UNIT 4 BURNS

Structure
4.0 Introduction
4.1 Objectives
4.2 Burns
4.2.1 Definition, Causes, Types of Burns and Recognizing Burns
4.2.2 Assessment of the Victim and General First Aid
4.3 Thermal and Radiation Burns
4.3.1 Definition, Causes and Recognition
4.3.2 First Aid in Thermal Burns/Radiation Burns
4.4 Chemical Burns
4.4.1 Definition, Causes and Recognition
4.4.2 First Aid in Chemical Burns
4.5 Electrical Burns
4.5.1 Definition, Causes and Recognition
4.5.2 First Aid in Electrical Burns
4.6 Let Us Sum Up
4.7 Key Words
4.8 Answers to Check Your Progress
4.9 References and Further Readings

4.0 INTRODUCTION
In the previous unit we discussed about injuries to tissues, joints and bones.
In this unit we will discuss about first aid in Burns. Burn is an injury causing
damage to the skin and other body organs usually caused by fires, heat, electricity
and so on. They cause a burning sensation and are characterized by skin damage
that causes the affected skin cells to die. These are one of the commonest
household and work place injuries. It is important to manage burns immediately
because it leads to infections and disturbance of water balance in the body.
If untreated, it can cause death. It can be dangerous especially among children
where more surface area of the body is damaged.
Most of the burns occur accidently and it is difficult to reach to the proper
health facilities in time. First aid helps to remove the cause of injury and prevents
further deterioration of the condition. In this unit you shall be appraised about
various types of Burns and their first aid management. So, lets begin.

4.1 OBJECTIVES
After completion of this unit, you shall be able to:
 define Burns;
 list the causes and Types of Burns;
 explain the assessment of Burns;
 describe the first aid to be provided in Burns; and
 enumerate the Do’s and Don’ts in management of Burns.
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First Aid in Accidents
and Injuries 4.2 BURNS
In this section, we shall learn about burns, its definition, causes, types, assessment
and general first aid.
4.2.1 Definition, Causes, Types of Burns and Recognizing
Burns
Definition
Burns are injuries caused due to heat which damages the skin and its layers
causing pain, redness and swelling. They can be caused by many reasons and
are most common reason for accidental death (Fig. 4.1).

Fig. 4.1: Burn

Causes
There are many causes of Burns which include flames, hot liquids, hot surfaces,
hot air, chemicals, radiations, electric current, explosions, friction, fires, strong
acids and strong alkalis (Fig. 4.2).

Fig. 4.2: Common Causes of Burns

Note : You can remember the causes by help of an acronym CIDERS

which is explained as :
C – chemical e.g. alkali, acid or other corrosive chemicals, gases/
fumes, paint, bleach
I – ice or cold burn (discussed in Unit 2 of Next Block)
D – dry heat e.g fire, friction, flames from matches, candles, and
lighters, hot air
E – electrical e.g. high voltage current
R – radiation e.g. X-rays or other radiations which are high
intensity, sun exposure
S – scald or wet heat e.g. hot water, boiling liquids like tea,
coffee, steam.
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Types of Burns Burns

Burns may be classified in various ways.

We can classify them based upon the severity i.e.
1. Superficial/minor burns: The injury involves only the upper layer of the
skin (Fig. 4.3).
2. Deep/major burns: The injury to skin extends beyond the top layer of
skin (Fig. 4.4).
These burns are more dangerous and difficult to treat.

Fig. 4.3: Superficial Burn Fig. 4.4: Deep Burn

We can also classify them according to the extent or depth of burn as:
1. First Degree Burn : In this the top layer of skin is effected. It is painful
burn with presence of swelling and redness in the area of burn (Fig. 4.5).
2. Second Degree Burn: In this the burn involves upper as well as some
lower layers of the skin. This is painful burn with presence of blisters
(Fig. 4.6).
3. Third Degree Burn : In this deeper layers of skin alongwith muscles,
fat and nerves get involved due to which the skin appears to be blackish
and its not painful as nerves have been burnt (Fig. 4.7).

Fig. 4.5: First Degree Burn Fig. 4.6: Second degree Burn Fig. 4.7: Third Degree Burn

Remember
First degree burn: red, non blistered skin
Second-degree burn: blisters and some thickening of the skin
Third-degree burns: widespread thickness with a white, leathery
appearance.

