Burns Management
Burns can become life-threatening or cause serious disability directly or through secondary issues such as infection. Burns, for the sake of this article, are injuries caused by heat. On a bushwalk, that heat is most likely from hot food/drink, stove, fire or sunburn. Burns can also be caused by chemicals, electricity (lighting), friction (rope burn) or a few other sources.
Burns become more severe the longer the skin is exposed to the heat source, the higher the temperature, and the larger area is affected. Especially vulnerable parts of the body are joints, groin and face.
Prevention
1) Spilling of hot liquid when cooking is one of the most common causes of bad burns on bushwalks. Avoid sitting at a table (such as a picnic table) and cooking with a stove on the table. If the pot is spilled or boils over, the water is far too likely to end up on your lap. Instead, cook at a standing table or sitting near a stove where it is not likely to spill towards you or others.
2) Be careful near fires, stoves and chimnies. It is too easy not to think and lean on or touch a very hot metal. Be mindful and keep clear of potentially hot items.
3) Use stoves correctly. Ensure stoves are well maintained and correctly assembled. Ensure there are no fuel leaks before lighting.
And always Slip, Slop, Slap, Seek & Slide.
Signs & Symptoms
It is possible that there will be a range of burn levels, but different severity or thickness of burns do occur. The deeper the burn affects the skin the worse the burn is.
Superficial (1st degree) burns
The skin will likely be:
- Red,
- Painful.
Deep (2nd degree) burns
The affected skin may be:
- Red, white or splotchy,
- Blister,
- Very painful.
Full-thickness (3-rd degree) burn
The affected skin may be:
- Much more black, brown or white than usual,
- Feel dry and leathery,
- Maybe less painful than expected (due to the nerve been destroyed).
Management of burns
Safe and quick action is helpful when responding to burns. The sooner treatment can be done the better.
Remove from heat source
Patients clothes on fire?
- STOP them walking around,
- DROP them to the ground,
- ROLL them on the ground covering them in a fire-safe blanket to stop the fire.
Other heat sources
- Move the person away from fire,
- Remove clothing that contains hot liquids.
Cool the burned area with running water
As soon as possible run cool water over the burn areas for at least 20 mins. Use water bottles to start with then if safe move patient to a more constant supply of water. If patent not able to safely walk to nearby water then establish a team to bring water to the patient.
The goal here is to remove the heat that the skin has absorbed. If extra water is delayed, try using wet clothes to cool the area the best you can. Dirty water is better than none.
Gently remove clothing and jewellery from the burnt area
Unless burnt on the skin remove clothing and any jewellery from near the burn. The area may swell and these pose a risk of constriction as well as potential infection.
Cover in loose nonstick (and non-fluffy) dressing
Cover the burn with a nonstick dressing. Ideally a dressing with a plastic layer against the skin. A clean plastic bag (or better still clean cling film) serves as a good dressing and will help reduce pain. Avoid fluffy or other material based dressing that may stick to the wound site. Never cover the burn in an oil or butter or other creams/ointments.
Normally in first aid, the use of any lotion is discouraged. Hydrogel products such as Burnaid® are only for use on superficial burns and can be very helpful in reducing pain. Analgesics can be used as directed to reduce pain as well.
Monitor for shock and infection
Ask around fellow walkers on track, there may well be a doctor or other health professional who can provide a higher level of care. In a remote area situation continue to monitor the patient for signs of shock. Also, replace dressings at least every 12 hours (or as directed) and monitor for signs of infection.
When to evacuate
General first aid advice is to seek medical aid for any burn larger than 20c piece.
In a remote area consider immediate evacuation:
- If the burn (other than superficial sunburn) affects the face, groin or hands.
- If the burn is Deep or Full-thickness.
- If the airway has been compromised.
- If the patient has reduced consciousness.
- If significant pain continues.
- If signs of infection develop.
- Or any other significant concerns for their welfare.
DRSABCD
Shock