Burns and Scalds

Following a burn or scald, one should make sure that self and the affected person are safe from further burns or danger – then burnt or scalded area should be cooled immediately with water (preferably running cool water – not cold) for at least 20 minutes.

First aid for burns and scalds

Safety first

• The burning process should be stopped and any sources of heat removed. The flames should be put out with water or smothered with a blanket.
• If the victim’s clothing is burning, the victim should be rolled on the ground to smother the flames.
• Clothes that are over the burn should be removed. Clothing can retain heat (even in a scald burn) and so should be removed as soon as possible. However, the clothing that has stuck to the skin should not be pulled off. This may cause skin damage.
• Burns caused by tar should be cooled with water but do not remove the tar itself.
• For electrical burns – the victim should be away from the source of electricity before attempting first aid.

If the electricity cannot be switched off:

If the person has been injured by a low-voltage source (220-240 volts, domestic electricity supply) then remove the person from the electrical source, using a non-conductive material such as a wooden stick or wooden chair.

Do not approach a person connected to a high-voltage source.

For chemical burns – affected clothing should be removed. The chemical should be brushed off the skin if it is in a dry form. Then the burn washed with lots and lots of water, as described below. Neutralising the chemicals should not be attempted.

Treat the burnt area immediately with cool water

Running water should be preferably used, for at least 20 minutes. For example, put the burnt area under a running cold tap. A shower or bath is useful for larger areas.

Note: Very cold water, ice or any objects from a freezer should not be used – this can damage the skin. It should be ensured the person is otherwise kept warm to avoid hypothermia. Chemical burns should be washed (irrigated) with lots of of water and for longer than 20 minutes.

Remove rings, bracelets, watches, etc from the affected area

These may cause tightness or constriction if any swelling occurs.

Cover the burn – ideally with cling film

Cling film is ideal to cover a burn as it is sterile – as long as the first few centimeters are thrown away and not used. Also, it does not stick to skin, a doctor can see through it to assess the burn, it is protective and it is soothing. A clear plastic bag is an alternative if no cling film is available. Leave cling film on until seen by a doctor.

Important: apply cling film in layers rather than round like a bandage, to prevent it causing pressure if the burnt area swells. So, for example, cling film should never be wrapped round and round a burnt arm or leg. A burnt hand can be put into a loosely fitting clear plastic bag.

The following should never be done:

Pricking any blisters. It is better to leave them intact until medically assessed, to lessen the risk of infection.

Applying creams, ointments, oils, grease, etc. (The exception is for mild sunburn. A moisturiser cream may help to soothe this.)

Put on an adhesive, sticky or fluffy dressing.

Types of burn

Superficial burns affect the top layer of skin only. The skin looks red and is mildly painful. The top layer of skin may peel a day or so after the burn but the underlying skin is healthy. It does not usually blister or scar. A good example is mild sunburn.

Partial-thickness burns cause deeper damage. The skin forms blisters and is painful. However, some of the deeper layer of skin (the dermis) is unharmed. This means the skin usually heals well, sometimes without scarring if the burn is not too extensive.

Full-thickness burns damage all layers of skin. The skin is white or charred black. There may be little or no pain, as the nerve endings are destroyed. These often require skin grafting.

Electrical burns can cause damage inside the body even if there is little damage to the skin.

Home care v/s medical help

One must see a doctor if one is unsure about what to do after a burn. However, one may be happy to manage small, mild (superficial) burns at home. Mild sunburn, small mild burns, or mild scalds are best left uncovered. They will heal more quickly if left to the fresh air. Even a small blister is best left uncovered to heal. If the blister bursts, a dry, non-adhesive, non-fluffy sterile dressing can be used. This will soak up the weeping blister and stop dirt and germs from entering into the wound. However:

A doctor should be seen as soon as possible if:

The burn becomes infected. Infection causes a spreading redness from the burn, which becomes more painful.

One is not up to date with tetanus immunisation.

Blisters occur.

One should go straight to casualty (after cooling with cool water and first aid) for the following:

• Electrical burns.
• Full-thickness burns – even small ones. These burns cause white or charred skin.
• Partial-thickness burns on the face, hands, arms, feet, legs or genitals. These are burns that cause blisters.
• Any burn that is larger than the size of the hand of the person affected.
• If one suspects breathing in smoke or fumes (smoke inhalation) has occurred.

The effects on the lungs from smoke inhalation may be delayed by a few hours so a person may appear OK at first. Symptoms such as sore throat, cough, wheeze, singed nasal hair, facial burns or breathlessness may suggest there may have been smoke inhalation.

As described earlier, the burn should be covered with cling film or a clean plastic bag before going to casualty.

Common causes of burns and scalds

Nearly half of severe burns and scalds occur in children aged under 5 years. About half of these accidents happen in the kitchen, with scalds from hot liquids being the most common. Many accidents involve the child reaching up and pulling on a mug or cup of hot drink.

Other common causes include:

Children falling or climbing into a bath of very hot water.

Accidents with kettles, teapots, coffee-pots, pans, irons, cookers, fires and heaters.

Tips on preventing burns and scalds – particularly to children.

Keep young children out of the kitchen unless they are fully supervised.

The front of the oven and even the washing machine can become hot enough to burn a young child. Keep them away.

Use the back rings of cookers when possible.

Turn pan handles towards the back and away from where a child may reach and grab.

Never drink hot drinks with a baby or child in your lap.

Never let a child drink a hot drink through a straw.

Never heat up a baby’s milk in a microwave. It may heat the milk unevenly and some parts may become very hot. Stir baby food well if it is heated in a microwave.

Put cold water in the bath first and then bring up the temperature with hot water.

Do not set the thermostat for hot water too high in case children turn on the hot tap. (Water at 60°C takes one second to cause a full-thickness burn, and five minutes at 50°C.)