Basics of Burns

Field
Care for burns

The Basics of Burns (A hot topic)

Always Better. | October 27th, 2021

When I started the BFG MED Blog, my promise to the reader was that we would provide basic to-the-point medical information without terminology that made you Google. Since starting, I have received the occasional “but you didn’t mention XYZ condition” and my response has always been: “You are right, but I am not going to burden the reader with subset medical conditions that occur in 0.028% of the population.” As always, and especially today, we are sticking to easy to understand AND REMEMBER FOR LATER information. We are shooting for the high points, if you encounter a medical situation not discussed here the default response should be to seek care from a trained provider. 

Today, we are going to discuss field care for burns. Understand that burns are an extremely specialized area of medical care. As a former Special Operations Medic, my extensive training only began to brush the surface of this very complicated area of medicine. We were taught myriad calculations to determine the total involved Body Surface Area of the burn patient (“Rule of Nines”) and complicated fluid resuscitation algorithms. Those subjects are well beyond this blog. Let’s establish this rule first, if you aren’t an Advanced Care Provider and encounter a burn patient that causes you to ask: “I wonder how much of their body this burn covers?” That patient needs to be seen at a medical care facility. What are some other types of burns that should immediately trigger transport to a medical facility? 

These patients need to see a doctor immediately

  • Large burns
  • Burns to the face or eyes (besides the obvious cosmetic concerns you also need to ask “did this patient inhale heated gases that could burn their airway?”)
  • Burns to joints (very common with the hands, can lead to restricted range of motion if not treated properly)
  • Burns to hands, feet, genitalia (we don’t need to dwell on this one, go to the hospital)
  • Very young or very old patient (under 6 or over 60)
  • Circumferential burns (burn all the way around the torso, a limb or even a finger or toe can cause restriction of blood flow)
  • Severe burns and Specialty burns

Why are burns so serious? Because they affect the skin. Skin, the largest organ of the body, has two primary purposes – to control body temperature and to keep infection out of the body. When burned, skin cells die and can be breached, leading to loss of their protective functions. A patient can also receive burns to their airway by inhaling super-heated gasses. This can cause all sorts of issues but the most immediate is swelling of airway tissues and constriction or even total loss of the airway. ANY patient with burns to the face, soot around their nose / mouth or other indications of serious facial burns should be transported to a medical facility immediately. Friendly reminder, don’t smoke if you are on therapeutic Oxygen. Explosive gases and flames are a bad combination (I have seen it happen).

Severity of Burns

Burns are classically categorized as First-Degree (superficial), Second-Degree (partial thickness), Third-degree (full thickness) and Fourth-Degree.

Illustration showing First-Degree (superficial), Second-Degree (partial thickness), Third-degree (full thickness) and Fourth-Degree Burns
  • First Degree (superficial) – Affecting only the outer layer of skin. The burn site will be red and painful.
  • Second Degree (partial thickness) – Affecting the outer layer of skin and the layers underneath. Red and painful like First Degree but you will also notice blisters. The blisters are the primary indication that this burn is more serious.
  • Third Degree (full thickness) – Involving all layers of the skin. This burn may look white, blackened, charred or the skin may split open exposing underlying tissues. These burns may not hurt at first because the nerve endings have been destroyed.
  • Fourth Degree – This burn involves not only the skin but underlying tissues, muscle and even bone. You will know it when you see it. It’s not a pretty sight.

Types of Burns

  • Thermal – Exactly what you are thinking. It’s hot, you touched it, now you are burned.
  • Cold – Tissue damage due to extreme cold is medically classified as a Burn. We aren’t going to get into cold injuries in this post. It is its own subject to be covered later.
  • Friction – Combination of skin damage from contact with a surface and the heat generated from that contact. Usually seen as road rash or carpet burns
  • Chemical – Wet and Dry (we will discuss below)
  • Radiation – We are talking about sunburn. If you are burned by a nuclear reactor, go to the hospital.

