Chapter 12: Burns

What Can Happen

A care worker is making tea in the kitchen of a woman in her eighties. The woman reaches for the cup before it is ready, her hand shakes, and hot tea spills over the back of her hand and her wrist. She gasps, then says that it is nothing and that she wants to carry on with her morning. The skin is already turning red. The care worker knows that what happens in the next few minutes will decide how deep the burn becomes.

Burns are painful, and in older people they can be deeper and slower to heal than they look at first. This chapter explains the first aid for burns that courses teach today, how to tell when a burn needs emergency help, and how to prevent burns in daily care. It also explains how to deal with burns from hot surfaces and the sun on the road in summer. Quick and correct cooling is the most useful thing you can do for a burn, and it needs nothing more than cool running water. As in every chapter, follow your workplace's emergency procedures and report what happened.

Step by Step: First Aid for Burns

Step 1. Stop the burning as quickly and safely as you can. Move the person away from the source of heat, or switch off the kettle, the cooker or the heater. If clothing is on fire, help the person to the ground and smother the flames with a heavy blanket, a fire blanket or a coat, or tell a person who is able to do it to stop, drop to the ground and roll. Do not let the person run, because moving air makes the flames stronger.

Step 2. Cool the burn under cool running water for about 20 minutes, as many guidelines advise. Start as soon as possible; cooling still helps even if some time has passed. Cool water is enough, so do not use ice or ice-cold water, because they can damage the skin further. If there is no tap, use a shower or any cool, clean water you have, such as bottled water poured slowly over the burn.

Step 3. For a large or serious burn, call the emergency number, or ask someone else to call, while the cooling continues. Do not stop cooling to make the call yourself if another person can make it. Put the phone on speaker and follow the operator's instructions. The next section explains which burns need emergency help.

Step 4. While the burn is cooling, gently remove rings, watches, bracelets and tight clothing from around the burned area, because the skin may swell quickly. If clothing is stuck to the burn, leave it in place and cool over it. Cut clothing away around a stuck part rather than pulling it off, because pulling can tear the burned skin.

Step 5. Keep the rest of the person warm while you cool the burn. Older people and people who are thin or frail can become cold quickly when they are wet for a long time, so cool the burn, not the whole person. Cover the parts of the body that are not burned with a dry towel or a blanket. If the person starts to shiver strongly, tell the operator or a nurse, and follow their advice.

Step 6. After cooling, cover the burn loosely to protect it from dirt and air. Clean plastic food wrap makes a good cover; lay it over the burn in a layer rather than wrapping it tightly around an arm or a leg, because the limb may swell. A clean plastic bag works well for a burned hand. If you have neither, use a clean cloth that will not leave fluff on the wound.

Step 7. Do not put ice, butter, oil, creams, ointments, sprays or any home remedy on a burn, because they keep the heat in, can cause infection and make the burn harder for a doctor or nurse to assess. Do not burst blisters and do not touch the burned area, because blisters protect the skin underneath. Do not use sticky plasters or fluffy cotton on a burn. If the person asks for a remedy they remember from the past, explain kindly that cool water is what helps the skin most.

Step 8. Stay with the person, reassure them, and watch for signs of shock, as described in Chapter 10, especially with a large burn. A burn on an older person that is more than very small should be seen by a doctor or a nurse, even if no ambulance is needed. Tell the doctor, the nurse or the paramedics how the burn happened, when it happened and how long it was cooled, because this helps them to judge how deep it is. Record the burn and report it as your workplace's procedure says.

When a Burn Needs Emergency Help

Call the emergency number for a burn that is larger than the palm of the person's hand, for a deep burn, and for any burn that goes all the way around an arm or a leg. A deep burn may look white, grey, brown, black or leathery, and it may hurt less than a smaller, shallow burn, because the nerves in the skin have been damaged. Do not let a lack of pain reassure you. Call also for burns on the face, the hands, the feet, the joints or the genitals, because these areas are hard to heal and important for daily life.

Smoke and hot air can burn the inside of the mouth, the throat and the airway. If the person has been near a fire or in smoke and has soot around the nose or mouth, singed hair on the face, a hoarse voice, a cough or difficulty breathing, call the emergency number at once, even if the skin looks fine. Help the person into fresh air if it is safe for you to do so, and help them sit in the position that makes breathing easiest. Swelling in the airway can get worse over time, so do not wait to see whether it passes.

Every burn from electricity needs emergency help, because the damage under the skin can be much worse than it looks, and electricity can upset the heartbeat. Never touch a person who may still be in contact with electricity. Switch off the power at the switch or the main supply first, and if the source is a fallen power line outside, stay far away, keep others away and call the emergency number. When it is safe, check the person's breathing and be ready to start CPR, as described in Chapter 4, and then cool any burns.

Burns from chemicals, for example from strong cleaning products, also need emergency help. Protect yourself with gloves, brush off any dry powder, and rinse the skin with plenty of cool running water for as long as the operator advises, while you remove any clothing with the chemical on it. If a chemical has splashed into an eye, rinse the eye gently with running water, keeping the eye open and letting the water run away from the other eye. Keep the container or the label to show the paramedics.

