Burns

While the leading cause of fatal fires is related to smoking materials such as cigarettes, the majority of residential fires that result in burn injuries are caused by cooking equipment (Stanford, 2006). Though the majority of deaths caused by fire are related to smoke inhalation, many severely burned patients survive the fire but later succumb to infection.

Burns are commonly categorized as first-, second-, or third-degree, which are sometimes known as superficial, partial-thickness, or full-thickness, respectively. Superficial burns are painful burns that are characterized by inflamed red skin. Though field treatment of superficial and partial-thickness burns is directed at controlling pain, the first priority for all burns is ensuring that the burning process has stopped.

First-degree burn reddens the epidermis; (2) second-degree burn penetrates the epidermis and causes blistering; (3) third-degree burn penetrates the dermis and requires careful attention to heal successfully. (Illustration by Jason M. McAlexander, MFA. Copyright © 2007 Wild Iris Medical Education.)

After observing Universal Precautions, any jewelry or clothing that may be retaining heat should be removed, followed by a water or saline flush for most burns. Burns caused by dry lime, soda ash, phenol, lithium, and sodium metal should not be flushed with water or saline. Local poison control or CHEMTREC should be contacted for direction on appropriate management of these patients (PHTLS, 2003).

Once the burning has been controlled, the area should be covered to avoid further contamination. Burns should only be covered by dry sterile dressings. Moist burn sheets, ointments, lotions, or antiseptics should never be used prehospital. Use of moist dressings for large burns can result in hypothermia. Pain should be managed by the use of analgesics when allowed by protocol. Avoid breaking open blisters, as this increases the risk of infection. Most local protocols allow for burn patients who do not have acute airway compromise to be transported to specialty facilities capable of managing these patients.

Burn patients should be continually reevaluated for airway compromise. Painful burns may distract a patient from recognizing symptoms of advancing airway edema. Stridor, coughing, singed facial hair, and soot around the mouth or nares may indicate potential airway involvement. All patients who have experienced thermal burns should receive supplemental oxygen to treat possible hypoxia related to inhalation and compromised circulation

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