A wide variety of situations, both in normal times and disaster settings, put us in proximity with high levels of heat. If we’re knocked off the grid, it won’t be unusual to cook food over a fire of our own making, something very few do on a regular basis. As such, the survival medic will often be faced with burn injuries. Having the materials and knowledge to treat burns will be absolutely necessary in times of trouble.
Burns can be caused by contact with sources other than flames, including:
• Scalds due to contact with hot water or steam.
• Contact with electricity associated with lightning or another source.
• Friction burns due to contact with hard surfaces such as roads (“road rash”), carpets, or hard flooring.
• Skin exposure to extreme cold and winds. Yes, extreme cold can cause burns.
• Chemical spills.
• Radiation due to contact with energy emitted by x-rays and other medical testing or treatment, “dirty bombs,” or thermonuclear explosions.
In general, the different types of burns are treated similarly, although some burns, like those caused by electricity or radiation, may cause internal damage without destroying the skin. Inhalation of superheated air may cause damage to lung tissue. Off the grid, the lack of advanced care will make these cases a challenge for the medic.
The severity of a burn injury and resulting chance of death or disability depends, in part, on the percentage of the total body surface involved, as measured by the “rule of nines.”
Assessing the percentage of body surface area burned is standard practice and helpful in modern medicine. It may, however, have less practical benefit in austere settings where transport isn’t an option. In any case, knowing the “rule of nines” may give the medic an idea of the chances of recovery for a burn victim.
Burns to the face, feet, hands, genitals, and lungs are considered the most problematic. Burns that go completely around a body part, say, an arm, cause constriction that may affect circulation. Areas with a lot of scar tissue may have limited mobility.
BURN DEGREES
Besides total surface area involved, an important factor is the amount of penetration of the burn. This is usually measured in degrees.
First-Degree Burns
Most burns you’ll see will be due to excessive exposure to the sun. A majority of cases will be “first-degree burns.” In first-degree burns, the patient may be red as a lobster, but only the superficial layer of the skin (the “epidermis”) is injured.
A first-degree burn will appear red, warm, and dry. It will be painful to the touch, especially when large areas of skin are involved. Fortunately, major complications are rare unless other symptoms such as nausea and vomiting appear. Treatment is simply focused on relieving discomfort.
Immersion in a cool bath will be helpful; at the very least, run cool water over the injury. A cool moist cloth on the burn for 20 minutes will give some relief. So will anti-inflammatory medicines such as Ibuprofen. Aloe vera, zinc oxide, and benzocaine sprays are effective alternatives. Expect the discomfort to improve after 24 hours. Until then, avoid constrictive, tight clothing and wear light fabrics, such as cotton.
Prevention, of course, is worth a pound of cure. To avoid this type of sunburn:
• Don’t “sunbathe” (a tan is not healthy).
• Avoid the peak sun hours for the time of year and latitude.
• Wear long pants and sleeves, hats, and sunglasses.
• Spend time in the shade whenever possible.
If extended exposure to sunlight is unavoidable, be certain to use a sunblock. Apply 15 minutes prior to going outside and re-apply frequently throughout the day. Even water-resistant sunscreens should be reapplied every one to two hours. Most people fail to put enough on, so be sure to use plenty.
As an aside, sunblock and sunscreen are not the same thing. Sunblocks contain tiny particles that “block” and reflect UV light. A sunscreen contains substances that absorb UV light, thus preventing it from penetrating the skin below. Many commercial products contain both. Sunblocks and sunscreens should be an integral part of your medical storage.
The SPF (Sun Protection Factor) rating system was developed in 1962 to measure the capacity of a product to protect against UV radiation. It measures the length of exposure to the sun before you burn. A SPF (sun protection factor) of at least 15 is recommended. It takes about 20 minutes without sunscreen for your skin to start turning red. SPF 15 blocks 94 percent of the sun’s rays, SPF 30 blocks 97 percent, and SPF 45 98 percent. The higher the number, the longer it takes for the skin to burn.
Although the increase in protection may seem small, higher SPF numbers are especially beneficial to those with fair skin. They offer better protection against long-term skin damage leading to cancer.
Besides the sun, first-degree injuries will most likely be related to cooking or campfires. Using hand protection will prevent many of these burns, as will careful supervision of children near campfires and food preparation areas.
Second-Degree Burns
Second-degree burns are deeper injuries that penetrate through the superficial epidermis and partially through the deeper layer of the skin (the “dermis”). Thus, they’re often called “partial thickness burns.” While first-degree burns may cover a large percentage of surface area without becoming life-threatening (but are painful), a relatively small percentage of the body covered with significant second-degree burns may require serious medical intervention.
Unlike first-degree burns, which appear dry, second-degree burns will be moist and often have blisters with reddened bases. The area will have a tendency to weep clear or whitish fluid. Second degree burns will cause swelling as well, so it’s important to remove rings and bracelets.
To treat second degrees burns:
Remove the victim from the heat source immediately. Run cool water over the injury for 10-15 minutes (avoid ice, which will traumatize already-damaged skin). After washing and running water over the wound, pat the area dry. The next step is to apply moist skin dressings such as Xeroform, Spenco Second Skin or non-stick dressings (Telfa pads) with thin layers of products like aloe vera or Aquaphor. Be sure to replace regularly and review the progress of healing. Other actions should include:
• Removing jewelry like rings and bracelets (swelling may cause painful constriction).
• Elevating burned extremities.
• Applying cool compresses.
• Giving oral pain relief such as Ibuprofen (Advil).
• Applying anesthetic creams such as benzocaine or lidocaine.
• Avoidance of “peeling” burned skin, which sometimes comes off in sheets.
• Protecting adjacent burned fingers and toes with a dry barrier in-between.
• Encouraging hydration.
• Using a “tenting” method to keep sheets above extensive burns.
We’re often asked whether to pop blisters associated with second-degree burns. It’s wisest to avoid the lancing of blisters, if possible, unless they’re infected and filled with pus. Some very large blisters will, however, break with the slightest pressure and may benefit from controlled drainage. If this is the case, use a sterilized needle or scalpel blade to pierce the side of the blister near the base. The roof of the blister is often retained to provide additional protection to the healing base.
It’s important to avoid the use of lard or butter on burns: They tend to keep in heat and may worsen the injury. Egg whites and toothpaste, long considered to be home remedies, may increase the risk of infection. It’s better to use sterile saline solutions to keep the burn area and (non-stick) dressing moist, especially in severe burns.
In part 2 of this series, we’ll discuss third-degree burns. Is there anything the survival medic can do if confronted with this life-threatening issue?
Joe Alton MD
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