We were recently asked by our friend Jeremy Knauf of howtosurviveit.com about possible issues with injuries caused by over-exuberant 4th of July celebrations (read: fireworks).
The safest way to enjoy fireworks is to be a spectator at your municipality’s show. In 2011, fireworks caused an estimated 17,800 reported fires, including 1,200 structure fires, 400 vehicle fires, and 16,300 outside fires. These fires resulted in an estimated eight reported civilian deaths, 40 civilian injuries and $32 million in direct property damage. In 2011, U.S. hospital emergency rooms treated an estimated 9,600 people for fireworks related injuries. Most fireworks injuries are seen in children or teens; unsupervised use of fireworks by children is a very bad idea. I was on the beach watching fireworks one July fourth, and a bottle rocket lit by a 6 year-old whizzed by, missing my head by a few inches.
It struck me that I hadn’t written recently about burn injuries and that it was time to discuss this in detail. Before I go further: In stable times, get anyone with a signifcant burn to the emergency room. While you have modern technology, take advantage of it.
If we find ourselves off the power grid, we will be cooking out in the open more frequently. The potential for significant burn injuries will rise exponentially, especially if the survival group includes small children; naturally curious, they may get too close to our campfires. A working knowledge of burns and their treatment will be a standard skill for every group’s medical provider.
Severity of Burns
The severity of the burn injury depends on the percentage of the total body surface that is burned, and on the degree (or intensity) of the burn injury. Although assessing the surface percentage is helpful to burn units in major hospitals (“rule of 9’s”), this practice will likely be of limited helpfulness in a collapse. Therefore, let’s concentrate on learning to identify burns by their degree.
First Degree Burn: red and dry
FIRST DEGREE BURNS: First degree burns are superficial, only affecting the “epidermis” (the part of the skin you can see). These burns will be very common, such as simple sunburn. The injury will appear red, warm and dry, and will be painful to the touch. Placing a cool moist cloth or Spenco Second Skin on the area will give some relief, as will common anti-inflammatory medicines such as Ibuprofen. Aloe Vera is also an effective treatment. Usually, the discomfort improves after 24 hours or so, as only the superficial skin layer is affected.
Second Degree Burn: red and moist with blistering
SECOND-DEGREE BURNS: These burns are deeper, affecting the deep layer of the skin (the “Dermis”). You will see areas that appear moist and are painful and have blisters with reddened bases. The area will have a tendency to weep clear or whitish fluid.
Third degree burn: deep areas burned; bad news any way you look at it
THIRD-DEGREE BURNS: The worst type of burn injury; it involves the full thickness of skin and possibly deeper structures such as subcutaneous fat and muscle. It may appear charred, or be white in color. The burn may appear indented if significant tissue has been lost. In third-degree burns, you have lost your body’s armor (the skin); this will cause loss of fluids and cause dehydration. Giving fluid is essential to keep the patient stable. Expect infection in the burn area over time, as your defenses are down.
When a person gets burned, it’s of paramount importance to remove the heat source immediately. Run cool water over any degree of burn for at least 10-15 minutes as soon as possible after the injury. Immersion in a cool bath is another option, especially for torso burns. Don’t do this in large, severe burns, as third degree burns receive somewhat less benefit from this strategy. Cool water is preferable to ice as it is less traumatic to the injury. Be certain to remove rings or jewelry, as swelling is commonly seen in these kinds of injuries.
Application of topical burn ointments with Benzocaine will sooth first and second degree burns. Oral pain medications such as Ibuprofen or Acetaminophen may also be effective. 0.5% hydrocortisone cream has been used with beneficial effect. Silvadene ointment is an excellent antibacterial agent (contains Silver Sulfadiazine) to prevent infection. Your patient will experience less discomfort if they wear fabrics that don’t irritate the skin, such as light cottons or silks.
In a second-degree burn: Moist skin dressings such as Spenco Second skin may give some relief, as will lancing some of the larger, more tense blisters. Generally, most blisters do not have to be lanced, as infection may ensue. Antibiotic ointment may be an option, although these burns are usually sterile for the first 2 days or so. Products that contain Silver Sulfadiazine (Silvadene) will prevent infection in healing wounds.Be aware that those who are allergic to Sulfa drugs should not use Silvadene, although silver solutions applied topically may be acceptable.
Don’t forget to remove rings and bracelets due to swelling that may occur.