We can also classify them as per the cause of Burns as follows: 89

First Aid in Accidents a) Thermal Burns : It results from making contact with heated objects
and Injuries (Fig. 4.8).

Fig. 4.8: Thermal Burns

b) Chemical burns : It occurs as a result of irritation and destruction of

human tissue due to exposure to a chemical, usually by direct contact with
the chemical or its fumes many a times (Fig. 4.9).

Fig. 4.9: Chemical Burns

c) Electrical Burns: It occurs as a result of contact with electric wires or

electrical sources or lightning (Fig. 4.10).

Fig. 4.10: Electrical Burns

d) Radiation Burns : Radiation burns occur upon the exposure from a
radiation source (Fig. 4.11).

Fig. 4.11: Radiation Burns

Recognizing Burns
Superficial burns involve a small part of the body and only the top layer of
90 the skin. They may show any or a combination of following sign and symptoms:
 Redness Burns

 Pain
 Swelling
 One or two blisters.
If there is no infection, skin starts to peel after a day of the burn and healing
occurs within 7 to 10 days. No scars are formed after healing.
If there is infection, the burn area may have wet/weeping appearance, does
not heal, may smell badly and scar is formed after the healing.
Deep burns involve a large part of the body and deeper layers of the skin.
They may show any or a combination of following sign and symptoms:
 Extremely red and sore skin
 Multiple skin blisters
 Burn area has wet/weeping appearance
 Waxy and white color/Dark Brown /blackish color
 Raised and leathery area
 No pain as nerves are damaged.
These heal with scars and person may develop deficits in functioning . It may
take two to three weeks to heal with scars. If blisters are many or wound
is infected it will take longer for the burns to heal. In some severe cases,
skin grafting may be needed to repair the damaged skin.

4.2.2 Assessment of Victim and General First Aid

The assessment of Burns is done as follows:
General Assessment
The assessment for a victim having burns is done as per following details:

Scene Safety
 Call for help

Is the person responding?

 
Responding Not responding
  
Breathing with pulse Breathing with pulse Not breathing/No pulse
  

Check for DOTS
  Place in recovery
position
Start CPR and Use AED

Identify the type of

Burn



If the victim is revived
Provide First Aid
and fine
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First Aid in Accidents Specific Assessment
and Injuries
1. Check for DOTS and look for deformity, swelling, tenderness and any
other sign and symptoms.
2. Identify the type of Burn Injury by recognizing the sign and symptoms as
given in Section 4.2.1.
3. Ask History regarding cause of injury/wound from the victim or onlookers/
bystanders etc. or by observing the scene to find out the cause of injury.

Note:
You can do specific assessment of Burn by following acronym
SCALD as follows:
S-Size
C-Cause
A-Age
L-Location
D-Depth of the Burn

4. Determine the extent of Burn

This is determined by the percentage of body surface affected. To calculate
the percentage of body surface affected, you can use the “Rule of Nine” which
divides the body surface into roughly equal segments, each representing 9%
of the total body surface. Roughly, the surface of our palm and fingers stretched
equals to 9% (Fig. 4.12).

Upper Back =9%

Upper Chest =9%
Lower Back =9%
Abdomen =9%

Thigh =9%
Thigh =9%

Lower Leg=9% Lower Leg=9%

Fig. 4.12: Rule of Nine

Any percentage exceeding 18 % is an extensive burn and needs immediate

transportation for specialized care in hospital.
General First Aid
There are some general first aid measures that you as a first aid provider must
92 keep in mind when providing first aid to victims of Burns. These are:
1. Assess the situation, Maintain scene safety and call for help Burns

 Perform assessment of the situation .

 Remove the source causing burns from the victim, or the victim from
the source, whichever is easiest and safest.
 If fire is present, try to extinguish the fire if possible.
 Also call for help.
2. Maintain Victim Safety
 If the victim is on fire, tell him/her not to run. Now use a blanket
or jacket and extinguish the flames. (Fig. 4.13). You can also log roll
the victim in blanket to put off the flames. (Fig. 4.14).

