Emergency Care of Burns in the Field

It happens so fast. The fire gets out of hand, the boiling pot spills over, or a flash of steam fills a space and before you know it, someone has been burned. How bad is it? What do you do? Do they need a doctor?
The first step is to understand how severe a burn is. This depends on the degree of burn, how much of the body is burned, and the location of the burn.

• First Degree: These burns are usually minor as they involve the top layer of skin only. They are characterized by reddening of the skin, mild to moderate pain, and are free from blisters.
• Second Degree: This is when the skin begins to form blisters. If over a small area, these burns generally do not require hospital-based treatment.
• Third Degree: This is when the burn goes through the skin and creates an open injury. There may be white charring around the borders of the burn. Often times, the actual burn area does not hurt as the nerves have been destroyed. These injuries need hospital care.
• Fourth Degree: This is a burn that involves the bone. Not much can be done in the field for this and without hospitalization the patient stands little chance of survival.

To determine how much of the body is burned, we refer to the “Rule of 9” as a guide for how much surface area is involved. This guide is for adults only, as children are portioned differently and have a separate “Rule of 9.”

Starting at the top:
• Head and Neck: The front and back are 4.5% each
• Arms: The arm is in 4 sections; the upper front, upper back, lower front, and lower back. Each is 4.5%
• Torso: From the bottom of the neck to the bottom of the ribs, the torso is 9%
• Back: From the bottom of the neck to the bottom of the ribs, the back is also 9%
• Abdomen: From the bottom of the ribs to the groin is 9%
• Lower Back: From the bottom of the ribs to the bottom of the buttocks is 9%
• Groin: This accounts for 1% of body surface area.
• Legs: The upper front, upper back, lower front, and lower back are each 9%

A second method to determine the percentage of body surface involved is the “Palm Rule” and translates well into the “Rule of 9.” From fingertips to heal of the palm is 9% of the body, roughly. This is best done with measuring the patient’s hand to compare it to their own body. If this isn’t possible, the caretaker’s palm will be close enough.

Burn Location will affect how sever a burn is. In addition, if a burn goes all the way around the torso or a limb, this creates a serious situation that requires hospital care. Any burns to the face, groin, palms, or joints will also require hospital treatment. If there are any burns to the face, singed eyebrows or nose hair, or soot in or near the mouth, it must be assumed that the airway has been burned as well. 3rd degree burns over 5% of the body as well as 1st and 2nd degree burns over 20% of the body require hospital care.

Actions:
• Stop the process: Even after removed from the heat source, the tissue that has been heated can continue to burn surrounding tissue. To stop the burning process, remove the heat source and apply copious amounts of tepid (not cold) water to the area.
• Inspect: Determine the location of the burn, what percentage is involved, and the degree of the burn.
• Treatment: Flush the burn area to help cool it and remove any debris that can lead to infection. To continue to soothe the burn, a wet, sterile dressing can be applied with a dry dressing over it. If wet dressings are used, caution must be exercised as to not over cool the patient. If the burn is over a large area, dry dressings may be a better choice in this regard. Dry dressings must be non-adherent. Keep the patient warm. The skin helps regulate body temperate so this may be a challenge. Avoid any oily or greasy ointments on 2nd and 3rd-degree burns. Change the dressings at least three times a day with fresh, sterile dressings.
• Pain Management: Ibuprofen or other anti-inflammatory pain killers can be used, but these will mostly only help with swelling. Without opioids, there will be little that can be done for the pain. Applying cool compresses in short intervals can help but be sure to not over cool the patient.
• Blisters: Avoid popping blisters in the field, especially on the palms of the hands or bottoms of the feet. If blisters pop on their own, keep them clean and dressed with dry, non-stick dressings.
• Infection: Burns come with a high risk of infection. Any open burns must be cleaned with warm water and anti-bacterial soap during each dressing change. Check the area for red, swollen skin. Also, red or reddish-purple streaks around the burn indicate infection. Without antibiotics, cleaning the area is about all that can be done.

Any significant burn should be taken to a medical facility as soon as possible, however, this is not always possible. With these steps, burns can be managed as best as possible in the field and it will be easier to identify injuries that require hospital attention. As always, locate supplies beforehand and have a plan in mind to avoid the injuries in the first place.

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Seth Belt

Seth grew up in Southern Arizona before joining the U.S. Navy. While serving in the Navy, Seth was an anti-narcotics operator and an anti-submarine operator for 5 years. He was lucky enough to travel to many of the Central and South American countries, as well as visiting many South East Asian nations and islands. One of Seth’s greatest joys from his time in the Navy was teaching new Sailors firearms education and safety. After leaving the Navy in 2010, Seth returned to Arizona and had a rough time learning how to be a civilian again, often working jobs that could barely pay the bills. After going to school, Seth became an Emergency Medical Technician in the Phoenix Valley, where he now lives with his wife and son.His areas of knowledge cover military, firearms, and emergency medicine.
Seth Belt
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