Burns

Burns are a complex injury, as there are varying degrees of burns, different sizes, and different locations that can present unique challenges. And there are also different types of burns – thermal, chemical, and electrical.

In this lesson, when we talk overall about burns, then how to treat them, starting with thermal burns. Then, we'll discuss some information on chemical and electrical burns.

How to Assess and Treat a Burn Injury

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.

"Hi, my name's _____. I'm a paramedic. I'm going to help you."

The first thing you want to do is assess how bad the burn is. To determine the degree of burn, look for the following signs:

• 1st degree (superficial) – usually presents itself as a pink outer ring; characterized by redness and pain
• 2nd degree (partial-thickness) – will present itself with blistering skin and is usually very painful
• 3rd degree (full-thickness) – dark, charred areas; can include life-threatening complications

• Large 2nd burns that involve the face, hands, feet, or genitalia
• All 3rd degree burns
• Any burn that has concern for inhalation injury (soot around the nose or mouth, difficulty breathing) 

The concerning part about burns is that you may not see the full extent or concern of the injury until hours later. After the burning process has ended, the injured skin starts the healing process. This involves the moving of fluid to the injured area causing swelling, pain, dehydration/shock and other potentially life threatening conditions. Minor seeming injuries may be far more serious if not evaluated or treated by professionals.

Sequence of Treatment for Burn Victims

• Remove the body from the burn. This can mean a few different things – like the presence of smoldering clothing or a victim who's laying in burning embers.
• Cool the burn. Pour cool clean water over the burn for five to 20 minutes. Your goal is to remove residual heat from the burned tissue. This will stop the burning process. Even room temperature water is appropriate as that is still over 20 degrees cooler than normal body temperature and can remove heat from the skin.
• Apply loose, dry, sterile dressing over the wound. Begin wrapping above the burn and wrap particularly lightly over the burn. During 3rd degree burns, the nerve endings become damaged, so there is less pain. However, 1st and 2nd degree burns can be quite painful.

• Look for inhalation burns. Is the victim wheezing? Is there some swelling or burns around the face? Have the eyebrows been burned? Is there soot on the inside of the victim's mouth or nose? All of these could signal possible future complications in the form of respiratory issues.

Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.

Chemical Burns

You're likely going to encounter two types of chemical burns – those from dry chemicals and those from wet.

When you're dealing with dry chemicals, you first want to brush off as much of the loose, dry chemical as you safely can. Safety is key. You don't want to become the next victim. After brushing off the loose chemical, rinse the burn for a minimum of 15 minutes, again using cool clean water.

When dealing with wet chemicals, go right into rinsing them off using cool, clean water.

Electrical Burns

Electrical burn situations require an extra level of safety. Before anything, make sure the energy source has been removed before coming into contact with the patient. This could mean removing the patient from the energy source, cutting the power, or something else.

You cannot risk becoming another patient at the scene.

Manage the entry wound the same as you would a thermal burn. Manage the exit wound as the situation requires, which will likely include treatment options for tissue damage and excessive bleeding.

With electrical burns, monitoring for heart dysrhythmias for 24 to 72 hours in hospital might be necessary.

A Word About Burn Victim Pediatric Considerations

It's important to note that children have greater surface areas relative to their weights than adults. This can become a major factor when it comes to staying warm and hydrated.

Victims with severe burns tend to lose a lot of water through evaporation and leaking from the burned area. This increases our concerns as it can lead to hypothermia and shock. Monitor the victim for signs of dehyration, shock or hypothermia. Immediately seek advanced medical intervention if any of these are seen.

After Burn Care

If the burn is minor, and the burning has been completely stopped, at-home treatment might be appropriate. The 2024 ECC Guidelines suggest petrolatum (with or without topical antibiotics such as polymyxin), honey, and aloe have been shown to improve healing time in certain burns. Over the counter pain medications may help with pain when used correctly. All treatment should be under the direction of your physician.