Fig. 4.13: Putting off flames with blanket Fig. 4.14: Log rolling the victim in blanket

 Be alert and be ready to resuscitate the victim as and when required.

 Check for Levels of response and CAB as discussed in flowchart
on Page No. 91 of this Unit.
3. Remove constrictive clothing as needed
Remove any constrictive clothing around the burn. If cloth is sticking to
the burnt area, do not try to remove that portion of cloth.
4. Provide First Aid
a) For minor burns
 Follow safe practices.
 Soak the wound in/under cool running water either in a bucket
or under running water from tap for 10-20 minutes (Fig. 4.15).

Fig. 4.15: Keeping Burnt area under Running cool water

93
First Aid in Accidents  Apply an icepack if swelling is present to relieve the pain and swelling
and Injuries for five to fifteen minutes and then remove it for 10 minutes and then again
apply the ice pack. Always use the icepack after covering it with towel
or cloth and avoid putting it directly on the burn area (Fig. 4.16).

Fig. 4.16: Use of Ice pack on Burnt area

 Apply gauze dressing/clean cloth as required for better healing and

protection of the burnt part.

b) For major burns

 Help the casuality to sit or lie down.

 Keep the victim warm by giving hot drinks and covering in blankets.

 Be alert for Shock and provide first aid in case it develops ( Shock is
discussed in Unit 5 of next Block).

5. Transport

Transport the victim to hospital for further care and support.

Thus, in this section we have discussed the definition, causes, types, recognizing
and assessment along with general first aid in Burns. In the next sections, we
will discuss the important Burns in detail.

Check Your Progress 1

1. What are the causes of burn injuries?
.......................................................................................................
.......................................................................................................
.......................................................................................................
2. How do you Differentiate between superficial and deep burns?
.......................................................................................................
.......................................................................................................
.......................................................................................................

4.3 THERMAL AND RADIATION BURNS

94 In this section, we will discuss about Thermal and Radiation burns.
4.3.1 Definition, Causes and Recognition Burns

Definition
Thermal Burns are the burns which result from contact with heat sources in
any form. Radiation Burns are just like Thermal Burns which occur due to
contact or exposure to a radiation source (Fig. 4.17).

Fig. 4.17 a: Thermal Burns b: Radiation Burns

Causes
The Thermal Burns result due to exposure to:
 Fire in the house
 Friction due to accidents
 When dealing or playing with flammable items like gas or match stick etc.
 Faulty electrical systems or heaters
 Fire crackers/Fire works
 Kitchen accidents with hot liquid, hot oil, hot steam, hot food, hot utensils
and so on.
 Flames/ candle flames
 Contact with hot objects e.g. iron, toaster etc.
The Radiation Burns occur due to High intensity radiations like:
 X-rays
 Radiation used in Cancer Treatment
 Sun rays etc. (which is discussed as sun burn in Unit 2 of Next Block)
Recognition
The Thermal or Radiation Burns are recognized by typical symptoms of burns
as superficial or deep burns as discussed in Subsection 4.2.1 of this Unit.

4.3.2 First Aid in Thermal Burns/Radiation Burns

 Remove the victim for the source of heat/radiation. If fire is present, deal
as discussed in Subsection 4.2.2.
 Remove constrictive clothing immediately e.g. watches, jewellery etc.
(Fig. 4.18).
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First Aid in Accidents
and Injuries

Fig. 4.18: Remove watch or any other constrictive clothing

 Cool the burnt area by the following ways:

 Hold the skin under cool running water or immerse in cool water until
pain subsides (Fig. 4.19).

Fig. 4.19: Cool the burnt area under water

 Use ice pack if required as discussed in Subsection 4.2.2 of this Unit.

