Burns in the woods

[mrcharly]

There is a lot of discussion about treating cuts, but I don't see much about burns. I reckon most of us know to pour clean cold water constantly over a burn, but what next? Say if help is hours away?

I scalded myself with the contents of a kettle when I was 16. On the farm by myself. 2nd-degree burns to about 2sqr feet of my body, weeks in hospital.

A big 2nd degree burn is, erm, impressive. Think of skin, with gobbets of fat stuck to it, peeling off like steamed wallpaper, blister the size of a hand filling with yellow liquid in minutes.

[Melonfish]

ideally you need to keep 2nd degree burns under wraps, i.e. cling film. this stops the area loosing moisture in a pinch a plastic bag could possibly do the trick too
for minor scalds and burns i always carry germaline, oddly i use it an awful lot as i'm always burning my bloody fingers :D

[devonclarkey]

try to carry burn spray or flamazine if you can hope this helps

[lab72]

I tip cold then warm water on burns and do that for while .

[John Fenna]

Cool, cover - evacuate!
Any blister over the size of a 50p coin needs looking at by a professional....
If help is hours away get moving ASAP!

[Smith28]

I've heard many things about using Vaseline on burns, can anyone put this down simply for me?

I've heard it helps, but I've also heard it doesn't because it's a barrier, not a moisturiser.. Confused.

[resnikov]

Cool, cover - evacuate!
Any blister over the size of a 50p coin needs looking at by a professional....
If help is hours away get moving ASAP!

Is that an old 50p or a new one?

[v-ness]

This is good advice:


Cool, cover - evacuate!
Any blister over the size of a 50p coin needs looking at by a professional....
If help is hours away get moving ASAP!



I've heard many things about using Vaseline on burns, can anyone put this down simply for me?

I've heard it helps, but I've also heard it doesn't because it's a barrier, not a moisturiser.. Confused.

Please dont put any creams on anything but the most superficial burn- after it has cooled down. Moisturiser is good to aid healing and to reduce scar tissue, but creams on open wounds, which include burns are usually not a good idea.
I carry some clingfilm in my FAK, it folds down small and could be a lifesaver.

Cheers
Ness :)

[Barn Owl]

I carry burn gel and burn plasters for minor burns and scalds and they do work well.

Anything larger or classed as 2nd degree, as John says.

Never used vaseline on a burn or scald personally.

If out and you've no 'clean' water,remember and cover the burn with a waterproof barrier before cooling with the water you have.

[treefrog]

I get with water-jel dressings and can't recommend them enough. A couple of 10x10 dressings should find their way into any camp kit.
http://www.spservices.co.uk/product_info.php?products_id=1 456&osCsid=j231qbjtd964nn6he2g6sgp k75 (no connection etc)

[daryl]

Burns

Well Johns advice was spot on.

The application of any 'potions or lotions' other than watergel or burnshield is a big no no. The use of creams to moisturise or reduce scarring will be advised by the recieving ED or burns unit so forget about that until reaching definitive treatment.

Cling film is a great burns tool however to points to remember when using.
1) cool the burn first,dont apply to an uncooled burn as it can in fact melt causing bigger more serious issues.
2) remember where possible to discard the first few layers of the roll to ensure maximum cleanliness before application
3) tear and apply in strips and dont wrap around limbs or chest as this could lead to circulatory restriction or respiratory difficulties.

Burns, whatever there area or severity = cooling with water, lemonade, milk or other ph neutral fluid etc. and where possible keep as clean as possible.
If severe or extensive, Remember Danger first, no good getting yourself burnt, Airway, ensure this is maintained , treat for shock, patients with burns lose massive amounts of fluid, leading to shock which is impossible to reverse without advanced skills and kit.
Lastly consider hypothermia, especially in children, that amount of cooling over a large area of the body on top of the loss of fluids will result in an increased risk of hypothermia.

