the respiratory tract, and may obstruct breathing as swelling increases. Prompt medical attention is imperative.

V. First Aid

The objective of first aid burns is to relieve pain, prevent contamination, and treat for shock. Usually, medical treatment is not required.

A. First-degree burns

1. Apply cold water applications, or submerge the burned area in cold water.

2. Apply a dry dressing if it necessary.

B. Second-degree burns

1. Immerse the burned part in cold water (not ice water) until the pain subsides.

2. Apply freshly ironed or laundered cloths that have been wrung out in ice water.

3. Blot dry, gently.

4. Apply dry, sterile gauze or clean cloth as a protective bandage.

5. Do not break blisters or remove tissue.

6. Do not use an antiseptic preparation, ointment, spray, or home remedy on a severe burn.

7. If the arms or legs are affected, keep them elevated.

C. Third-degree burns

1. Do not remove adhered particles of charred clothing.

2. Cover burns with thick, sterile dressings or a freshly ironed or laundered sheet or other household linen.

3. If the hands are involved, keep them above the level of the victim’s heart.

4. Keep burned feet or legs elevated. (The victim should not be allowed to walk.)

5. Have victims with face burns sit up or prop them up and keep them under continuous observation for breathing difficulty. If respiration problems develop, and open airway must be maintained.

6. Do not immerse an extensive burned area or apply ice water over it, because cold may intensify the shock reaction. However, a cold pack may be applied to the face or to the hands or feet.

7. Arrange transportation to the hospital as quickly as possible.

8. If medical help or trained ambulance personnel will not reach the scene for an hour or more and the victim is conscious and not vomiting, give him a weak solution of salt and soda at home and en route: 1 level teaspoonful of salt and ½ level teaspoonful of baking soda to each quart of water, neither hot nor cold. Allow the victim to sip slowly. Give about 4 ounces (a half glass) to an adult over a period of 15 minutes. Give about 2 ounces to a child from 1 to 12 years of age, and about 1 ounce to an infant under 1 year of age. Discontinue fluid if vomiting occurs.

If medical help will not be available within an hour or more, fluids may be given if not otherwise contraindicated. (Do not give alcohol.)

9. Do not apply ointment, commercial preparations, grease, or other home remedy. (Such substances may cause further complications and interfere with treatment by the physician.)

D. Chemical burns of the skin

For chemical burns of the skin, first aid steps are—

1. Wash away the chemical with large amounts of water, using a shower or hose, if available, as quickly as possible and for at least 5 minutes. Remove the victim’s clothing from the areas involved.

2. If first aid directions for burns caused by specific chemicals are available, follow these directions after the initial flushing with water.

3. Apply a dressing bandage and get medical aid.

E. Burns of the eye

1. Acid burns

First aid for acid burns of the eye should begin as quickly as possible by thoroughly washing the face, eyelids, and eye for at least 5 minutes. If the victim is lying down, turn his head to the side, hold the eyelids open, and pour water from the inner corner of the eye outward. Make sure the chemical does not wash into the other eye.

a. If a weak soda solution (1 teaspoonful of baking soda added to 1 quart of water) can be made quickly, use the solution after first washing the eye with tap water.

b. Cover the eye with a dry, clean, protective dressing (do not use cotton) and bandage in place.

c. Caution the victim against rubbing his eye.

d. Get medical help immediately (preferably, an eye specialist).

2. Alkali burns

Alkali burns of the eye can be caused by drain cleaner, strong laundry and dishwater detergents, or other cleaning solutions are progressive injuries. An eye that first appears to have only slight surface injuries may develop deep inflammation and tissue destruction, and the sight may be lost.

a. First aid

1. Flood the eye thoroughly with water for 15 minutes.

2. If the victim is lying down, turn his head to the side. Hold the lids open and pour the water from the inner corner outward.

3. Remove any loose particles of dry chemicals floating on the eye, by lifting them off gently with a sterile gauze or a clean handkerchief.

4. Do not irrigate with soda solution.

5. Immobilize the eye by covering it with a dry pad or protective dressing.

6. Seek immediate medical aid.

3. Irritating gases

a. Effects

Injuries to the eyes from irritating gases are common, and lung damage also may result if sufficient quantity is involved. Many drugs and chemicals are used in spray from. Tear gas in concentrated from may cause blindness and should be handled carefully.

b. First aid

First aid consists or irrigation of the eyes with large quantities of water.

F. Prevention of sunburn

The most effective sunburn prevention lies in limiting the length of initial exposures at the beginning of warm weather each year, especially for individuals sensitive to the sun. For swimming and sunbathing, the first exposure should not be longer than 15 minutes, with gradual increases of from 5 to 10 minutes. On beaches and while boating or fishing during the summer, however, both children and adults should avoid long exposures from midmorning until midafternoon. Sunburn may develop following exposure even on a cloudy day. Persons engaged in outdoor work or sports should wear protective clothing during this critical period, and those with light complexions should cover their hands and faces with suitable ultraviolet-light-screening preparations.

