First Aid for Typical Fire Injuries

A burn is defined as an injury to the skin or mucous membranes by one of the following agents: excessive hear, excessive cold, chemicals, and electricity.

Heat burns are liable to occur as the result of exposure to various sources of heat: the sun, hot liquids, hot steam, hot metals, open flames, and a flash following an explosion.

Note: Burns are familiar to virtually everyone. Very few people have never been burned. Generally, these burns are minor.

Very often, when the burn is not very deep, the victim him/herself can treat the burn, at least initially. Often, this treatment may prevent burn damage within a short period of time, and render any further treatment unnecessary. Severe and deep burns must be treated by a physician.

a.       Loss of fluids: This is the primary injury in the first hours after the burn. This can be dealt with by an intravenous fluid drip.

b.       Loss of heat and energy: The injured must be evacuated while covered in a clean sheet in order to prevent a rapid drop of body temperature.

c.       Infection: This jeopardizes the life of the injured at a later stage, and is the main problem of burn victims after they’ve overcome the loss of fluids.

d.       General phenomena of the digestive tract: Burns over large areas of the body might cause the victim’s stomach to swell and induce vomiting. Therefore, a burn victim must not be allowed to eat or drink, and must be encouraged to lie on his/her side to prevent the possibility of him/her choking on vomit inhaled into the lungs.

e.       Inhalation burns: Inhaling overheated air and smoke into the airways causes inhalation burns. If the victim was in an enclosed space where a fire took place or was discovered unconscious near the site of a fire, there is a concern that s/he has been injured by inhaling poisonous fumes or poorly oxygenated air. Carbon monoxide (CO) is responsible for most such poisonings; another poisonous gas is cyanide (CN), which is released when many materials, including plastics, burn.

f.         Direct injury from the heat: This is usually caused to the upper airways, above the glottis. This make cause edema, thereby wholly or partially obstructing the flow of air to the lungs. The symptoms of such an obstruction are hoarseness and harsh breathing sounds, and this requires the immediate evacuation of the victim to a treatment center with a doctor who can quickly insert a breathing tube into the trachea.

It is possible to classify burns into three degrees of severity, depending on the depth of the injury:

·         First degree burn – superficial: This is the mildest type of burn, in which the injury caused to the skin is limited to the upper layer of the epidermis only. These burns hurt a lot at first, but tend to disappear within a few days, with peeling of the upper layer of the skin.

·         Second degree burns – partial depth: This is a burn of medium severity in which the damage includes the epidermis and part, but not all, of the dermis. The upper layer of the skin may tear, and the burned area is covered by a fluid-filled blister. The blistering may occur up to several hours after the burn. The burned area swells with edema, and looks moist and sweaty. The victim suffers intense pain, and the burn itself is extremely sensitive. Even air moving over the burn causes the victim intense pain.

·         Third degree burns – full depth of the skin: This type of burn causes total destruction of the skin, i.e.: the epidermis and the dermis are completely destroyed. At times, injuries may go deeper still, and affect subdermal tissue such as fat, muscle, and bone. The depth of the injury depends not only on the temperature of whatever caused the burn, but also on the length of time the skin was exposed. Dead skin, composed of coagulated proteins, creates a thick and inflexible layer, called an eschar, a type of scab that has separated from the unaffected part of the body. The scab is hard to the touch, dry, and not sensitive to pain because of the destruction of the nerves that fed the skin.

1. Extinguish the fire!

• Immediately extinguish fire that is burning the victim’s clothing and hair. Anything that is smoking must be removed from the victim’s vicinity.
• It is important to extinguish any fire to the victim’s clothing immediately and thoroughly.
• The victim must not be allowed to run; this might allow the fire to burst into flames.
• The victim must not be allowed to stand; this might allow his/her hair to catch fire, and/or allow hot smoke into his/her lungs.
• The victim must be laid on the ground and told to roll, or be helped to roll, in order to smother the fire.
• After the fire is out, the victim’s clothing must be removed as the clothing may represent an ongoing source of heat.
• Clothing that is stuck to the victim must not be ripped off with force.
• If the victim’s clothing is saturated with flammable and burning liquids, the victim should be wrapped in a blanket or a sheet, and not sprayed with water.

2. Cool the burn!

The simplest, quickest and most efficient way to cool a burn is to run cold water from the faucet over it. If the burn is large, use the shower. Continue to soak or wash the site until the pain from the burn eases. If the skin has not been damaged, you can ice the burn. However, do not place ice directly on the skin, as this can cause additional damage (cold burns). Place a clean cloth on the skin, and the ice over it. The ice also eases the pain of the burn.

3. Keep the skin intact!

• Do not break blisters that form over a burn. The blister is nature’s most efficient bandage for burns. Breaking the blister creates a serious risk of infection.
• Do not tear off pieces of clothing that have stuck to the skin, so as not to cause further injury.
• Remove any clothing that is not stuck to the skin, to allow for better cooling of the burn.

Note well: All of the above applies to superficial burns over relatively small parts of the body. If the burn is very deep, and the skin sooty, charred, or hard and wax-like (indicating the presence of an eschar), do not wet the burn with water.

Additional directions

Do not cover the burn with oil, margarine, suntan lotion, toothpaste, etc. These not only do not help but can cause more injury.
Burns should be bandaged with clean bandages or with a clean piece of cloth. The victim should be brought to the hospital as soon as possible.

Burns in sensitive locations

Burns to the palms of the hands, the soles of the feet, sexual organs, elbows, knees and underarms, are considered more severe, not because they are life-threatening, but because of the degree of disability they may ultimately cause the victim. Therefore, such burn victims should be evacuated with the greatest urgency, immediately after victims whose lives are at risk.