[WeThePeoplexfbm]

i use burn gell ^^ but few month ago i went camping in summer was about 37 summer hot and walked around for 1 day without a shirt then went home and next day my back red and blubblein XD so pain full


---
Skipp

[Ronnie]

My family alway use aloe vera 99% gel on all burns with remarkable results. Run under cold water to take the heat out, then slap on the aloe liberally and leave to dry on. We keep a tube under the sink and one in the family sized FAK.

http://blogs.spokenword.ac.uk/niamhanderson/files/2010/11/aloe-vera.jpg

I've never used it on a really serious burn. Looking at the research, there are a lot of contradictory and often poorly designed studies with differing results. However, a meta analysis by Vogler & Ernst (1999) suggest Aloe Vera does help burns heal faster - including 2ND degree burns.

*.pdf copy of the research here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313538/pdf/10885091.pdf

Problem with aloe is that you can't patent it, so there's not much in it for the drug companies to promote it :(

[mrcharly]

I'm inclined to follow the advice of the trained people. Clean water or watergel only on 2nd degree or worse burns.

[Totumpole]

Being a Doctor I think Daryl has pretty much said it all.
The one thing I would add is burns to the face/neck/mouth/lips, singing of eye brows and nasal hair, canrbonaceous sputum (coughing up black stuff) are signs that there could be burns to the airway, which will compromise the airay extremely quickly (due to swelling), if this is the case they need urgent urgent urgent evacuation, these are the kind of people who may even need the old bic pen to the throat in a properly rural/emergency setting (if properly trained of course - please please please dont go stabbing anyone in the throat because I said so - I am most certainly not saying so).
Also don't burst blisters, they may do so in hospital, but in the field you want them intact as they still offer some kind of a barrier to nasties - most people who die with signifiacnt burns will die of sepsis (ie bugs rampaging around the blood stream causing multiple organ failure amongst other things).

As to what Ronnie is saying regarding aloe vera - I think yes, but any open wounds/blister I would avoid anything but burn gel in the acute setting. Cooling followed by clean clingfilm for anything with broken skin/blistering. I certainly swear by aloe vera for sunburn. I have fine Scottish extremly pale complexion, and burn easily - ie burt quite badly yesterday - yes in April!!! - I keep it in the fridge at home in summer, lovely cooling effect on the sunburn. In terms of prevention of sunburn, I'm sure I'm not alone in my haterd of suntan lotion. I tend to use Reismanns P20 (an oil that applied once lasts all day, is waterproof, but stains clothes) or Piz Buins 8 hr range is probably a bit nicer and perfectly effective for the average day in the UK (it does last all day, even after a swim).

Good thread, definately a topic worth covering. I cannot recommend first aid training highly enough, especially if you are going to be rural (ie far from help)

P.S. Just for those of you wondering about burns classification. 1st degree burns (aka superficial) = redness of the skin, painfull (involve only the outer layer of skin - epidermis), 2nd degree burns (aka partial thickness) = redness, blistering, exudate (oozing fluid), PAINFULL (involve the epidermis and dermis), 3rd degree burns (aka full thickness) = white leathery appearence, painfull at edges but no sensation in affected area (all sking layers and some subcutaneous tissues affected), 4th degree burn (full thickness with injury to muscle) = describes burns so deep they involve underlying muscle.

[ex member coconino]

I was on an outdoors-focussed first-aid refresher course at the weekend, so this is... er... fresh in my mind.

Apart from the usual stuff such as checking for hazards and other wounds, the advice is as per several folks above:

Priorities:

Cool the burn
Keep the burn sterile


The first priority is to cool the wound under running water for ten minutes (even if the only water available is a muddy stream, immediate cooling trumps being sterile), failing that, use whatever is to hand; milk, coke, or other cool liquid is better than nothing.

Remove any rings, watches, wristbands, which may cause constriction if the injury swells.

