Common sources of burns:

• Scalding: Hot water or steam
• Radiation: Sun burn
• Chemical: Acids, alkalis, corrosive materials
• Electrical: Lightning or electrical current
• Thermal: Hot surfaces

Burns depth

There are 3 degrees of burns depending on the layers of the skin that are affected.

• First degree burns: Affect only the epidermis (outermost layer of skin). Its symptoms include redness, pain and warmth. The skin, blood vessels and nerves are intact. A common example is sunburn.
• Second degree burns: Affect the epidermis and the dermis (middle layer of skin). Its symptoms include all the symptoms of first degree burns, plus damage to capillaries which leads to blisters and fluid loss.
• Third degree burns: Affect the epidermis, the dermis and the subcutaneous layer (innermost layer of skin). Its symptoms include the above-mentioned symptoms, plus black or grey charring due to damage to capillaries, other blood vessels and nerves.

Burns need to be treated not just because they are painful, but also because they come with risk of shock (loss of blood circulation) and infections.

Severity of burns

For a normal adult:

• Any 2nd degree of 1% or more must be seem by a doctor.
• A 2nd degree of 9% or more may lead to shock, the person needs hospital treatment.
• A 3rd degree of any size requires immediate hospital treatment.

First aid for scalding and thermal burns

1. Remove the person from the source of the burns.
2. Stop the burning process.
3. Perform a primary survey:
   1. DANGER: Check for danger in the environment, e.g. sharp objects, electricity, staircases.
   2. RESPONSE: Check the person’s response by tapping shoulders and asking, “Hello! Hello! Are you ok?”. If unresponsive, press shoulders more forcefully
   3. SHOUT: Ask a bystander to call 995 for emergency medical help.
   4. AIRWAY: Check if their airway is clear.
   5. BREATHING: Look for chest rise and fall as indication of breathing.
   6. CIRCULATION: Check pulse for indication that blood circulation is normal.
4. Assess the depth and extent of the burns
5. Apply the 4 C’s
   1. Cool the burn (e.g. with water (for at least 10 minutes)).
   2. Constrictions (e.g. watch, bracelet) need to be removed.
   3. Cover the burn (blot dry and cover with a sterile dressing or any clean cloth)
   4. Consult a doctor for tertiary care.
   5. For 2nd degree burn, do not break blisters nor cover blisters with adhesive dressings r use antiseptic preparation.
   6. For 3rd degree burn, watch for breathing difficulty when burns involve face and neck. Treat for shock if present.

First aid for radiation (e.g. sun burn)

• Apply the 4”C”.
• Hydrate the perso
• If signs of heat disorders are also present, treat the person accordingly and call 995 for emergency medical service
• Apply aloe vera gel on the affected area. Use only a thin layer of the gel. Leave it on for about 10 minutes, then rinse with cool water and (blot) pat dry.

First aid for electric burns

1. Shut off electrical supply.
2. Remove person from danger.
3. Check ABC (Airway-Breathing-Circulation) and perform Cardio Pulmonary Resuscitation (CPR) if required. Find out more about CPR at [Link to our CPR article]
4. Treat for shock
5. Cover the entry wound and exit wound.
6. Call 995 for emergency medical services) Evacuate to hospital.

First aid for chemical burns

1. Protect yourself with gloves before you protect the affected person.
2. Immediately flush the affected area with clean water for a minimum of (15-20 minutes or longer) 10 minutes.
3. If it’s a dry chemical, brush off before rinsing the burn.
4. (Call 995 for emergency medical services) Evacuate to hospital.

Article reviewed by David Tay, Senior Principal Educator (Nursing and Prehospital Care), HMI Institute.