Commercial preparations for sunburn protection vary in their effects. Most preparations contain oils to keep the skin from drying on exposure to heat, wind, and to water. Some have hardly any protective effects; others are highly effective but expensive. Many of these preparations may cause allergic reactions in individual cases. A small sample should be tested on the skin before liberal amounts are used. Preparations that protect against ultraviolet rays should be protected, either by shade or by sunglasses, against irritation from overexposure to the glare of sun, sand, water, ice, and snow.

VI. Prevention of Heat Emergencies

The following information relates to the more common conditions and activities that produce heat emergencies. A responsible attitude toward acquiring additional preventive information, particularly in regard to fires and burns, should lead the reader to resources beyond the basic discussion contained herein.

A. Injuries from extreme heat

Fires, burns, and other emergencies produced by fire are the third leading cause of accidental death. About 20 percent of the fatalities are children. The home environment is particularly dangerous. Some four out of five deaths due to fire occur in the home. In addition, numerous persons are affected by nonfatal burn injuries each year. Prevention of burns is, essentially, a matter of preventing fires, as well as protection of self and others from sources of extreme heat other than fire.

1. Smoking and matches

Home fires and burn injuries are often the result of children playing with matches and careless handling of matches by adults. When the hazards of dangerous play are not fully understood by children, protective measures similar to those controlling accessibility to dangerous poisons should be followed. Careless handling or disposal of matches and lighted cigarettes is a primary factor in the cause of about 25 percent of all fires of known origin.

Smoking while in bed is one of the frequent causes of fire in homes and places of public accommodation. In addition to the danger of burns, a fire in bedding also releases toxic gases that can quietly suffocate sleeping persons in the room or in other parts of the building. Considering the number of fire fatalities where smoking in bed has been identified as the primary causative factor, smokers should see that the practice seems most unwise.

2. Cooking and heating equipment

Cooking and heating equipment is a common source of fires and burns. It is very important that equipment be kept clean and in good repair. A qualified person should inspect and clean heating systems and chimneys annually. If repairs are needed, an expert should be called upon.

Flammable liquids create a special handling and storage problem. If a stove uses fuel oil, store surplus quantities outdoors. Do not use highly flammable liquids for household purposes or for lighting a charcoal grill or other fire. Store flammable liquids in safety containers that seal off explosive vapors from the air. Any flame or spark can produce an explosivelike flash fire wherever a concentration of volatile fumes exists. Similar precautions are necessary where gas is used as a fuel. If a pilot light or gas burner blows out, ventilate thoroughly, and then carefully follow the manufacturer’s directions in relighting the unit.

Fire and burn prevention also requires that good housekeeping and safe personal practices be fallowed in the use of cooking and heating equipment. Cooking surfaces should be kept clean from grease. Turn pot handles so that they do not stick out over the edge of a stove; otherwise, children might pull scalding liquids down upon themselves. Keep portable space heaters out of room traffic lanes and turn them off before going to bed. Make sure that curtains cannot blow across cooking surface and that loose clothing is not worn around cooking burners. Remember, too, that children need special protection from these and other potentially hazardous fire situations.

3. Fires of electrical origin

Fires of electrical origin are usually the result of overloaded or defective wiring, and worn-out or damaged power tools, appliances, fractional horsepower motors, fixture outlets, and cords.

Many older homes are not electrically wired to accommodate the number of appliances and amount of electrical equipment that are in common use today. In such homes, it is most important that fuses are the right size so that circuits are protected from becoming overloaded. A fuse or a circuit breaker, which acts as a safety valve for overloaded circuits, slows or cuts off the current so that wiring will not overheat and create a fire.

Fire and burn protective also requires worn-out or damaged tools, appliances, cords, and other electrical items to be either discarded or repaired. Repairs should be made by qualified repairmen. Repairs are particularly important where television sets are concerned. Unless a television set is designed specifically for installation in a tightly enclosed space, do not install it where required ventilation will be obstructed; a fire hazard can be created if adequate ventilation is not provided.

An absence of grounded circuits and electrical appliances or equipment without grounded wiring poses the ever-present danger that a current of electricity can reach and pass through the body. A three-prolonged plug on an appliance cord or piece of electrical equipment implies that the item is wired to afford protection against electric current’s reaching the body provided that the item is plugged into a grounded circuit. Whenever a manufacturer recommends that electrical appliances or equipment should be grounded, follow the advice. If both the circuit and the appliance are improperly wired and plugged for grounding, have a competent electrician inspect the circuit wiring, circuit load, and wall receptacle, and request him to ground the piece of equipment or appliance.

B. Radiation burns

The usual source of radiation burns is an overexposure to the ultraviolet rays of the sun during warm weather seasons. Light-complexioned persons are particularly susceptible to burning by the sun’s rays. Sunburn can be prevented by controlling the amount of exposure to ultraviolet rays until a suntan has developed, and by avoiding excessive exposure, particularly during the midmorning to midafternoon period, when the amount of ultraviolet radiation is greatest.