BTW, don’t cover second degree burns with loose cotton or regular gauze. Sterile non-stick dressings like Telfa pads will be less uncomfortable, especially during removal and dressing changes. When I was a kid, I got a pretty bad second degree burn on my back; my mom put gauze on it and took about 6 inches of skin off when she removed it!
In a third degree burn: As long as the victim’s clothing is not smoldering, don’t remove clothing over the burn. Elevate the burn injury about the level of the heart. Spenco Second Skin is, again, useful, as a burn wound cover, for protection purposes. Also, Celox combat gauze, when moistened, forms a reasonable gel-like dressing. Silver Sulfadiazine (Silvadene) cream is helpful in preventing infections in third degree burns. Cover the victim with a light sheet or blanket to help preserve body core temperature.
(Note: You might see fourth, fifth and sixth degree burns described in some other medical resource books. They are treated essentially the same as third degree burns.)
Honey has been used as a coating for significant burns and this may be implemented by spreading it over the wound and covering it with plastic wrap. Any burn this severe that is larger than, say, an inch or so in diameter, will require a skin graft to heal completely. Unfortunately, this is unlikely to be available in a collapse situation. A person with third-degree burns over any significant percentage of the body could be in shock, and may die despite your best efforts.
Different types of burns may be helped in different ways:
Fire burns: Smother any flames by covering them with a blanket or dousing them with water. If clothing catches fire, don’t run (and fan the flames). Stop, drop, and roll on the ground.
Cold burns: Yes, cold can burn you (think of freezer burn). Frostbitten appendages can be warmed by blowing warm air on them, tucking them inside your clothing or putting them in warm water (no more than, say, 104 degrees F).
Hot liquid burns (scalds): Run cool tap water over the burn for 10 to 20 minutes. Do not use ice, as this constricts the blood vessels that supply circulation to the damaged area.
Electrical burns: Electricity can affect the function of your heart. Check for irregular heart rhythms (CPR may be needed).
Hot tar or plastic burns: Immediately run cold water over the area.
Chemical burns: Get some gloves on to protect yourself. Flood the wound with cool water for 20 minutes and be sure the runoff doesn’t get on undamaged areas (or you). Don’t put ointments on the wound until you can identify the chemical and are certain they will not interact negatively with it.
It’s important to realize that our traditional medicine resources may not be available some day and a successful medic will ensure that everyone will have some knowledge regarding alternate burn treatments. Various plants will have properties that will allow you to improve burn healing, even if no modern medical supplies are available. Although of limited use for severe burns, many first and second degree burns will respond to their effects.
The first remedy to consider is Aloe Vera. Most people recognize this treatment as something they heard before; studies have shown that Aloe Vera helps new skin cells form and speeds healing. This would be an excellent option for first or second degree burns. If you have an aloe plant, cut off a leaf, open it up and either scoop out the gel or rub the open leaf directly on the burned area. Reapply 4-6 times daily, with or without a bandage covering. Simplicity and fast relief are the key benefits to using Aloe Vera on burns, especially in a collapse situation.
Most articles you can find on burn treatments also commonly include any type of vinegar as a treatment for burns. Vinegar works as an astringent and antiseptic and helps to prevent infections. The best way to use vinegar on smaller sized burns is to make a compress with 1/2 vinegar and 1/2 cool water and cover the burn until the compress feels warm, then re-soak the compress and reapply. There is no limit to how many times you can apply the vinegar soaks. Another method is a cool bath with vinegar added. Start with tepid water and let the water cool off while the patient is soaking. if the burn is on the central body area use a cotton t-shirt soaked in vinegar and then wring it out. This method is especially useful as a treatment while sleeping.
Another “cooling off” treatment for burns is Witch Hazel compresses. Use the extract of the bark, which decreases inflammation and soothes a 1st degree burn. Soak a compress in full strength Witch Hazel and apply to the burned area. Reapply as frequently as desired. Elder flower and comfrey leaf decoctions are also an excellent remedy for burns.
For those unfamiliar with the term “decoction”, it is an extraction of the crushed herbs produced by boiling. Using lower water temperatures produces a tea instead. The Decoctions of these plants can also be used for compresses just like the Witch Hazel. However, they can also be freshly crushed and rehydrated and then applied directly to the burned area with a sterile gauze cover, this is called a poultice.
