The information contained within this article will assist you in identifying the cause, severity and percentage of a burn. It is important that you do not attempt to treat a burn until you are certain any potential hazards have been neutralised.

1) Classification for burns

Superficial:
1. Reddenning and discolouration of skin
2. Some swelling
3. Pain

Partial thickness:
1. A combination of discolouration, swelling and blistering of the skin
2. If any blisters have burst a clear watery fluid issuing from the burst blisters (serum)
3. May involve one or more blisters forming
4. Pain

Full thickness:
1. Pitted/charred appearance
2. Surrounding skin around the burn site may appear wax-like and false
3. Clear watery fluid may leak directly from the burn site
4. Blisters may form around the site of the main charred area, but not on it
5. If the skin is badly charred, the casualty may not experience pain as the nerve endings may be destroyed

The severity of burns depends on the surface area and part of the body affected and the classification of the burn (superficial, partial thickness or full thickness). Please note that 1% of the body's surface is roughly equivalent to the palm of the casualty's hand.

Casualties should be referred to hospital in the following circumstances:

  • Any superficial burn covering more than 5% of the body's surface
  • Any partial thickness burn covering more than 1% of the body's surface
  • Any full thickness burns
  • Any burns involving children
  • All burns involving feet, hands, face or genital areas
  • All burns that extend around a limb
  • Any burns with a mixed pattern of depth
  • If unsure of depth or severity of burn

2) Treatment of burns

1. Ensure that the cause of the burn (i.e. an ongoing fire) does not endanger your life or that of the casualty
2. Assess if the casualty is still responsive. If not, check their Airway, Breathing and Circulation (ABC) and proceed to either the recovery position (if breathing) or CPR (if not breathing)
3. If casualty is responsive or breathing and placed in recovery position where possible, establish the cause of the burn - go to section: 3) if chemical burn is suspected
4. Immediatey begin to cool the burn. Cool under cleaning running water for 10 minutes. Alternatively, apply a burn gel or dressing, or if neither are possible, use a water-soaked dressing. Be careful not to over cool the casualty, lowering their body temperature to the point of hypothermia
5. If the burn has affected a limb (e.g. an arm), remove any constrictive items such as watches, rings etc. in anticipation of swelling. DO NOT remove if directly in contact with the burn.
6. After cooling for 10 minutes or until burning sensation has stopped, apply a non-adhesive sterile dressing. This is unnecessary if you have applied a special burn dressing.

3) Chemical burns

1. If a chemical burn is suspected, the burn must be irrigated with copious amounts of water after the casualty's responsiveness and ABCs have been checked. This dilutes and washes away the chemicals and prevents further damage.
2. The contaminated skin must be washed under running water for at least 20 minutes.
3. Ensure the chemical is washed off the skin and not on to unaffected areas.
4. Any contaminated clothing must be removed (assuming it is not adhering to the skin) to allow the water to irrigate the skin correctly
5. Attempt to establish the cause of the burn. Use the C.O.S.H.H. Data Sheet and information given on relevant containers to confirm the chemical involve. This can help the EMS and hospital to treat the casualty.
6. As the majority of chemical burns occur some time after contact it is advisable to refer all casualties to professional medical help.

Take care not to inhale any fumes or come into contact with dangerous chemicals yourself. Always wear your Personal Protective Equipment (P.P.E.)

4) Dressing a burn

1. When a burn has been cooled sufficienty sterile non fluffy dressing should be applied
2. Gently remove any rings, watches, belts, shoes or smouldering clothes from the injured area before it begins to swell. If clothing is burnt into the wound DO NOT pull it off
3. A water based gel soaked sterile dressing is ideal as it helps prevent burn-progression and infection
4. If a suitable dressing is not available, you may improvise using a sterile triangular bandage or cling film.
DO NOT apply any dressings that may cause a tourniquet effect.

5) Clothing on fire

If a casualty's clothing is on fire the greatest danger will be to their airway. Due to a combination of panic and pain they may be on their feet and moving flames will naturally rise and endanger the airway of the casualty.

Action to take:

1. Activate the fire alarm
2. Instruct the casualty to STOP, DROP and ROLL. If they do not/cannot do so, attempt to get the casualty flat on the floor - you may have to push them over using a broom or fire blanket, etc. to ensure you do not come into contact with the flames.
3. Once the casualty is flat on the floor try to smother the flames. Ideally use a fire blanket but alternatively improvise with a (preferably wet) towel, wool or cotton blanket. Do not use highly flammable material!
4. Assess the casualty's ABCs
5. Cool the burn(s) if appropriate

Be careful not to over cool. DO NOT roll the casualty. Extinguish flames from the head down.

6) Complicated burns

Airway

All burns involving the airway are potentially life-threatening. Attempt to treat any external burns and dial 999/112 for help.

Burns to the respiratory system

As well as sustaining damage to the airway, the lungs and associated tissue may be damaged by hot fumes and smoke. This may cause blistering to the tissue and requires urgent medical attention.

Circulation

Normally resulting from chemical contamination, a circle burn involves damage to the skin that encircles any part of the body such as the arm. As it swells it constricts circulation of other body systems. treat as in section 3 and dial 999/112 for help.

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By Steven
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