Basic First Aid for Burns

By Medicine Man
Green Beret - Combat Medic - Paramedic

What are burns?

We all wonder what to do for someone who has been burned. What do we do to lessen the pain? What do we do to stop the ‘burning’. What do we do the help the burn heal more quickly.

Burns can be caused by many things. Exposure to the sun (sunburn), exposure to radiated heat (a pot-bellied stove), exposure to open flame such as from a candle or stove burner, exposure to hot water more than 106Fº/41.1ºC in temperature, exposure to steam, exposure to hot metal, exposure to electrical current and exposure to chemicals (acids or bases). There are thermal burns (from heat), chemical burns and radiation burns (from ionizing and non-ionizing radiation).

Burns happen when the skin comes in contact momentarily with something that is hot, or, as in the case of sunburn, a long enough exposure to the (ultraviolet) rays of the sun. We, as humans in our infinite wisdom, have decided that there are three degrees or levels of burn in relation to live skin, tissue and muscle. There are first degree, second degree and third degree burns.

First degree burns show up as a ‘reddening’ of the skin. The best and most common example is a sunburn. They are surface burns affecting the first layers of skin.

Second degree burns show up as blisters surrounded by reddening of the skin. The blisters will contain ‘water’. The ‘water’ is actually the clear liquid (or serum) part of the blood and tissues. They are burns affecting the first and second layers if skin.

Third degree burns show up as black and charred or white (blanched) skin. They are burns that cause damage to at least the first, second and third layers of skin and many times go much deeper to damage the muscle tissues and bone. Third degree burns are not, contrary to common thought, painful. They are not painful because the nerve endings, which feel pain, are found in the third layer of skin and when the third layer of skin is destroyed, so are the nerve endings. Hence, no pain. Around any third degree burn are second degree burns and first degree burns.

First degree burns happen when the skin comes in contact momentarily with something that is hot. The normal reaction (reflex) is for the body to pull away (recoil) from the offending object. If it (the reaction) is not quick enough, a burn results. It is painful; remember the last hot pot you picked up. In my experience, it doesn‘t take long to look at a hot pot!

Second degree burns happen when the skin comes in contact for a longer period of time (sometimes only a matter of fractions of seconds to seconds) with something that is hot. It is long enough to cause damage to the first and second layers of skin. The body rushes fluids to the affected area and the pressure created causes serum to invade (leak into) the area between the first and second layer of skin causing blisters. This burn too, is painful.

Third degree burns happen when the skin is in contact with open flame, hot/boiling water, steam, or radiated (thermal) heat long enough to kill the cells in the first, second and third layers of skin.

Ultraviolet rays can cause burns that resemble burns caused by thermal energy (heat). Again, we are all painfully aware of the consequences of spending too much time in the sun. I do not recall ever having seen or heard of third degree burns resulting from exposure to the sun. This does not say, though, that it is impossible.

Ionizing radiation includes alpha rays, beta rays, gamma rays, neutrons, X rays and other atomic particles. The burns received from these rays and particles are different from the other sources. The end result, however, after a period of time may resemble the appearances of thermal burns. That is about all I will be saying about this topic.


How do we treat burns?

In a word... Carefully.

If you chance to talk with fourteen different people, you will come away with at least nineteen different opinions. How do we cut through all the fecal matter? Let me tell you what not do. Let me take you back to mom’s cookbook and make a very simple comparison. Then I will walk you through some procedures I have both witnessed and utilized in treating various types of burns. I apologize that my methods are not holistic in that I do not know of herbs and poultices that are used in treating burns. I base some of my treatment on having trained and worked as a State Certified Paramedic in the State of Arizona, USA for eight years. And, I base some of my treatment on acquired knowledge from others that I have used successfully on myself, my family members and others.


First how do we not treat burns and why?!

DO NOT!!!
Put oils (of any kind) on burns.
Put lard on burns.
Put butter on burns.
Put mayonnaise on burns (it has oils in it).
Warm or hot water on burns.

Why???
Oils, lard, butter and mayonnaise have will keep the heat in and allow the burn to worsen until removed. How do the doctors (and we) remove these things? They are removed with soap, water and a brush (OUCH!!!)

Mom’s cookbook tells us that after you have cooked your beef or pork roast, you should remove it from the oven and leave it set (untouched) for one-half hour. What does this have to do with burns, you ask? What is cooking a roast but controlled burning. But, say you, I still haven’t answered your question.

As they say in the King’s vernacular, “Don’t get your knickers in a twist.”, or words to that effect.