Cover the cooled burn using a sterile non-adhesive dressing and cover that with cling film, if available. Cling film can be used as the primary dressing as it won't stick to a cool burn and is likely to be sterile if unopened, but if there is any doubt, it is better to dress with a known sterile dressing and use the cling film to wrap over the dressing to keep dirt out.


DO NOT touch the burn
DO NOT burst any blister
DO NOT use any creams, ointments, balms, etc.
DO NOT attempt to remove clothing which has stuck to burn (apply dressing over stuck clothing).


Immediate medical treatment is essential if:

the burn is larger than a 50p (or one inch square)
the burn is to the palm of hand or sole of foot
the burn is to the groin or above the shoulder
the patient is a child.


Depending on the severity of the burn, other general considerations include to check the patient every few minutes for stress reactions (‘shock’), and not to leave the patient alone.

EDIT: It probably goes without saying, but "don't touch the burn" also means don't try to remove ash, cinders, etc. which don't come away with the cooling water.

Also, Totempole's point (see message above) is really useful about checking for indications that there may be damage to the airway.

[_mark_]

Don't forget your pain killers as burns can be agonizing!

[The Lord Poncho]

I badly scalded my hand in an office accident a few months ago (basically I had a bit of a brain fart and washed my hand under a wall mounted water boiler). After running it under cold water for a good 30 minutes (and some phone based cajouling by the wife- she enticed me by telling me she knew a really attractive nurse who worked in the hospital!) or so I drove a short distance to the local minor injuries unit which happens to be part of the hospital that is one of the leading burns places in the country. They covered the scald with petroleum jelly soaked gauze (basically sterile Vaseline) - several layers, and then loosely bandaged over the top. As soon as the gauze was applied the pain pretty much disappeared instantly. I think they told me it was due to the air being occluded. I went back and they replaced the dressing with a same stuff a few days later, than after about a week I took it off. They gave me a tube of Vaseline to keep the skin moist thereafter basically to stop the dead skin peeling for as long as possible to allow healthy skin to grow underneath it first.

So in an emergency and if I was a number of hours from help, once I had cooled the burn, I would probably consider a loosely applied dressing covered in a thick layer of Vaseline if push came to shove.

But with the disclaimer that this treatment was given to me when my skin was unbroken- I’m not sure it would apply if the skin had already cracked- i don't know.

I was always taught in first aid not to apply any creams etc for anything but the most minor burn, otherwise once you get to hospital they would have to scrape the cream off first to inspect the burn- which sounds fairly unpleasant!

[Totumpole]

Don't forget your pain killers as burns can be agonizing!


very true!

[Paul_B]

Long time since I took first aid training but IMHO it is common sense not to apply any creams to any open skin in a first aid situation unless its those minor grazes you get as a kid. My understanding in burns it doesn't help and A&E need to remove what you put on before treatment anyway. That's for the more serious burns of course. I have burnt myself in camp a few times but only up to the blister stage and I find its easier just to get on with it after a short cooling spell with clean water. So far never had anything more serious than an open blister from burns. <touches wood after probably cursing myself to a nasty burn on next trip>

Also in industrial situations a lot of burn creams / sprays are not allowed these days. Heck you can't even use eye wash in a lot of companies. I guess that all is different as the first aider would be prescribing if using those items. I guess that is another consideration for the first aider anywhere to consider before applying anything other than dressings and clean water.

Good thread this. Always good to get good first aid advice from people and a forum like this will always have someone highly trained like a paramedic or doctor. I wonder if there are any other first aid related threads on this forum. Could be worth a kind of archive of good first aid advice however proper training is more important and I guess a site collating advice is probably not wise for them. Afterall there is no way online you could confirm someone who gives advice saying they are a paramedic with 15 years experience is really what he or she says. Other than if you have some knowledge and it sounds right advice to you.

