Disclaimer: This document is review material for training nights at the Laingholm Volunteer Fire Station. The author isn't a doctor and suggests that if you need medical advice you go see a real one. Remember to take a well-stuffed wallet. Firefighters don't actually get burnt much, but they do get to see a lot of less cautious people who have been burned. Come Guy Fawks night, we get to see far more than we'd like to so please, please, please go easy on the pyromania.
Overview
Skin is handy stuff. It keeps all our insides in, keeps bugs out, insulates us, cools us, gives us a sense of touch and stops fluids leaking in our out. It's the largest organ in the human body, it's quite complex, and it really does not appreciate having holes burned in it.
The Skin
The bit the outside world sees is called the epidermis. The bit underneath that they only see under painful circumstances is called the dermis. Under that we have a layer of subcutaneous fat of varying thickness according to the individual, and then we're down to muscle.
Burns that damage only the epidermis are said to be superficial, though that does not mean that they are trivial. The burn may be very painful, red, and dry. There may be slight swelling but no blisters. These are typically caused by flash burns, mild steam and mild scalding.
Partial thickness burns go through the epidermis and into the dermis. They are characterised by redness, pain, blisters and mottled skin. They tend to be moist as the body's interstitial fluid leaks out.
Full thickness burns go right through the skin and start wrecking the underlying muscle. The surface is baked to a tough leathery finish, usually with quantities of charring called eschar. The burns do not hurt in the middle because the nerves have been destroyed, but the periphery will hurt.
The Cause of The Burn
Other than making sure it doesn't get you next, the cause of the burn is important to note. An electrical burn, for instance, may only show up as a small patch of singed flesh at entry and exit. Unfortunately, you are unable to see the massive singed pathway running through the patient.
Burns are injuries that result from dry heat like fire/flames, pieces of hot metal, contact with live wires, etc. Scalds are caused by moist heat due to boiling water, steam, oil, tar etc.
Chemical burns present a whole series of new hazards and contamination scenarios - remove victim's clothing. Substances such as sodium or quicklime need to be removed while dry, then quickly flushed with lots of water. Thionyl compounds will give off poisonous gas when dampened, and hydrofluoric acid (used to etch glass) continues to hurt for days after the wound has been flushed. Cement will burn skin if left in prolonged contact, such as in a gumboot.
Radiation burns are not that rare – sunburn is a radiation burn. It is every bit as dangerous as any other superficial burn and may cover a very large area.
Do not forget that extreme cold can cause burns. As kids start making replacements for firecrackers from dry ice and liquefied gases in plastic fizzy drink bottles, we may well come across some of these.
Beware the “stealth burn” or one occurring where you least expect it. Such as a motorcycle rider who has crashed his bike and is unconscious – with a hot exhaust pipe branding its mark on his butt as he sleeps. Equally, do not let burns detract from other serious injuries.
Plan of Action
Minor burns just get held under cold water for 20 minutes. Chin up, have a lolly and go back to the playground.
For more advanced cases, as with all emergency work, our own safety comes first. So removing the patient from where they are being burned is not only a top priority for them but us as well. Once the patient is extinguished, the “ABCs” come into play again, and the next concern is the airway. If it looks like it might be singed, cool the throat area and notify ambulance control immediately - it is likely that they will dispatch the helicopter to intubate the patient before the airway swells up and closes. Cooling slows the swelling process down.
Remove any tight clothing and/or jewelery as soon as possible. It's a heck of a lot easier to do before things start swelling up. Then cool with water. Ideally we'd use saline, but we don't carry that much of it. Seawater or tap water is fine, at a pinch use some of the water lurking in the fire truck. No high pressure deliveries, thank you.
Separate burnt digits from their neighbours with lint-free dressings to stop them all sticking together into an 'orrible mess.
Cover burns with something that is clean and won't generate fluff such as a sheet, pillowcase, tea towel or Glad-wrap. Treat for shock.
Management of Very Extensive Burns
1. Keep the patient quiet and reassure him. It helps to extinguish smouldering bits first.
2. Wrap him up in a clean cloth if available.
3. Do not remove adhering particles of charred clothing. More may come off than you bargained for.
4. Cover the burnt area with a sterile or clean dressing and bandage. In the case of burns that cover a large part of the body it is sufficient to cover the area with a clean sheet, towel, Glad-wrap etc.
5. Keep the patient warm but do not over heat.
6. If the hands are involved, keep them above the level of the victim's heart.
7. Keep burnt feet or legs elevated if possible – we're treating shock and fluid loss here.
8. If the victim's face is burnt, sit or prop him up and keep him under continuous observation for breathing difficulty. If respiratory problems develop, an open airway should be maintained in the traditional manner.
9. Do not immerse the extensively burnt 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 hands or feet.
10. Do not pop the blisters!
11.Treat for shock.
Remove quickly from the body anything of constricting nature like rings, bangles, belt and boots. If this is not done early, it may be difficult later on as the limbs begin to swell.
If ambulance cannot reach the scene for an hour or more and the victim is conscious and not vomiting, give rehydrating fluids. Allow victim to sip slowly. Discontinue the fluid if vomiting occurs, 'cos it's not helping.
Hairy First Aider's Hints
Don't shout “Frying Tonight!”
Despite being well roasted, burns victims will get hypothermia if immersed in cold water for any length of time. Try to only cool the burnt bit rather than the whole patient or you're the one who is going to have to warm them up again.
Pain with large burns is caused by oxygen in the air getting to nerve endings. By excluding oxygen, the pain can be stopped. This is done with Glad-wrap, and ambulances carry a roll in the bedding cupboard for just this purpose. Anecdotally, I'm told it's more effective at pain relief for burns than morphine.
Do not use butter, all it does is make the victim taste better.
And Finally
Play safe and don't cause the blasted things in the first place.