+ BURNS

First aid for

BY LINDA LASKOWSKI-JONES, RN, APRN,BC, CCRN, CEN, MS

EMERGENCIES

in the field

Learn how to quickly stop the burn and protect the victim with materials at hand.

PHOTOS BY GENE SMITH

ADMINISTERING IMMEDIATE FIRST AID to a burn victim helps limit the extent of injury and prevent complications such as hypothermia and infection. Knowing what and what not to do in the first critical minutes after a burn can significantly affect the victims outcome. Keep in mind that responding inappropriately could harm you both. In the following text and photos, Ill detail quick steps you can take to protect a burn victim.
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Stop the burning

The primary step in first aid for a burn victim is to put out the fire or remove the victim from the fire. Follow these general guidelines. Victim on fire. Have him stop, drop, and roll; cover him with a blanket to smother the flames or apply water to douse them. Immediately cool burned skin with cool waternot ice. Once the area is cool, however, stop applying water because it can induce hypothermia. If the victim has inhaled smoke or encountered fire in a closed space, quickly get him to where he can breathe fresh air. Chemical burn. Immediately remove all contaminated clothing. Brush off dry chemicals from the victims skin, then continuously wash the area with plenty of water to remove all the chemical. Electrical ORDINARY ITEMS YOU burn. Make CAN USE TO HELP sure that the water to douse flames and victim is no wash off contaminants longer touch a blanket or large cloth (prefering the electric ably made of natural material) source or you a clean, dry sheet or dressing could become material a victim too. scissors to cut away clothing gloves and eye protection The safest action is to turn off the main power switch or breaker. When youre sure hes no longer in contact with electricity, call 911the current might have triggered a serious but hidden injury. (You may see entrance and exit burn wounds.) Protect the victims cervical spine if the jolt caused him to fall or be thrown.

Smother the flames with a blanket or heavy cloth. Use cool water to douse the flames and to cool burned skin, but stop applying it once the area is cooled.

DOS AND DONTS FOR PROTECTING AGAINST BURN INJURY

DO...treat a minor burn (resembling a sunburn without blistering) with cool compresses, aloe vera gel, or oral nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen to relieve pain and inflammation. Irrigate chemical burns with waternothing elsefirst and ask questions later. In the case of an electrical burn, find out where the buildings main breaker switch is located so power can be turned off without delay. DONT...use any type of salve, lotion, cream, or greasy substance on a serious (partial-thickness or full-thickness) burn wound. Staff at the burn center will have to remove it, causing more pain. Dont let bystanders apply home remedies (butter, shortening, herbal treatments) or ice to significant burn wounds. Dont wet burn dressings; keeping them dry helps prevent hypothermia. Dont disrupt blisters, which act as a sterile, physiologic dressing. Dont try to neutralize an offending chemical with another chemical; the process could generate heat and worsen the burn.

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Attend to the victim

Prepare to transfer care

Your basic response Use the following measures to preshould be the same for pare the victim for transport to the any type of burn. Be prehospital: pared to report your Warn him not to smoke or to assessment findings and drink alcohol after an acute burn interventions to Emerinjury, even if he wants something gency Medical Service to calm himself. If his burns are (EMS) providers. serious, keep him from taking any Assess the victims level thing by mouth. of consciousness, airway, Look for evidence of airway breathing, and circulainvolvement (carbon in the spution. If necessary, tum, singed nasal hair, facial or Cover all burned areas with dry, sterile dressings start cardiopulmucosal burns, change in voice monary resuscitation. or a clean, dry sheet to prevent painful airflow. quality). Tell him to alert you Put on gloves, if immediately if he has trou If a victims fingers or toes are burned, place available, and inspect ble breathing or swallowdressings between them to prevent the skin from the burned areas to ing. Anticipate the possible determine the extent sticking together. need for advanced cardiac and severity of injury. life support interventions, Remove all the victims including intubation, and jewelryeven items not report the problem when near the burn because you transfer care. fluid shifts and swelling Provide calm reassurare inevitable. ance. Try to learn as much Remove any clothing as possible about the incifrom the burned area. If dent and any pertinent fabric adheres to the medical history, including wound (synthetic cloth the victims tetanus immucan melt into the skin), nization status. gently cut away as much as possible with scissors. Pass on information Any remaining fabric will Report to the EMS probe removed later by staff viders how the victim was at the emergency department or burn burned, including information about the burn source (such as the center. type of chemical or the voltage of electric current, if known); how Cover all burned areas with dry, sterile long he was in contact with the source; emergency actions taken; dressings, if available, or a clean, dry your assessment findings and treatment rendered; and any signifisheet. This prevents airflow over the burn cant medical history. If you removed the victims jewelry or other site, reducing pain. valuables, record what you did with them or whos holding them If the victims fingers or toes are burned, for safekeeping. place dressings between them to prevent SELECTED REFERENCES the skin from sticking together. Advanced Burn Life Support Course Provider Manual. Chicago, Ill., American Burn Association, 2005. Try to keep him warm. Hypothermia Auerbach PS, et al. Field Guide to Wilderness Medicine, 2nd edition. St. Louis, Mo., Mosby, 2003. develops quickly when skin has been Newberry L. Sheehys Emergency Nursing Principles and Practice, 5th edition. St. Louis, Mo., destroyed, and it can worsen shock relatMosby, 2003. ed to the burn. Rapid Response to Everyday Emergencies: A Nurses Guide. Philadelphia, Pa., Lippincott Williams
& Wilkins, 2006.
Linda Laskowski-Jones is the director of trauma, emergency, and aeromedical services at Christiana Care Health System, Christiana Hospital, in Newark, Del. Meet Ms. Laskowski-Jones, whos speaking at the Nursing2006 Symposium in Las Vegas, Nev., April 19 to 22, 2006.

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