Burns

Burns can be caused by direct dry heat (eg fire, roasting tins, welding equipment), wet heat (scalds), radiation (including sunburn), chemicals and electricity.

Treatment is broadly the same for each, which involves cooling the burn with running water and covering with something that doesn’t stick, but there are other factors to be aware of

Burns can be classified by how deeply the tissue has been damaged:

Superficial (first degree) – Only the outer layer (dermis) is affected. An example could be sunburn or a scald.
Partial thickness (second degree) – As the title suggests this burn affects more layers of tissue and damage will extend to the epidermis tissues. This type of burn usually occurs from direct contact with a hot object, eg cooking equipment or direct flame.
Full Thickness (third degree) – Damage to all skin layers with potential nerve damage and burning of the subcutaneous fat tissues. An example could be from a high voltage electric shock or direct and prolonged contact with flame or heat.

Signs & Symptoms

Superficial burns will be red, painful, dry and swollen. They will not have blisters.

Partial thickness burns will be raw and blistered with severe pain. The burned area will be moist, mottled and red with swelling present.

Full thickness burns may look pale, charred, brown or black. The burned area may appear waxy in appearance. There are likely to be blisters around the edge of a full thickness burn and partial thickness burns are also likely on the periphery. There may be reduced pain in the areas of full thickness burning due to the damage to nerve endings.

Treatment

Stop the burning by removing the heat source. If clothing is on fire you may need to smother the flames with a coat or blanket or rolling the person on the floor.
Cool the burned area immediately by running under cold running water for at least 20 minutes. Do not use ice or iced water for this purpose, tap water is ideal. Be careful to protect the rest of the casualty from the effects of cold and manage shock by keeping them warm. Only use specialist burn dressings if running water is not available.
Carefully remove jewellery and clothing as soon as possible, before swelling starts, but don’t remove anything that is stuck to the injury. Swollen, burnt limbs can cause constriction and reduced circulation if jewellery and clothing are not removed.
Cover – If available use cling film to cover the burned area and minimise infection. An unused plastic bag can provide the same function. Rest the plastic onto the burn, don’t wrap it. Specialist low lint (non-fluffy) dressings may also be used if available.
Call 999/112 if you need further assistance or if burns have occurred to the face or airway.

Do not:

Use ice to cool the affected area
Burst blisters
Touch the burn
Apply adhesive dressings
Apply creams or ointments
Remove anything stuck to the burn

Chemical/acid burns

Corrosive substances, such as acids and alkalis can cause chemical burns which result in tissue damage.

To treat a chemical burn, utilise the Remove, Remove, Remove advice:

Remove the person, or yourself, from the area and seek fresh air. As a first aider ensure you only approach if safe to do so and utilise any personal protective equipment.
Remove clothing – pull upper body clothing from the back to avoid touching the face.
Remove the substance from the skin. If the chemical is a solid, such as a powder, brush any residue off the skin rather than wipe it (which can worsen any burning) otherwise use absorbent materials to remove any liquid.
Wash with cold running water for at least 20 minutes.
If the chemical is around the mouth or nose, ask the casualty to cough and blow out of nose.
If there are burns to the face, prioritise flushing these areas – avoid washing the chemical into eyes, nose or mouth.
Call 999/112.

Sunburn (or radiation burn)

Remove the casualty to a shaded area – ideally indoors.
Ensure the casualty is hydrated with frequent sips of water.
Cool the area in a cool shower or bath.
Mild sunburn can be treated with after-sun cream or calamine lotion.

Electrical burn

Electrical burns can be deep where the current has passed through the body – you might only see symptoms at the points of entry and exit. As the electricity passes through the body the resistance causes lots of heat and this will cause the burn.