First Aid Classes teach that severe burns and scalds are a medical emergency and must receive hospital treatment. There are high risks of significant fluid loss and high risk of infection. There may be bad tissue damage, or even damage to nerves, fat tissue, muscles, and blood vessels with deep burns.
On recognizing a severe burn, you may notice the patient will also have pain, difficulty breathing and signs of shock.
Always take a history of the incident, to establish how the burn happened, where the burn injury or injuries are, and how severe they are. If the patient has been in a fire, you should also suspect smoke or hot air damage to the respiratory system.
The aims of a first aider when faced with a patient with severe burns are listed in the workplace approved First Aid manual as:
- stop the burning and relieve the pain
- maintain an open airway
- treat related injuries
- minimize the risk of infection
- arrange urgent transport to hospital
The first aim is to stop the burning and relive the pain. The longer the wound burns, the more significant the damage will be.
Assist the patient to lie down, taking care not to allow the burnt area to make contact with the ground. To rapidly cool the burn, you should douse the site with cold liquid. Continue to do this repeatedly for at least 10 minutes and until the pain is relieved. If one is available, it is a good idea to place a bowl under the patients legs or affected body part to catch water as you pour it on. However, workplace approved Training warns you to take care not to over cool the patient because you don’t want to make their core body temperature too low, particularly in vulnerable patients such as children and the elderly.
Wear disposable gloves if there are some available in order to prevent the risk of infection. Try to remove any restricting objects before the skin starts swelling. This can include rings, watches, belts, shoes or clothing. Remove any burnt clothing unless it is sticking to the burn. If there is clothing stuck, do not try to remove it as doing so can cause more tissue damage and introduce infection.
You should apply a sterile dressing to the wound if possible, to protect it from infection. If a sterile dressing is not available, you could try a folded triangular bandage, part of a sheet or kitchen film. For burns to hands or feet, a clean plastic bag could be used. However, if there are burns to the face, do not dress the wound if it will cause distress for the patient or restrict their airway.
A patient with a severe burn, will very likely suffer from shock due
to significant fluid loss. This is a serious condition and can be fatal. First Aid Classes teach you to treat the patient for shock by elevating their legs above the level of their heart. Continue to reassure and comfort the patient until assistance arrives.
Continually monitor the patients level of responsiveness, pulse and for signs of difficulty breathing. You may be required to give chest compressions and rescue breaths as taught in workplace approved Training if the patient becomes unconscious and stops breathing.
REFERENCES
First Aid Manual (The Authorised Manual of St. John Ambulance, St Andrew’s Ambulance Association and the British workplace approved), 2006.