[Paul_B]

While there are likely to be some medics on here can I ask a slight off topic question about mountain first aid. If you are stuck on a crag waiting for evacuation with your colleagues (sorry I should say British mountains so really only hills to other nations). If one of them offers you some pain relief that is not available over the counter would you take it?? Reason I ask is I took something from a retired MRT member with 15 years experience and two 5litre tubs of first aid equipment in his sack!! Didn't feel pain after that but had to watch as two layers of large ambulance dressings fill with my blood. I think it was something like a strong kopake sort of thing. Codine based but stronger dose. Not sure I was feeling pain before it but certainly was glad of it when the MRT medic tried to take the dressings off one side of my hand to take a look. I guess pain was the body's way of telling me to puch his lights out!! :D Good job I'm a peaceful bloke.

[Totumpole]

I badly scalded my hand in an office accident a few months ago. I drove a short distance to the local minor injuries unit which happens to be part of the hospital that is one of the leading burns places in the country. They covered the scald with petroleum jelly soaked gauze (basically sterile Vaseline)
I was always taught in first aid not to apply any creams etc for anything but the most minor burn, otherwise once you get to hospital they would have to scrape the cream off first to inspect the burn- which sounds fairly unpleasant!

I think what you are referring to is Jelonet - you can pick it up online for your FAK if you want (and this reminds me I need to borrow some from work), probably not a bad idea if you do play with fire. You could even put this on broken/blistered skin as there would not be too much excess petroleum jelly left hanging around to be "scraped off". Also, it doesnt stick (if you simply stuck some gauze on it, it will stick to broken/bleeding/oozing wounds, and taking that off hurts!), this then some clean cling film is ideal. Most burns would have this type of dressing (jelonet) applied in the long run, until the underlying skin has healed or is amenable to skin grafts if that is what is required. Moisturisers come into play in the long run also to aid healing/reduce scarring.

[Paul_B]

I guess the range of dressings available in hospitals is quite wide. I had some of that rubbery grid like stuff that looks like the matting you can get to stop things sliding around on your car dash. Apparently non-stick to wounds but bloody does. Also once out of A&E your local GP surgery never has anything as good. In fact I think the GP surgery put that mat on and the Hospital stuff was better. None of it is easily found in chemists on the high street. I guess speciality dressings are trade only or at least direct from companies or distributors not retail chemist shops.

[Tadpole]

When practicing first aid you have to remember your job is “first aid”, not to promote faster healing nor reducing scaring.
It’s simple cool, cover, hospital in that order. Cling film:- great stuff but only AFTER you’ve cooled the skin/burn. Cool with gently running water for ten minutes, wait two minutes and if the burn feels warm or the burn still hurt cool for ten more minutes, repeat until the burn no longer feels hot. Then and only then apply a loose cover (cling film, or if the wound is on the hand /foot a clean large plastic bag) always a burn larger than a thumb joint goes Hospital. (Their thumb joint not yours, it’s all about proportion, a child’s thumb is in proportion to that child) I’ve treated a dozen or so partial thickness burn and only on has scarred and that was because the person, an adult, refused to do more than run it under a cold tap for a few minutes.

[ex member coconino]

...
If out and you've no 'clean' water,remember and cover the burn with a waterproof barrier before cooling with the water you have.

Aren't there problems with this? Apart from it taking vital time to find a waterproof barrier, surely it will also slow down the cooling process and could anyway stick to the burn. Also, unless one has a sterile waterproof barrier immediately to hand, an improvised barrier is unlikely to be any cleaner than the water. The advice I was given on a course yesterday was that, assuming no further danger and no other injuries, the first priority of cooling overrides everything else.

[Totumpole]

I guess the range of dressings available in hospitals is quite wide. I had some of that rubbery grid like stuff that looks like the matting you can get to stop things sliding around on your car dash. Apparently non-stick to wounds but bloody does. Also once out of A&E your local GP surgery never has anything as good. In fact I think the GP surgery put that mat on and the Hospital stuff was better. None of it is easily found in chemists on the high street. I guess speciality dressings are trade only or at least direct from companies or distributors not retail chemist shops.