 Protect burn by covering with sterile, non adhesive bandage or clean cloth.
 See doctor immediately if any signs of infection, increased pain, redness,
fever or oozing is present.
 If large area of skin is involved in thermal/radiation burns, keep the victim
warm by use of blanket/giving hot drinks and immediately transport to
hospital.
Do’s and Don’ts in Thermal/Radiation Burns
Do’s
 Minor Burns are usually treated with home care.
 Treat early for quicker healing.
 If any clothing of the victim is wet due to hot liquid or is on fire
remove it carefully but quickly.
 Remove any clothing which is tight or constrictive or watches/rings/
jewellery from the injured part to avoid risk of swelling.
 If clothing sticks to skin, cut or tear around it but don’t remove
the fabric in contact with the burnt area.
 Limit the time of contact under cooling water since it can reduce
the body temperature of the victim.
 Be alert for responsiveness of victim, sign and symptoms and shock
which is complication of major burns.
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 Burns
 Cover the burn area with dressing/clean cloth to avoid contamination.
 Cover victim with blanket if he/she feels cold.
 Give fluids to the victim only with conscious.
 Rush immediately when:
r Burn is larger in area more than the victim’s palm.
r Areas of body like Hands, feet, face, eyes or genitalia have
been burnt.
r Victim has history of heart problems, diabetes or is infant, child
or senior citizen.
r Major joints are involved, which include knee, ankle, foot,
spine, shoulder, elbow or forearm.
r Large radiation burns are present.
Don’ts
 Oils, jellies, ointments, pastes, haldi, sprays or butter should not
be applied .
 Avoid use of butter or eggs as home remedies since they are not
effective.
 Make sure you don’t use ice directly or ice water to cool the skin,
as this may worsen the damage.
 Never apply cotton balls as its fibers can stick to it increasing the
risk of infection.
 Avoid removal of any clothing/fabric sticking to the burn area.
 Don’t break blisters.
 Don’t apply adhesive bandage or pressure bandage.
 Don’t apply any ointment or dressing material in deep burns.
 Don’t remove loose tags of skin.

4.4 CHEMICAL BURNS

In this section, we will discuss regarding Chemical Burns.

4.4.1 Definition, Causes and Recognition

Definition
These are caused by Contact, Ingestion, Inhalation of fumes of Strong acids
or strong bases (hydrochloric acid/sodium hydroxide) or organic material.
Exposure of skin to chemical can damage human tissues. In case victim survives,
it may lead to scarring and disability. Chemical Splashes to eyes are very serious
and can cause eye damage especially the alkali chemicals (Fig. 4.20).

Fig. 4.20: Chemical Burns

97
First Aid in Accidents Causes
and Injuries
The main causes include acids, alkalis and other chemicals which irritate the
skin or can cause severe damage to inner body system if inhaled or eaten
accidentally (this condition is called poisoning and has been discussed in Unit
1 of Theory Block 4). These chemicals are usually present as household cleaning
solutions, batteries, some oil products etc. Sometimes toxic fumes or gases
coming from these items lead to burns.
Recognition
The Chemical Burns on skin are recognized by typical symptoms of burns as
in case of superficial or deep burns as discussed in Subsection 4.2.1 of this
Unit. In case of poisoning, refer to details in Unit 1 of Next Block.
4.4.2 First Aid in Chemical Burns
The First Aid for chemical burn on skin surface and eyes is as follows:
 Remove the victim from the contact of the chemical. Quickly remove any
contaminated clothing .
 Try to find the chemical that has caused the burns.
 If the chemical is a powder brush it off slowly.
 Cool the injury. Rinse the burnt area with large amounts of water and
continue for up to 20 minutes.
 If a chemical solution has splashed into the eyes, hold the affected eyelids
open to ensure water washes thoroughly under the lids to remove any
trapped chemical (Fig. 4.21).
 Refer to Hospital immediately .

Fig. 4.21: Rinsing the eye under running water

Do’s and Don’ts in Chemical Burns

Do’s
 Remove burn clothing. If clothing sticks to skin, cut or tear around
it but don’t remove the fabric in contact with the burnt area.
 Limiting time of exposure to chemicals can greatly reduce the
damaging effects.
 Be careful while rescuing as to not become yourself a victim of
contamination.
 Remove ornaments/watch/belt/socks/shoes completely affected by
the chemical.
 Be careful if heavy metals like calcium, potassium or sodium
available in powder form have caused the burns since they react
with water and can cause further damage. First brush them off and
remove the particles then high pressure jet of water should be used
to clear off the remainder.
Don’ts
 Don’t apply butter or ointments, which can cause infection.
 Don’t rub eye if chemical spray gets into the eye.
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 Burns
4.5 ELECTRICAL BURNS
In this section, we will discuss regarding Electrical Burns.

