Burns are a common minor injury in all walks of life, and unfortunately occasionally are very serious. Major burns can indeed be life threatening.
Heat is the main cause of a burn injury, although burns can also be caused by the cold in the case of frostbite, and also by chemicals in the case of acid burns.
Heat sources that cause burns can be obvious, such as fires, cooking equipment, Kelly Kettles, fireworks, etc. They can also be caused by friction during outdoor activities such as rope burns when sailing, climbing or horse riding, or friction caused by new shoes or walking boots causing blisters. Sunburn is also a consideration, and that is covered in more depth in this blog.
How Serious is a Burn?
Burns are traditionally classified in degrees – first, second and third degree burns are based on the depth and scale of burn, but can be quite confusing for the lay person to define. So we prefer to categorise burns simply as Minor or Major.
Minor burns are smaller, shallower, and not in a critical location that could cause further complications.
A surface burn that is not blistered can be quite large before it becomes a danger. A classic case of this is sunburn, which can affect a large area of the body, but not be too deep to be a worry. In this case we use the 5% rule:
The palm of a person’s hand is approximately equivalent to 1% of their body’s surface area. Any burn that is larger in area than 5 palms, would be considered to be larger than 5% of their surface area and should be cause for concern.
If a burn affects the skin more deeply than just on the surface, it will blister, split, or the skin will be broken in some way. In this case we again consider the size of the burn to define the seriousness. If a burn with broken or blistered skin is larger than a large coin (such as a 50pence piece) then medical attention should be considered.
Major burns therefore are those that are deeper, larger, or in a location that could cause further complications. Examples of these are burns to the genitals or face (particularly around the mouth or airway), burns that circulate a digit or limb (where circulation could be compromised). Any acid or chemical burn should also be considered as serious and in all of these examples, medical attention should be sought.
In some cases major burns can be very nasty and immediately life threatening. They can be extremely traumatic situations to experience, both for the casualty and any bystanders, and immediate medical attention is required.
How to Treat a Burn
Ensure You Are Safe
The first thing, as in any first aid incident is to ensure that you and any bystanders are safe and are at no risk of being burned.
Remove any jewellery such as rings, bracelets, watches etc quickly. Burns can cause significant swelling, and removing jewellery before this happens can help to prevent circulation issues.
Once safe, we treat a burn of any size by flushing it with cool running water for at least 20 minutes, or longer if the injury is still painful following removal from the water. This would indicate that there is still heat in the flesh and further cooling is required.
Running, or moving water is important as this draws the heat out of the injury. But the water doesn’t have to be cold. If the cold is becoming uncomfortable warm it up a little. Tepid water is OK, we just don’t want to be adding heat to the injury.
Recent studies have shown too that this treatment is effective for up to 3 hours following the injury. So in the case where you don’t have a source of running water to hand immediately, simply try to get to one as soon as possible.
Apply a Dressing
Following the cool water, apply a non adherent dressing to the injury, particularly if the skin is broken. This ensures that it will stay clean and be protected while you seek medical help.
In the case of a more serious or larger burn you may need to cut away any clothing that is involved in the injury – don’t attempt to unstick it from the burn itself – to enable you to apply a dressing. If you do not have a large enough dressing, clingfilm can be used effectively to protect the injury. Simply lay clingfilm over the injury – don’t wrap tightly in case of swelling – before applying a bandage over the top to keep it in place.
Treatment of Very Serious Burns
If the burn is more serious and requires continued cooling, towels or clothing soaked in cold water can be used to try and keep cooling the burn while the casualty is transported to hospital.
A burn that is sufficiently serious to require an ambulance requires the same treatment as above, although in this case the dressing is far less important than irrigation and ensuring that the casualty’s airway is safe.
We should also treat more serious burn victims for shock as a large volume of fluid can be lost, causing further complications.
Burns should be treated by running under cool running water for at least 20 minutes. The water can be tepid, and should not be freezing or iced. This treatment should continue until all pain in the injury is gone. This is effective up to 3 hours after the burn occurring.
No. Blisters are the body’s natural way of dealing with minor trauma and should be left intact. This ensures that the injury is kept clean and does not become infected.
Yes, clingfilm can be an effective way of protecting a burn where the skin is broken, and ensuring that the bandage or dressing does not adhere to the injury. Do not wrap tightly, simply lay it carefully over the injury prior to applying a bandage to hold it in place.