Google shopping is a wonderfull tool for finding all sorts of things.
http://www.millermedicalsupplies.com/wound-dressings/jelonet/jelonet-paraffin-gauze-dressing-5cm-x-5cm-x50

[mrcharly]

P.S. Just for those of you wondering about burns classification. 1st degree burns (aka superficial) = redness of the skin, painfull (involve only the outer layer of skin - epidermis), 2nd degree burns (aka partial thickness) = redness, blistering, exudate (oozing fluid), PAINFULL (involve the epidermis and dermis), 3rd degree burns (aka full thickness) = white leathery appearence, painfull at edges but no sensation in affected area (all sking layers and some subcutaneous tissues affected), 4th degree burn (full thickness with injury to muscle) = describes burns so deep they involve underlying muscle.

Oh, that's interesting. I was told I had 2nd degree burns, but they actually match your description of 3rd degree (skin peeled off with gobbets of fat attached, but the burn sites weren't actually painful after the initial burn).

I'd like to emphasize to people that the burns I had were inflicted merely by a kettle of boiling water.

[The Lord Poncho]

I think what you are referring to is Jelonet

Yep that's the stuff- it was legendary. I might see about getting hold of some for my first aid kit too.

[dwardo]

Just my 2 peneth worth but no one ever seems to cool long enough and then complain about blistering???
15 seconds under a lukewarm tap isnt going to cut it, i always say how long does cooked fat take to cool?
A cold beer works well too ;)

[Ronnie]

I guess the range of dressings available in hospitals is quite wide. I had some of that rubbery grid like stuff that looks like the matting you can get to stop things sliding around on your car dash. Apparently non-stick to wounds but bloody does. Also once out of A&E your local GP surgery never has anything as good. In fact I think the GP surgery put that mat on and the Hospital stuff was better. None of it is easily found in chemists on the high street. I guess speciality dressings are trade only or at least direct from companies or distributors not retail chemist shops.

It's called Mepitel (http://www.dressings.org/Dressings/mepitel.html). It's replaced Jelonet in many clinical areas.

[Stirling3749]

An old kitchen trick to stem the pain of minor burns is to just tick your hand in flour. The idea is to block off the exposure to air so I guess that's why some folks have mentioned vaseline.

[WanderLust]

Hi all....new to forum and made a few posts in other threads.... a quick background on myself for purposes of medical background....
I served in the US Army for 8 1/2 years as a combat medic, have multiple deployments and have treated a diverse group of patients. My forte is obviously field trauma medicine, however I did work in the US Army's burn trauma center for several months while undergoing other medical training. I have had to treat different kinds of burns ranging from blast injuries, chemical, boiling water, burns from JP8 ( jet fuel) that ignited on someone. The advice I will be giving is based upon the fact that most people here have been posting under the scenario that they are in the wilderness. With that said there will be govt implemented standards of quality pre hospital care that are assumed, or disregarded for a survival situation.

In training we are taught about body surface area- BSA and how to calculate it percentage wise, this is great for describing to someone who hasnt seen the patient for themselves how much of the body is damaged due to burns. Rather a waste of time if the person is in front of you... if you want more info on BSA I will be glad to share on it later on.

1st deg burns for all intensive purposes are a minor annoyance, the meat and potatoes comes in the differing levels of damage and pain from 2nd and 3rd deg
Since I'm assuming that most reading are hear to get quick advice on how to help a friend or loved one in an emergency I will not go into a whole lot of depth describing each difference between degrees of burns.... also if the person/s are wearing jewelry in the affected area, you may want to remove it, as burnt flesh tends to swell...think of hot dogs in the microwave, if left on has a potential to cause an amputation.