4.5.1 Definition, Causes and Recognition

Definition
The burns occurring due to contact with electrical source are Electrical burns.
In these cases, current passing through the body heats the tissue causing electro-
thermal burns both to the surface of the skin as well as deeper tissues. Sometimes
due to sparks or flame through electric source may also cause deeper burn
injury (Fig. 4.22).

Fig. 4.22: Electrical Burn (due to electrical shock)

Chemical and electrical burns may affect the skin in deeper tissues
and are usually Major burns. They need immediate medical
attention because they can affect the inside of the body, even if
skin damage is minor.

Causes
These are caused by a number of sources of electricity, such as lightning, stun
guns and contact with household current, malfunctioning of electric wiring, electric
arc, high voltage power line or machines and so on. In simple words, it occurs
due to electrical shock.
Recognition
The Electrical Burns are recognized by typical symptoms of burns as in case
of superficial or deep burns as discussed in Subsection 4.2.1 of this Unit.

4.5.2 First Aid in Electrical Burns

 Don’t touch the injured person if he or she is still in contact with the electrical
current.
 Maintain your own safety by staying at least 20 feet (about 6 meters) away
— farther if wires are jumping and sparking.
 Turn off the power, switch off the equipment and take the plug out of
the socket.
 Separate the victim from electric current by using a non-conductive
equipment like dry wool, gauze, wooden rod etc. (Fig. 4.23).
99
First Aid in Accidents
and Injuries

Fig. 4.23: Using wooden rod to separate the victim from electrical source
Stand on wooden board, rubber mat or newspaper pile when doing this
especially if the victim is in contact with water.
 If the victim is conscious:
 Remove the victim by asking him to move, if he/she can or by moving
the victim yourself using various methods of moving discussed in Unit 2
of Block 2 of this Theory Course. You can also pull on the victims
loose dry clothing.
 Assess his levels of consciousness, respiration and pulse, extent of
burns.
 Cover any burnt areas with a dressing and bandage (Fig. 4.24).

Fig. 4.24: Covering the Burnt area

 If the victim is unconscious :
 Check for the responsiveness.
 Begin CPR if the person shows no signs of circulation or no response.
 Reassess the victim upon gaining consciousness.
 Assess and treat shock.
 Refer the victim to the health facility/hospital immediately.
Do’s and Don’ts for Electrical Burn
Do’s
 Turn off the power and then only touch the power source.
 Look for your safety first.
 Avoid going near high-voltage wires until the power is turned off.
 Try to prevent the injured person from becoming chilled.
 Keep away from water as it is good conductor of electricity.
 In case the victim is in contact with wire which cannot be separated,
separate the wire using long wooden stick and stand on newspaper
pile/ wooden board while doing so as wood is bad conductor of
electricity.
100
 Burns
 Wear rubber gloves if present as this is also bad conductor of
electricity and save you from getting electrical shock/burn while saving
the victim.
Don’ts
 Don’t move a person with an electrical injury unless the person is
in immediate danger.
 Don’t use a blanket or towel, because loose fibers can stick to the
burns.
 Don’t move the victim by holding under armpits in case of contact
with water.
 Don’t use any wet or mettalic objects to remove the victim.
 Don’t touch the victim’s skin with your bare hands.

Check Your Progress 2

1. What will be your action if you find a person with burn injury due to
tea spills?
........................................................................................................
........................................................................................................
........................................................................................................
2. Write the first aid management of electric burns for a victim in bath
tub.
........................................................................................................
........................................................................................................
........................................................................................................
........................................................................................................
........................................................................................................
........................................................................................................

