Burns Overview There are about 450,000 burn injuries requiring medical attention each year in the U.S. About 45,000 burn victims are admitted to hospitals: half go to specialized burn treatment centers, and half to regular acute hospitals. There are an estimated 3,500 fire and burn deaths per year.
The death rate from fire and burns has declined steadily over the years. Children age 4 and younger and adults age 65 and older are most at risk of fire-related injuries and death. Smoke alarms decrease your risk of dying in a fire by 50%. Only 60% of the people in the U.S. have a fire escape plan, and only 25% have practiced it.
While some burns are minor, others can cause permanent injury or even death. Fast, effective burn treatment can minimize the degree of injury, and even save a life.
Burn treatment is directed toward stopping further burning, and making the victim as comfortable as possible while awaiting emergency medical care. The young and the elderly have the most difficulty recovering from severe burns.
Critical burn areas include: Head Neck Hands Feet Genitals Over a large joint
Burns on these areas are more serious due to the potential for complications. Scarring can significantly impair appearance, movement and function, resulting in the need for cosmetic surgery or skin grafts.
Types of Burns: Thermal burns are caused by direct or radiant heat exposures to extreme temperatures. They result from fire, steam, hot liquids, or other exposure to increased temperature. The first action is to stop the heat source. Deaths from fire often result from smoke inhalation rather than heat or flames. Victims may suddenly develop signs of respiratory distress. Rescuers should be cautioned to observe for evidence of respiratory tract burns such as soot or singing of hairs around the mouth and nose.
Chemical burns require large amounts of water to flush chemicals from the skin. Powdered chemicals should be brushed from the skin, followed by flushing for 20 minutes. Do not use bare hands to brush off the chemicals. Ensure run-off water does not flow over unaffected skin or onto the rescuer. Follow the first aid directions on the label of the chemical container; locate the Material Safety Data Sheet (MSDS). Contact the Poison Control Center. Obtain medical care as soon as possible.
When treating a victim with an electrical burn, the most important consideration is to make sure the power supply has been turned off. Rescuers should not attempt to remove anyone from an electrical source unless they are specially trained to do so. After the power source has been eliminated, treat the burn. Electricity follows the path of least resistance through the body. Commonly there is an entrance and exit wound.
Electrical burns can cause deep tissue injury and are always more severe than the external signs indicate. Cardiac or respiratory arrest can also be caused by electrical shock. Ordinary household current is powerful enough to cause severe burns. All victims of electrical burns need to be evaluated by a physician.
Assessment of Burns
Degree of Burn 1st Degree Burn: Burns the outer layer of skin (epidermis). There is redness, pain, and swelling.
2nd Degree Burn: (or partial thickness burn) Burns the second layer of skin (dermis). There are blisters, severe pain, and swelling, with a red and splotchy appearance.
3rd Degree Burn: (or full thickness burn) Burns all layers of the skin. It may involve fat, muscle and even bone. There is no pain because nerve endings have been damaged. Burned areas may appear charred black or gray and white. If there was smoke inhalation, there may also be respiratory system damage. The victim may complain of pain if areas of 1st or 2nd degree burns surround the 3rd degree burns. Activate EMS, because 3rd degree burns are life threatening.
Rule of 9s The Rule of 9s may be used to quickly assess the total body surface area (BSA) burned. It divides the body up into units of surface area divisible by nine in the following way:
Adult: (age 10 and older) Head = 9% Torso (chest and abdomen) = 18% Entire back = 18% Entire arm (front and back) = 9% Entire leg = 18% Infant: (up to age one; has a relatively larger head) Head = 18% Torso = 18% Entire back = 18% Entire arm = 9% Entire leg (front and back) = 14%
Child: (age 1 to 9)
The Rule of 9s is not as accurate for children due to the relative disproportion of body part surface area. o The head, neck and shoulders are larger. o The hips and legs are smaller. Decrease head size and increase lower extremity size 1% annually (0.5% each leg).
Rule of Palm: For scattered or small burn surfaces, the victim’s palm = 1% BSA.
Cool Burns with Water The preferred treatment for small or minor thermal burns is cooling the area with water. In addition to providing pain relief, cool water will help stop the spread of the burn. Continue the cooling process until the pain is relieved. If the victim begins to shiver, discontinue the cooling process. Hypothermia may occur because extensive burns reduce the body’s ability to retain heat.
Cover the Victim Prevent further heat loss by covering the victim. Quickly estimate the burn area, and then cover with a clean white sheet, blanket or other clean large cover. Remove any clothing or jewelry that does not stick to the burned skin. Jewelry retains heat and will continue to burn even after the heat source has been removed.
Burn Treatment: 1. Ensure scene safety. If electrical burn is suspected, ensure power source is eliminated. 2. Extinguish flames (stop, drop and roll); remove victim from environment if there is smoke and heat. 3. Activate EMS (call 9-1-1) for a critical burn. 4. Assess response, breathing, circulation and appearance. Assess airway for evidence of respiratory tract burns such as singed hairs or soot around the mouth or nose. Airway burns cause swelling, which may close the airway. 5. Cool small or minor thermal burns with water to relieve pain and stop the burning process. 6. Cover the burn area with a dry, sterile dressing, or a clean sheet for a large burn area. Keep as clean as possible to reduce risk of infection. 7. Assess for other life-threatening traumatic injuries. 8. Treat for shock 9. Remove clothing or jewelry that does not stick, because burned areas swell quickly. 10. Stop the cooling process if the patient begins to shiver. 11. Maintain an open airway and continue to monitor breathing.
Do not break blisters. They protect the burn area from infection. Do not apply ice directly onto the skin. Do not apply butter, ointment or creams to a severe burn.
Activate EMS for a critical burn: Burn to head, neck, hands, feet, genitals, or over a major joint Large burn area or multiple burn sites Burn to the airway or difficulty breathing 3rd degree burn, especially to the elderly or very young Chemical or electrical burn Burn with other traumatic injuries
Do not use butter, oil, salve or petroleum-based creams for the initial treatment of burns. These retain heat and allow the burning process to continue. They are also painful to remove for wound assessment. After medical evaluation of the burns, appropriate wound and burn care products may be used.
Fire Safety Tips: 1. If your clothes catch on fire, don’t panic: stop, drop and roll. 2. Escape first, and then call for help. If you cannot escape immediately, use the phone and call the fire department, yell for help, or wave a sheet or large object out the window to attract attention. Close all the doors that you can between yourself and the fire. Use rags to seal the door.
3. Know two ways to escape from every room. Windows can be considered emergency exits. 4. Practice escape routes, and keep them free of clutter.
5. Establish a meeting place at a safe distance outside the building. 6. Do not open doors that are hot to the touch. Open cool doors slowly, and slam them closed if smoke pours in.
7. When escaping, never stand up; crawl low, and keep your mouth covered with a moist cloth. Smoke rises, so the air is cleanest low to the ground.
8. Place smoke alarms in each room; change the batteries annually.
9. Respond to every alarm as if it were a real emergency.
10. Equip security bars or windows with a quick-release.
11. Never use an elevator during a fire.
12. Never re-enter a burning building to search for missing people or pets, or to retrieve property. Always wait for firefighters.