Black tea leaves have tannic acid that helps draw heat from a burn. There are several methods for the black tea treatment:
· Put 2-3 tea bags in cool water for a few minutes and use the water with compresses or just apply the liquid to the burned area.
· Make a concoction of 3 or 4 tea bags, 2 cups fresh mint leaves and 4 cups of boiling water. Then strain the liquid into a jar and allow it to cool. To use, dab the mixture on burned skin with a cotton ball or washcloth.
· If your patient has to be mobile, make a stay-in-place poultice out of 2 or 3 wet tea bags. Simply place cool wet tea bags directly on the burn and wrap them with a piece of gauze and some tape to hold them in place.
Both milk and yogurt have also been found to help cool and hydrate the skin after a burn. Wrap whole-milk, full-fat yogurt, inside gauze or cheesecloth and use as a compress. Replace the compress as the yogurt warms on the skin. Whole milk compresses can be used the same way.
Another method of application for large burn injuries is a yogurt “spa treatment” which involves spreading yogurt all over the burn then bathing with cool water after 15 minutes. Yet another home remedy is the baking soda bath. Add 1/4 cup baking soda to a warm bath and soak for at least 15 minutes or longer if needed until the water cools off.
There are two essential oils that can be used full strength on 1st or 2nd degree burns, Lavender and tea tree oils. They help with pain due to stinging and promote tissue healing. Mix tea tree oil with a small amount of water (lavender can be used full strength); apply all over the burned area. A loose covering of gauze over the oil may be helpful when used for 2nd degree burns. It is important to know that butter or lard, commonly used for burns in the past, will hold in the heat and are not to be used in the treatment of your patient. Egg whites, also used in the past, might lead to infection.
You can also make a poultice of Marigold (calendula) petals pounded with small amounts of olive or wheat germ oil; this can be spread lightly over the burned area and covered by loose gauze or a sterile covering. Marigold is a common ingredient in skin medication and it has been proven to have anti-inflammatory and antibacterial effects, which speed the healing of burns.
An oatmeal bath may be used to reduce itching related to healing, Crumble 1-2 cups of raw oats and add them to a lukewarm bath as the tub is filling and soak 15-20 minutes. Then, air dry so that a thin coating of oatmeal remains on your skin. You can do this as often as needed to reduce itching.
A time proven remedy related to Ancient Indian YUNANI healing arts has been used for many centuries to treat even severe burns. Here are the steps to make cotton-ash paste:
· Take a large piece of cotton wool; or any kind of pure white cotton fabric and burn it into ashes in a Dutch oven.
· Use the ASH of the burned cotton and mix with olive oil or any kind of cooking oil available
· Mix this into a thick paste and spread the black paste on the burned skin
· Cover it with ordinary plastic cling wrap and perhaps some gauze to hold it all in place.
· Add new paste every day for a week or so, depending on the severity of the burn.
One of the best natural remedies that is useful in treating the burn patient is honey. Honey in its raw unprocessed state is best to use, because of its antibacterial activity and hydrating properties. Honey has an acidic pH that is inhospitable to bacteria. Therefore, it will help prevent and even treat infections in many wounds. It can be used in 1st, 2nd and, if no other medical care is available, as a last resort for 3rd degree burns (along with a high protein diet, lots of water and a drink mixture of lemon juice, sugar and a pinch of salt in some water several times a day).
This is how to use the honey method:
· Immediately after the first 15 minute cooling-down treatment, apply a generous amount of honey in a thick layer all over the burned area
· Cover the honey with cling wrap plastic or waterproof dressings. Use tape to hold the dressing in place.
· If the dressing begins to fill up with fluid oozing out of the wound, change the dressing. The worse the burn, the more frequently the dressing will need to be changed. Repeat for 7-10 days.
· Do not remove or wash off the honey for the first 20 days (or earlier if healing is complete). Add more honey often and fill up any deeper areas as needed. Always have a thick layer of honey extending over the edges of the burn. You do not want any air getting to the burned skin until healing is completed. This will cut down the infection rate.
· Change the dressing at least three times a day regardless of the amount of oozing fluid.
Treating burns without a medical system available will require intense care and close observation. Severe fluid losses lead to dangerous consequences for these patients, so always be certain that you do everything possible to keep them well hydrated. The damage to the skin caused by burns leaves those injured to the mercy of many pathogens, so watch for fevers or other signs of infection.
Have a safe 4th of July out there!
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