K.I.S.S. - Keep It Simple, Stupid

2nd-moderate depth of burn, most recognizable by the blistering that occurs post burn
A. Severe enough that the bodys thermodynamics will have difficulty in regulating core temperature

3rd-' full thickness burn' will be noticable because the skin will look like a burnt steak
A. If a hospital is not in the immediate future great care must be taken in treatment, as well as given to the patient

Here's the tricky part... for every doctor you find that will tell you that dry sterile dressing are the best, you cand find just as many to say moist sterile dressings are the best.... in survival you must make the call, I myself am a proponent of wet dressings. There are a few emergency ways to go about this.

1. Buy petroleum impregnated gauze online
2. Go to a drug store and by either 2x2" or 4x4" gauze pads and white petroleum, and fill a container with the petroleum and let the gauze soak in it
3. In a pinch lip balm will work and some cloth if you do not have a first aid kit with you

The skin is the organ of the body that helps to prevent infections and to help regulate thermodynamics, with this protective barrier gone/damaged the body is now very prone to hypothermia and infection.... the more severe the burn, the more severe the risk of these are. The petroleum/neosporin/lip balm or whatever you use will help to create a water and airtight barrier against these outside threats. Not fool proof but better than a poke in the eye. Also burns get very dry and if non adhesive dressings are not available, this barrier helps to prevent further tissue damage/disruption.

If you are going to be ' stuck ' in this situation for a while you will also need a way to replenish the resources you have spent. IFAKS are great things to have, but the have very limited supplies in them, gauze will run out quickly. While not optimal, boiling a bandanna or it like will provide a fairly sterile wrap.

The other thing you must take into consideration, esp with more severe burns is hypothermia. Now burn patients are not only a high risk for infection, and they will 9/10 get one, hypothermia will kill them quicker. I have read posts on here that advocate the use of a lot of water, that's fine for minor burns, but for the more severe, you might want to reconsider.

Hypothermia is also a reason people argue to finite detail about dry vs wet dressings. the thought process is that if you cool them with wet dressings, you will kill them. this is when the big boy pants have to be put on and you have to make a conscious decision about what you are willing to do, and what you are willing to put the other person through.

the other thing not spoken about in these posts that I have read is the patients cooperation... They will be in a lot of pain and may not be still enough for you to help them properly without restraint, more likely the case for children. You may have to restrain them to help them. The amount of pain they experience is staggering, and pretty much nothing short of narcotics is going to help them. You will need to vigilantly assess and reassess while treating for shock.

If the burn is serious enough, even moving them to get them to help could put them into shock. If you can get them to a hospital, that's best, if not... my best advice is to keep them as clean, dry, warm, and comfortable enough until you are able to.

I hope this helps you out. I am no doctor and the advice given should be considered with a grain of salt. Most people who practice medicine may take issue with the advice I have given, because they more than likely have not been in a situation where they have had to provide care for seriously injured people for up to a week without the helps of special trucks and teams of nurses or doctors. I have...it is not fun, nor do I wish for any here to experience it first hand.

[WanderLust]

A quick addendum... when areas like hands or feet are concerned, take care to wrap each digit (toe/finger) individually, if not them will knit together creating a mitten instead of a hand or foot. If the airway is damaged due to super heated air or smoke inhalation... may have to perform an emergency airway. If the genitalia are damaged (mainly below the belt) A lot of clever folding and packaging will be needed. Also this may have damaged the persons ability to urinate or defecate. If they are unable to do this, new problems arise in the form of sepsis and septic shock.

[mrcharly]

Wow interesting and scary stuff.
I seriously hope I never have to remember your advice.

[WanderLust]

Wow interesting and scary stuff.
I seriously hope I never have to remember your advice.

I hope you don't either, but burns can be fatal in the cuty too, everything will be amplified out in the bush on your own. But maybe the info provided in this thread will help you someday

[crowded-solitude]

One thing DONT wrap in a towel, i remember in a few years ago my neighbors son fell in a bath full of boiling hot water his mum was a nurse but panicked and wrapped him in a wet towel and he spent the new few weeks in hospital removing the fibers and getting skin graphs. so as said before wrap in clingfilm till you can get to a hospital. A thing to add to your kit