The first few exposures at the beginning of an outdoor season should be limited to periods of no more than 15 minutes. Later exposures should be regulated so that a protective suntan can develop gradually. Commercial skin preparations that are made specially to screen out ultraviolet rays may also be helpful. Some commercial preparations have little protective effects against ultraviolet rays, and any one of them may cause an allergic reaction in individual cases. A person may wish to check with his own physician for advice in selecting a sunburn prevention preparation. For best results when using a particular preparation, follow directions on the container label.

Persons who spend a great deal of time in the hot sun should avoid excessive exposure by wearing protective clothing and using a sunburn preventive preparation on the hands, neck, and face. Remember, too, that cloudy weather does not ensure protection against ultraviolet ray exposure.

The eyes also need protection from long exposure to sunlight and glare. While a cap visor may shield the eyes from sun, sand, water, ice, and snow glare, protection against sunlight and water or surface reflection is best obtained by wearing sunglasses. Seek professional advice about the selection of effective sunglasses.

C. Chemical burns

Prevention of chemical burns would be almost universally accomplished if people would heed the warnings and carefully read and follow instructions printed on the original containers of products. Eye tissue is particularly vulnerable. Special precautions are necessary in the handling and use of sprays, gases, and the many household and garden products containing caustic chemical compounds that can be splashed or rubbed into the eyes.

Make a normal practice of carefully reading the label of every spray can, as well as any package containing laundry or dishwashing products, insecticides, pesticides, hair sprays, deodorants, garden and soil product, antiseptics, or medicines. Since these chemicals are also dangerous if swallowed or inhaled, the same preventive measures regarding security and storage as suggested in the chapter on accidental poisoning should be followed.

D. Specific fire or burn prevention

1. Install fire extinguishers in danger spots.

2. Keep a garden hose near a faucet for use in case of fire.

3. Install adequate insulation at all heating surfaces.

4. Repair or replace defective or inadequate electrical wiring.

5. Perform the required maintenance on heating systems.

6. Dispose of trash immediately.

7. Use only nonflammable cleaning fluids.

8. Hang clothes well away from stoves or fireplaces.

9. Place curtains so that they will not blow into flames from any stove, candle, etc.

10. Store flammable materials in a safe place.

11. Do not overload electrical circuits.

12. Surprise children playing near an open fire.

13. Store matches in a metal container and out of reach of children.

14. Turn pot and pan handles away from the edge of the stove.

15. Do not leave tubs of hot water where children can fall into them.

16. Do not smoke in bed.

17. Do not smoke if you are sleepy.

18. Provide adequate ashtrays throughout the house.

19. Install home fire detectors.

E. Escape from fire

Every family should have a fire escape plan that includes at least two possible ways to get outdoors from every room in the house. Emergency exit plans should be discussed and practiced until each family member knows exactly what to do. The two most important things to remember in case of fire are, first, to get everybody out of the house, and then to call the fire department.

Escape from fire is more likely to be accomplished safety if certain basic facts are understood. For example, since heated air and carbon monoxide gas tend to rise, persons should stay close to the floor. Any part of the body covered by a thick cloth, particularly if the cloth is wet, will be protected for a time from heat, but not from fumes. It is especially important to protect the hands, face, and respiratory passages. There is actually no satisfactory protection against carbon monoxide, but the lowest concentration of the gas will be found in air near the floor. If clothing catches fire, do not run; roll on the floor or ground. Smother the flaming clothes of another person with a coat or blanket.

When attempting escape, place the palm of your hand against any inside door before opening it. If the door feels hot, either leave by another exit or wait at a window for rescue. Open the window slightly, from the bottom, so that fresh breathing air can be obtained. Hang clothing or a bedsheet from the window to signal rescuers. If a door feels cool to the touch, open it slightly, staying low and behind the door. The next room may contain superheated air, under pressure, that could explode as it expands. Pass your hand across the door opening, and if the air feels cool, it should be safe to enter.

Close doors behind you upon leaving rooms and the house. Fire travels faster when doors and windows are open. After everybody is safely out of the house, call the fire department, giving your name and the address where the fire is located.

F. Prevention of heat illness

The extent to which various body systems can adapt to a hot climate or hot working conditions, exposures to alternately high and low temperature extremes, and conditions of high and low humidity is apparently related to an individual’s ability to avoid heat illnesses. This systematic adaptation ability varies among individuals.

Drinking adequate amounts of water and increasing the intake of salt are two preventive measures that may help to avoid heat illness, particularly in the case of heat exhaustion and heat cramps. Restriction of activity, good ventilation and movement of air by fans and air conditioning, moderate eating habits, and the wearing of loose and light-colored clothing in hot, sunny weather can help lower the incidence of heat reactions.

Heat stroke is an immediate, life-threatening problem. The cooling of body surfaces, such as the exposed face, neck, and arms, by periodic sponging with cool water is sometimes helpful in preventing the onset of heat stroke. Exposure and activity should be limited where extremely hot climatic and working conditions permit, particularly in the case of young children, elderly persons, and other people known to be susceptible to the effects of extreme heat.

Source:

Standard First Aid and Personal Safety by American National Red Cross

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