Treatment of Burns

The first thing to remember with burns is to stop the burning. If someone is on fire, put the fire out. If they are laying in a fire, move them. If they are in contact with the sun, chemicals or electricity remove them from the source. (SCENE SAFETY FIRST! Always make sure it is safe to approach the patient.)

Removing the heat source is only the first step though. One of the most important concepts to understand is that once heated, meat continues to cook until it cools. Anyone who knows their way around a BBQ grill can tell you that meat is taken off the grill BEFORE it is done as it will cook while waiting to be served. You didn’t know you were going to get a side of culinary advice with your medical today, did you? If a person is burned, we don’t want them to “cook” any more than has already occurred. We need to immediately cool the burned area. This is accomplished through the application of cool, clean water. Lots and lots of it (any medical text will use the word “copious” here, I hate that word). Use the cleanest water you can find. Sterile water would be the best (good luck), drinking or hose water is fine, ditch or lake water in a pinch. Someone will protest that last part but between the option of burning or jumping in a non-sterile lake, I know which one I am choosing. If its wet and cool, use it.

A quick note here on chemical burns. Wet chemical burns call for lots and lots of water as discussed. DRY CHEMICAL BURNS are another matter. Some dry chemicals react to water in a bad way. Before applying water, use gloves, a towel or an object to brush as much of the dry chemical off of the patient as possible before applying water.

Once you have poured water on the burn, pour some more. It takes longer than you think to cool a deep burn. This importance of this initial step can’t be overstated. Don’t skimp on it.

Burned areas will swell soon after the injury. Be sure to remove any rings, watches, piercings or other jewelry and clothing from the injury area.

Once cooled, we need to protect the wound because that is what the burn is at this point. We treat it like any other wound which means that INFECTION is our biggest concern. Cover the burn wound with a dry, sterile dressing. Don’t wrap overly tight, the goal is to protect the area, we aren’t stopping bleeding here and a tight dressing will likely be painful.

For minor closed burns, consider an antibiotic ointment or Aloe Vera (for sunburns) to assist with infection control and pain. If the burn has resulted in open wounds, see a medical professional. You may consider over-the-counter pain medications as needed. Use according to label instructions.

Continue to change the dressing daily, keep the wound clean and closely monitor for signs of infection. At the first sign of infection, seek medical care.

Simple right? Well not actually. It’s only seems that way because I have covered above the field care for a minor wound with which treatment goes exactly as planned. EVERYTHING ELSE needs to be referred to a medical professional for assessment and care. As I said at the beginning, burns are complicated and serious.

What we did not cover in this post are the 1,001 myths and witches treatments for burns. My personal Old South favorite being slathering the burn in butter. I never understood that one, as a child I always felt like they were seasoning me up to be eaten. If it isn’t fluids to cool, over-the-counter antibiotics or pain meds, or a clean dry dressing – don’t use it. Anything beyond that basic field treatment should come from a medical professional. The exception to this rule might be commercially available wet burn dressings from companies like Water-Jel. I have had success with these wet dressings in certain situations but the medical experts debate the use of wet vs dry vigorously so we will save that debate for another day.

TL;DR - BURN TREATMENT:

  1. Ensure the scene is safe
  2. Remove the source of burning
  3. Cool the burn with lots of water (brush dry chemicals away first)
  4. Remove jewelry and clothing from the burn area
  5. Use an antibiotic ointment or aloe vera for closed wounds
  6. Consider over the counter pain medication as needed
  7. Clean and change dressing daily, monitor for signs of infection
  8. Cool, cover and transport all other burns to a medical facility

 

About the Author

John “Brad” Gilpin

John “Brad” Gilpin is a prior law enforcement professional who served at the state and federal levels. He was a founding member of the USBP BORSTAR unit serving as Assistant Team Leader / Team Medic and has been involved in advocating tactical medicine skills for LEO’s since long before it was cool to do so.

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