Burns: how to treat
Classification of burns
A burn is an injury to the body’s tissue resulting from heat, chemicals, electricity or sunlight. A scald is a type of burn caused by steam or hot liquid.
The severity of a burn depends on the amount of tissue affected and the depth of the injury. Burns are often classified as:
- first degree (those causing damage to the outer layer of the skin, the epidermis);
- second degree (causing deeper damage to the dermis, the layer beneath the epidermis); or
- third degree (those causing the deepest and most severe damage — destruction of all layers of the skin and damage to tissues underneath).
How do you treat burns?
If a burn has any of the following features, treat it as a severe burn and get immediate medical help.
- Redness that involves major joints or the face, hands, feet, genitals or buttocks.
- Blistering or very red blotchy skin that covers an area larger than a 20 cent coin or involving major joints or the face, hands, feet, genitals or buttocks.
- Blackened or dry, white areas (these indicate third degree burns).
Safely approaching a person with severe burns
Firstly, make sure that you, others and the affected person are not in further danger.
If the person’s clothes are on fire, they should be wrapped in a non-synthetic blanket, coat or rug and rolled on the ground to smother the flames (‘stop, drop and roll’).
For electrical burns, switch off the power source if possible and remove the person from the electrical supply without touching them (use something dry and non-conductive like a wooden broom handle).
First aid for an unconscious person with severe burns
Does the person respond to your voice or to a gentle squeeze of their shoulders? If they do not, they are unconscious.
Have someone phone 000 for an ambulance.
Check their airway and breathing before proceeding further — they may need cardiopulmonary resuscitation (CPR).
First aid for a conscious person with severe burns
For a conscious person with severe burns, the following steps should be taken.
- Make sure someone has dialled 000 for an ambulance.
- Lie the person down, preferably on a rug or sheet to prevent the burned area from touching the ground.
- DO NOT immerse an extensive burn in cold water; this may cause the person to go into shock.
- For smaller burns, wash and cool the area under cold running water until the skin returns to normal temperature (up to 20 minutes for a thermal burn, at least 20 minutes for a chemical burn or 30 minutes for a bitumen burn). If this is not possible apply a cold-water compress. Do not use iced water as this can worsen the injury.
- DO NOT over-cool the person, especially if they are young or if the burn covers a large area.
- If possible, remove rings, watch or constricting clothing before the area starts to swell. Remove clothing soaked in boiling liquid or contaminated with chemicals, without contaminating yourself.
- DO NOT remove clothing or anything that is sticking to the burn. It helps to protect against infection and prevent fluid loss.
- Cover the burn with clean, non-stick material, such as a freshly washed pillowcase. Fix it in place with a scarf or a piece of clean cloth. Clean plastic cling wrap can be a useful dressing.
- For burns to the face, make a mask from a clean pillowcase by cutting holes for the nose, mouth and eyes.
- DO NOT use adhesive dressings, apply fat, ointment or lotion, break a blister or touch a burn.
First aid for minor burns
The majority of burns are minor and can be treated at home or in a doctor’s clinic.
- If possible, remove jewellery and clothing from around the injury.
- If the burn is very painful, it is probably superficial. You must act quickly to reduce further injury to the skin. Immediately cool the area under cold running water until the skin returns to normal temperature (up to 20 minutes for a thermal burn, at least 20 minutes for a chemical burn or 30 minutes for a bitumen burn). If this is not possible apply a cold-water compress. Do not use iced water as this can worsen the injury.
- Cover the burn with clean, sterile (if possible), non-stick material.
- For localised burns, cold water compresses changed frequently can be useful.
- DO NOT use adhesive dressings, apply fat, ointment or lotions, break a blister or touch a burn.
- If the burn is larger than a 20 cent coin, see your doctor or go to the emergency department of your local hospital.
How do you know if a burn victim should be hospitalised?
A person who is burned over a large area of the body (for example, the arm, thigh or chest) is likely to suffer shock and needs urgent hospitalisation.
Hospitalisation is also likely to be needed in the following situations:
- electrical or chemical burns;
- burns of the face, hands, genitals, feet or airway;
- it will be difficult to care for the wound adequately at home;
- the person is under 2 or over 50 years old;
- some third degree (full thickness) burns (the area will be white or charred but the person may not feel much pain if the nerves are destroyed); or
- the person has another serious medical condition such as diabetes.
- 1. St John Ambulance Australia. Managing burns and scalds (updated Sep 2012). http://www.stjohn.org.au/images/stjohn/information/fact_sheets/FS_burns.pdf (accessed Mar 2013).
2. Australian Resuscitation Council. Guideline 9.1.3: Burns; November 2008. http://www.resus.org.au/policy/guidelines/section_9/burns.htm (accessed Mar 2013).
3. MayoClinic.com. Burns: first aid (updated 1 Feb 2012). http://www.mayoclinic.com/health/first-aid-burns/FA00022 (accessed Mar 2013).