4.6 LET US SUM UP

Burn injuries vary from superficial injuries to severe damage to skin in deeper
burns. It is therefore necessary to assess the level of burn and provide
appropriate treatment in time to prevent damage and disability. Burn injuries
may occur at home, at work place and in public places. In this unit, we discussed
about the types, causes, assessment and first aid in various types of Burns.
One important thing to remember that removing the victim from the source
causing burns is very important to decrease the chances of complications that
may occur due to burns. Also, it is important to be alert for shock which may
develop if major part of body is burnt. One must be alert to avoid becoming
a Victim himself especially when helping someone in fires or during electrical
shock. And alertness is the key to deal with this emergency.
Hope this unit must have provided you with an insight into the first aid
management of burn injuries. The practical skills for this Unit have been discussed
in Unit 3 of Practical Block 2.
In the next unit we will discuss first aid in Foreign Bodies. 101
First Aid in Accidents
and Injuries 4.7 KEY WORDS
Injury : Damage to body or part of body
Swelling : Enlargement of part of body
Corrosive : Causing corrosion or damage
Alkali : Substance with pH greater than 7
Acid : Substance with pH lower to 7
Severity : Condition of being severe/extreme
Blisters : Fluid filled sacs/pouches formed on skin
due to accumulation of tissue fluid
Heal : Come to previous level
Scar : Mark present on skin after burn has not healed properly
Deficit : Decrease or something missing
Ingestion : Entry into body through oral route
Inhalation : Entry into body through breathing in
Disability : Handicap
Exposure : Affected by something against which one is not protected
Segments : Parts
Responsiveness : Level of reaction or response after injury
Radiations : High energy waves or particles
Intensity : Power
Severity : Degree of effect or limit of something
Combination : Having different qualities/a blend or mixture
Functioning : Working
Grafting : Surgery in which tissue/organ is transplanted in
problem area
Extinguish : Decrease or prevent from burning
Flammable : One which can easily catch fire
Contamination : Making impure with infection

4.8 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
1. Refer Subsection 4.2.1
2. Refer Subsection 4.2.1
Check Your Progress 2
1. Refer Section 4.3.2
102 2. Refer Section 4.5
 Burns
4.9 REFERENCES AND FURTHER READINGS
1. Andrew MK. First Aid. In: Settle JA, editor. Principles and Practice
of Burns Management. Edinburg Churchill Livingstone: 1996. pp. 199–
202.
2. Cuttle L, Pearn J, McMillan JR, Kimble RM. A review of first aid
treatment for burn injuries. Burns. 2009;35:768–75. [PubMed:
19269746]
3. Lawrence JC. Burn care-a teaching symposium. Hull: Smith and
Nephew; 1986. The causes of burns; pp. 13–26.
4. King TC, Zimmerman JM. First aid cooling of the fresh burn. Surg
Gynaecol Obstet. 1965;120:1271–3.
5. Ofeigsson OJ. Water cooling: First aid treatment for scalds and
burns. Surgery. 1965;57:391–400. [PubMed: 14261580]
6. Cinat ME, Smith MM. Acute burn management. In: Sood R, Achauer
BM, editors. Achauer and Sood’s Burn Surgery Reconstruction and
rehabilitation. 1st ed. Philadelphia: Saunders Elsevier; 2006. pp. 50–
76.
7. Rockwell WB, Ehrlich HP. Should burn blister fluid be evacuated? J
Burn Care Rehabil. 1990;11:93–5. [PubMed: 2312597]
8. Swain AH, Azadian BS, Wakeley CJ, Shakespeare PG. Management
of blisters in minor burns. Br Med J (Clin Res) 1987;295:181. [PMCID:
PMC1247035]
9. Stilwell JH. Chemical burns. In: Settle JA, editor. Principles and
Practice of Burns Management. Edinburg Churchill Livingstone; 1996.
pp. 355–68.
10. Jordan BS, Barillo DJ. Pre-hospital care and transport. In: Carrougher
GJ, editor. Burn Care and Therapy. St Louis: Mosby; 1998. pp. 61–
88.
11. http://www.ahchealthenews.com/ahc_scripts/symptom_checker/
WebPages3/housecalls/healthimages/chem02.htm
12. https://www.youtube.com/watch?v=ZY-WdRC_orU
13. https://www.wikihow.com/Treat-Electrical-Burns
14. https://www.convergencetraining.com/first-aid-burns.html
15. http://slideplayer.com/slide/6065144/
16. https://www.mayoclinic.org/diseases-conditions/burns/multimedia/radiation-
burn/img-20006134
17. http://herbalthera.com/thermal-burn-of-1-2-3-and-4-degrees-first-aid-at-
thermal-burns/
18. http://xenotherapeutics.org/burns-unmet-need/understanding-burn-
treatments/
19. https://www.slideshare.net/DrMAlabyad/burns-first-aid-by-drmohamed-
elabiad 103