Burns; Prevention and First Aid

I walked hurriedly into the triage and immediately pulled up my nose mask as the smell of freshly burnt skin hit me. I had just settled down to have dinner, when a phone call came in from a senior colleague… there had been a fuel tanker explosion along a major road in the city. Patients were being brought in overwhelming numbers, and all doctors were needed in the accident and emergency department immediately. Putting dinner on hold, I hurriedly changed into a pair of scrubs, grabbed the biggest bottle of coca-cola in my fridge, and drove to the triage as fast as I could. The car stereo tuned into radio Benue…the news was already on the radio. I quickly caught up on some of the details on my way to the hospital.

Scalded bodies lying on stretchers, covered the floor space of the triage, with more being rushed in. Doctors and nurses scrambled about the hall that was now filled with the stench of freshly burnt skin, and the sound of groaning from the patients who were in severe pains. Rushing toward the nearest sink, I washed my hands, pulled up a pair of gloves,and moved toward the nearest unattended patient. Thus began one of the busiest nights I had working as an intern.

WHAT IS A BURN?

A burn is an injury to the skin or other body tissue caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals.

Thermal (heat) burns occur when some or all of the cells in the skin or other tissues are destroyed by:

• Hot liquids (scalds)
• Hot solids (contact burns), or
• Flames (flame burns).

The skin is the largest organ of the body and has many important functions. It is made up of several layers, with each layer having specific functions.

Asides serving as a protective shield against heat, light, injury, and infection, the skin also:

• Regulates body temperature
• Stores water and fat
• Is a sensory organ
• Prevents water loss
• Prevents entry of bacteria

WHAT ARE THE TYPES OF BURNS?

Burns are classified depending on how deeply they affect the skin into:

• First-degree (superficial) burns:

First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare.

• Second-degree (partial thickness) burns:

Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.

• Third-degree (full thickness) burns:

Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. When bones, muscles, or tendons are also burned, this may be referred to as a fourth-degree burn.

WHAT ARE THE CAUSES?

1. Heat:

These burns are due to heat sources which raise the temperature of the skin and cause damage to the skin.

2. Radiation:

These burns are due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as X-ray.

3. Chemicals:

These are due to strong acids, alkalies, detergents, or solvents coming into contact with the skin or eyes.

4. Electricity:

These burns are from electrical current.

HOW COMMON ARE BURNS?

Burns are a global public health problem, making up about 180 000 deaths every year. Most of these deaths occur in low- and middle-income countries.

According to the WHO, in 2004, about 11 million people worldwide were burned severely enough to require medical attention.

WHO IS AT RISK?

1. Females: Females have a slightly higher chance of death from burns compared to males. The higher risk for females is associated with open fire cooking, and using unsafe cookstoves.
2. Children: Children are particularly vulnerable to burns. Many burns in children are due to improper adult supervision, or child maltreatment.
3. Regional location: Children under 5 years of age in Africa have a higher chance of suffering from burns.
4. Socioeconomic factors: People living in low- and middle-income countries are at higher risk for burns than people living in high-income countries. 
5. Other risk factors: There are a number of other risk factors for burns, including:

• Occupations that increase exposure to fire;
• Poverty
• Overcrowding and lack of proper safety measures
• Underlying medical conditions, including epilepsy, peripheral neuropathy, and physical and cognitive disabilities;
• Alcohol abuse and smoking;
• Easy access to chemicals such as acid used for assault.
• Inadequate safety measures for liquefied petroleum gas and electricity.

THE EFFECT OF BURNS

A severe burn can be physically and emotionally devastating. It can affect the burn victim, and the entire family. People who suffer severe burns may lose some physical abilities, become disfigured, scarred, lose mobility, and have recurrent infections because the burned skin has less ability to fight infection.

Burns can also cause emotional problems such as depression, nightmares, or flashbacks from the traumatizing event.

The age of a burn victim and the percentage of the body’s surface area that has been burned are the most important factors that determine the outcome of a burn injury.

PREVENTION OF BURNS

Burns are preventable. Some of the ways to prevent burns include:

1. Enclose fires and limit the height of open flames in domestic environments.
2. Promote the use of safer cookstoves and less hazardous fuels.
3. Apply safety regulations to housing designs and housing materials.
4. Prevention of access to cooking stoves by children.
5. Lower the temperature in hot water taps.
6. Promote fire safety education and the use of smoke detectors, fire sprinklers, and fire-escape systems in homes.
7. Avoid smoking in bed and encourage the use of child-resistant lighters.
8. Improve treatment of epilepsy, particularly in developing countries.
9. Proper management of people with burns.

FIRST AID/TREATMENT

The goals of burn treatment include:

1. Wound care
2. Pain management
3. Physical therapy for positioning, splinting, and exercise
4. Cosmetic reconstruction/skin grafting
5. Counseling to deal with common emotional responses during recovery, such as depression, grieving, anxiety, guilt, and insomnia
6. Patient and family education and counseling.

First aid for burns:

What to do:

• Stop the burning process by removing clothing and irrigating (cleaning the burnt area) with water.
• Put out the flames by allowing the patient to roll on the ground, or by applying a blanket, or by using water or other fire-extinguishing liquids.
• Use cool running water to reduce the temperature of the burn.
• In chemical burns, remove or dilute the chemical agent by irrigating with large amounts of water.
• Wrap the patient in a clean cloth or sheet and transport to the nearest appropriate facility for medical care.

What not to do:

• Do not start first aid before ensuring your own safety (switch off electrical current, wear gloves for chemicals etc.)
• Do not apply paste, oil, haldi (turmeric) or raw cotton to the burn.
• Do not apply ice because it deepens the injury.
• Avoid prolonged cooling with water because it will lead to hypothermia.
• Do not open blisters until antimicrobials can be applied, by a health-care provider.
• Do not apply any material directly to the wound as it might become infected.
• Avoid application of topical medication until the patient has been placed under proper medical care.