When you are burned by heat or electricity the temperature of the tissues is raised to a temperature that can cause them to ‘cook’. That cooking continues for approximately one-half hour, just like mom’s roast. What we need to do is bring the temperature of the tissues down below that cooking temperature and keep it there for the ‘magik’ one-half hour. How do we do that? We use large amounts of clean, cold water.

Standard treatment in hospital emergency rooms is to place ice in a basin or sink, fill the basin/sink with water and place towels in the ‘ice water’. The towels are loosely wrung out and placed over the burned area to keep it moist, cool it down and keep it cool. How long do they do it? Right you are, one-half hour or more. Now, not only does the water cool the burn area down it has another magical quality, it greatly relieves the pain in the burned area. Without the excruciating pain the victim can relax and not only physical, but also psychological healing can begin. And they didn’t have to scrub off that oily mess that some well-meaning idiot put on the burn.

After they cool the burn area for the right amount of time they cover it with a gauze (preferrable TELFA gauze) that has been swabbed with Silvadene Cream. Silvadene Cream is a prescription medication here in the U.S., elsewhere it may not be. It is extremely important to keep any open burn wounds clean and free of contamination.

If you are competent medical assistance is available to you and it is close by, you should get them rolling in your direction while you begin any First Aid treatment you intend to give.

Now I have for you a treatment for sunburn that will make it much more bearable in the first and second stages. I have suffered full-body sunburn (not including my genitalia) and I would not wish it on my worst enemy. I have also suffered a bout of what I was told was ‘sun poisoning’, whatever that is. My ‘sun poisoning’ resulted in my being able to literally peel off ‘sheets of skin’ from the area of my shins. The peels were about 2 inches/4-5 cm. wide by 3-5 inches/7-12 cm. long and 1/32nd of an inch/0.8 cm. thick. Believe me, it was freaky.

My sunburn treatment is somewhat of a torture too (not really) to help the victim remember (as if he really needs any kind of reminder). Have you ever heard of Epsom Salts? Here in the states (U.S.) we can buy it in a waxed cardboard container similar to the one a gallon of milk can be found. The container weighs 4 pounds/1.81 kg. You take about one-half (2 pounds/.9 kg) and place it into a tub (bathtub) you can immerse your body in. Put enough warm/hot water into the tub to easily dissolve the Epsom Salts. Then, you fill the tub with enough water (cool to the touch) so the victim can fully submerge themselves (except, of course, their head). There is still that old problem of having to breathe.

The victim (cookee) enters the E.S. water where (s)he will stay for one-half hour, exit the water and dry off. Do not drain the E.S. water yet. In about one hour the cookee will again enter the water torture, um, tub and again soak for about a half hour. Don‘t drain yet. Still another half-hour dip to come in another hour. The first dip is to cool the burn and stop the skin from ‘cooking’. The second and third dips are for good measure and to treat the skin with the Epsom Salts. I can tell you what the Epsom Salts are (Magnesium Sulfate, MgSO4 • 7H2O) but, I can’t honestly tell you what it does. I can, however tell you what it does for the cookee.

We all know that the general symptoms of acute (bad) sunburn is intense pain all over your body and no matter what touches your skin (even the breeze) makes it hurt even worse. “Don ‘t touch me or I’ll kill you!”, comes to mind as a suitable epithet when someone has been foolhardy enough to get even a little bit too close. What the treatment appears to do is virtually eliminate the initial pain, tightness of the skin, burning sensation and overall physical distress of sunburn. If you’ve been sunburned badly enough to ultimately result in peeling, the treatment will not stop it from happening. Nor will it stop the accursed itching that happens as the little blisters are forming before the peeling starts.

Remember the hot pot I mentioned earlier in the story? Well, the next time you goof and pick it up wrong or touch it with your finger and wind up talking at god because of your mishap, try this little cure. Go to the refrigerator (American term) or wherever you can find an ice cube or small piece of ice. Pick up a small chunk of ice and hold it between the thumb and burned finger. You can wrap the ice in a paper towel so that two layers of the paper towel are between the burn injury and the ice. This will have the added benefit of keeping you from dripping water all over the place. Hold the ice against the burned area until it melts (the ice) and if it is not yet a half-hour get another piece of ice to hold. You will most likely not blister but will still have the characteristic ‘hard area’ at the site of the burn. You will have relatively little pain and you can go on about your business.

I haven’t gotten into electrical burns or chemical burns. The reason for that is that they should each be treated differently as well as separately as topics. The bottom line is, the best way to treat a burn is with care enough to avoid having one in the first place. If someone has second or third degree burns on the head, face, hands, genitalia or over more than 15% of their body surface they must be seen by competent medical help. If someone has burns to their facial area there is a very great probability that they will have burns in the mouth, throat and lungs.

In any emergency situation, you must keep your head about you and cause no additional injury.