Burns and Scalds

First aid for burns and scalds

Safety first

If possible, or if required:

• Stop the burning process and remove any sources of heat.
• Douse flames with water or smother with a blanket. If the victim's clothing is burning roll the victim on the ground to smother the flames.
• Remove clothes that are over the burn. Clothing can retain heat, even in a scald burn, and so should be removed as soon as possible. However, do not pull off clothing that has stuck to the skin. This may cause skin damage.
• Tar burns should be cooled with water, but do not remove the tar itself.
• For electrical burns - disconnect the victim from the source of electricity before attempting first aid. If you cannot switch off the electricity:
  • If the person has been injured by a low-voltage source (220-240 volts, domestic electricity supply) then remove the person from the electrical source using a non-conductive material such as a wooden stick or wooden chair.
  • Do not approach a person connected to a high-voltage source.
• For chemical burns - remove affected clothing. Brush the chemical off the skin if it is in a dry form. Then wash the burn with lots and lots of water as described below. Do not attempt to neutralise chemicals.

Cool the burnt area immediately with cool or tepid water

Preferably, use running water, for at least 20 minutes. For example, put the burnt area under a running tap. A shower or bath is useful for larger areas. Note: do not use very cold water or ice, as too cold can damage the skin. Ensure the person is otherwise kept warm to avoid hypothermia. Chemical burns should be irrigated (washed) with lots of of water and for longer than 20 minutes. (Take advice from a doctor, if possible, as to how long to keep washing a chemical burn.)

Remove rings, bracelets, watches, etc, from the affected area

These may cause tightness or constriction if any swelling occurs.

Cover the burn - ideally with cling film

Cling film is ideal to cover a burn as is sterile, as long as the first few centimetres are thrown away and not used. Also, it also does not stick to skin, a doctor can see through it to assess the burn, it is protective, and it is soothing. A clear plastic bag is an alternative if no cling film is available. Leave cling film on until seen by a doctor or nurse. Important: apply cling film in layers rather than round like a bandage to prevent it causing pressure if the burnt area swells. So, for example, never wrap cling film round and round a burt arm or leg. A burnt hand can be put into a loosely fitting clear plastic bag.

Give painkillers

Paracetamol or ibuprofen may help to ease pain for small burns. A doctor may give stronger painkillers, if required.

Do not do the following:

• Prick any blisters. (A doctor or nurse may decide to 'de-roof' larger blisters to assess skin damage, but it is best not to pick smaller blisters unless advised by a doctor.)
• Apply creams, ointments, oils, grease, etc. (The exception is for mild sunburn. A moisturiser cream or calamine lotion may help to soothe this.)
• Put on an adhesive, sticky, or fluffy dressing.

Types of burn

• Superficial burns affect the top layer of skin only. The skin looks red and is mildly painful. The top layer of skin may peel a day or so after the burn, but the underlying skin is healthy. It does not usually blister or scar. A good example is mild sunburn.
• Partial thickness burns cause deeper damage. The skin forms blisters and is painful. However, some of the deeper layer of skin (the dermis) is unharmed. This means the skin usually heals well, sometimes without scarring if the burn is not too extensive.
• Full thickness burns damage all layers of skin. The skin is white or charred black. There may be little or no pain as the nerve endings are destroyed. These often require skin grafting.
• Electrical burns can cause damage inside the body even if there is little damage to the skin.

Home care, or should I get medical help?

See a doctor or nurse if you are unsure about what to do after a burn. However, you may be happy to manage small, mild (superficial) burns at home. Mild sunburn, small mild burns, or mild scalds are best left uncovered. They will heal more quickly if left to the fresh air. Even a small blister is best left uncovered to heal. If the blister bursts, you can use a dry, non-adhesive, non-fluffy sterile dressing. This will soak up the weeping blister, and stop dirt and germs getting into the wound. However:

See a doctor or nurse as soon as possible if:

• The burn becomes infected. Infection causes a spreading redness from the burn, which becomes more painful.
• You are not up to date with tetanus immunisation.
• Blisters occur. You may be happy to deal with a small burn with a small blister. However, a blister means a partial thickness burn, and it may be best to see a doctor or nurse.

Go straight to casualty (after cooling with water and first aid) for the following:

• Electrical burns.
• Full thickness burns - even small ones. These burns cause white or charred skin.
• Partial thickness burns on the face, hands, arms, feet, legs, or genitals. These are burns that cause blisters.
• Any burn that is larger than the size of the hand of the person affected.
• If you suspect smoke inhalation (breathing in smoke or fumes). The effects on the lungs from smoke inhalation may be delayed by a few hours so a person may appear OK at first. Symptoms such as sore throat, cough, wheeze, singed nasal hair, facial burns or breathlessness may suggest there may have been smoke inhalation.

Cover the burn with cling film or a clean plastic bag before going to casualty (as described earlier).

Common causes of burns

Nearly half of severe burns and scalds occur in children under five years. About half of these accidents happen in the kitchen, with scalds from hot liquids being the most common. Many accidents involve the child reaching up and pulling on a mug or cup of hot drink. Other common causes include children falling or climbing into a bath of very hot water, and accidents with kettles, teapots, coffee-pots, pans, irons, cookers, fires and heaters.

Tips on preventing burns - particularly to children

Preventing scalds and burns

• Keep young children out of the kitchen unless they are fully supervised.
• The front of the oven, and even the washing machine, can become hot enough to burn a young child. Keep them away.
• Use the back rings of cookers when possible. Turn pan handles towards the back and away from where a child may reach and grab.
• Never drink hot drinks with a baby or child in your lap.
• Never let a child drink a hot drink through a straw.
• Teach older children how to boil kettles and how to use the cooker safely. There is no right age for this. Every child is different. However, it is important to teach them correctly when the time is right rather than let them find out for themselves.
• Never heat up a baby's milk in a microwave. It may heat the milk unevenly, and some parts may become very hot. Stir baby food well if it is heated in a microwave.
• Put cold water in the bath first, and then bring up the temperature with hot water.
• Do not set the thermostat for hot water too high in case children turn on the hot tap.

Preventing fires

• Fit smoke alarms in every floor of the home and check them regularly.
• Use fireguards for fires and heaters. Do not dry or air clothes on fireguards.
• Shut all doors at night. This prevents any fire from spreading.
• Store matches away from children. Teach older children how to use matches correctly and safely. Do not just let them experiment and find out for themselves.
• Have a fire blanket in the kitchen.
• Do not leave chip pans unattended, and they should never be more than a third full with oil. Some people argue that you should get rid of any chip pans altogether as they are a major cause of kitchen fires.

• Keep children out of hot sun, particularly between 11 am and 3 pm.
• When out in the sun, remember: Slip, Slap, Slop - slip on a shirt, slap on a hat, and slop on some high protection sunscreen.