When you are in doubt, call or get medical help, especially for a burn on a very young child, an older person or a person with a serious health condition. For a small, shallow burn that is red and painful but not blistered, cooling and a loose cover are often enough, but watch it over the following days. Increasing redness, swelling, pus, a bad smell or a fever can be signs of infection, and they need a doctor or a nurse. Report these signs as your workplace's procedure says.

Burns in Daily Care

Many people who receive care are at higher risk of burns than other adults. Their skin is often thinner, so heat damages it faster and more deeply. Some health conditions reduce feeling in the hands and feet, so the person may not notice that something is too hot, and a person living with dementia may not be able to say that it hurts. A person who moves slowly may not be able to pull away from hot water or a heater in time.

Hot drinks and food are among the most common causes of burns in care. Let drinks cool a little before you hand them over, use cups with lids or handles that suit the person's grip, as the care plan says, and place hot drinks on a stable surface rather than on the person's lap. Never carry a hot drink over the person or pass it across them. Check the temperature of food that has been warmed, because some parts can be much hotter than others.

Check the bath or shower water before every bath, using the thermometer and the temperature your workplace sets, not only your own hand, because your hand may feel less heat than the person's skin. When filling a bath, follow your workplace's procedure, which often means running the cold water first. Never leave the person alone in a bath while the hot tap can be turned on, and check the water again just before the person gets in.

Hot-water bottles, heating pads and electric blankets can cause deep burns, even at temperatures that feel only warm, when they stay against the same patch of skin for a long time. Follow your workplace's rules about them; many workplaces do not allow them at all. Keep radiators, heaters and hot pipes covered or guarded, and check that the person does not sit or sleep pressed against them. Look at the skin of a person who cannot move easily for redness after they have been near any source of heat.

Cooking together can be a pleasant part of the day, and it is safer with a few habits. Turn pan handles inward so that they cannot be knocked, keep the person's loose sleeves and scarves away from the cooker, and stay in the kitchen while anything is cooking. Steam from a kettle, a pan or a heated dish can burn as badly as hot water, so open lids away from the person's face and hands. If the person likes to help, give them tasks away from the heat, such as stirring a cool bowl or setting the table.

Step by Step: Burns From Hot Surfaces and Sun on the Road

Step 1. Before an outing on a sunny day, touch the metal and plastic parts of the wheelchair, the car seat, the seat belt buckle and any bench with the back of your hand before the person sits down or holds them. Surfaces that have stood in the sun can be hot enough to burn skin, and a person with less feeling may not notice. Cover hot parts with a towel, or move them into the shade first.

Step 2. Keep the person off hot ground. Pavements, roads, sand and metal covers in the sun can burn bare feet, hands and legs within a short time, and a person who falls outside on a hot day can be burned while lying there. If the person has fallen, move them off the hot surface only if you can do so without moving an injured part. Otherwise, gently put a blanket, a coat or a mat between the skin and the ground where you can, and give shade.

Step 3. If skin has been burned by a hot surface, cool it under cool running water for about 20 minutes, as for any other burn. Outside, use water from a bottle, a tap or a hose. Let a hose run first until the water is cool, because water left in a hose in the sun can be hot enough to make the burn worse. Then cover the burn loosely, as described earlier in this chapter.

Step 4. If the person has sunburn, help them out of the sun into a cool, shaded place, and cool the skin with cool water, a cool shower or cool, damp cloths. Offer sips of water if the person is awake and able to swallow safely, because sunburn often comes together with heat and the loss of fluid. Ask a doctor or a pharmacist before putting anything on sunburned skin, and keep the skin covered from the sun until it has healed.

Step 5. Look for signs of heat illness at the same time. Heavy sweating, weakness, dizziness, headache or nausea can mean heat exhaustion, and confusion, strange behaviour or collapse can mean heatstroke, which is an emergency; Chapters 6 and 7 explain what to do. Call the emergency number for heatstroke, and get medical help for sunburn that blisters over a large area or comes with fever, chills or feeling very unwell.

Step 6. Prevent the next sunburn and the next burn from a hot surface. Plan outings for the cooler times of day, choose routes with shade, and dress the person in a wide hat and light, loose clothing that covers the arms and legs. Keep towels in the car to cover hot seats, and park in the shade when you can. Record any burn and report it as your workplace asks, so that the team can plan safer outings.

Things to Check

Check that the first aid kit at work and in the car contains disposable gloves, clean plastic food wrap or clean plastic bags, and dressings that do not leave fluff. With these, you can cover a burn properly after cooling.

Check where the nearest cool running water is in each place where you work, and carry enough water on outings in summer. Knowing this saves time when a burn needs about 20 minutes of cooling.

Check that the bath thermometer works and that you know the water temperature your workplace sets. Testing the water before every bath is one of the simplest ways to prevent a serious burn.

Check the person's care plan for anything that raises the risk of burns, such as reduced feeling in the hands or feet, shaky hands or difficulty speaking. This tells you where to take extra care with heat.

Check radiators, heaters, kettles and cookers in the person's home for guards, safe positions and damaged cables. Report anything that looks unsafe as your workplace's procedure says.

Check the wheelchair, the car seats and the seat belt buckles with the back of your hand before every summer outing. A towel kept in the car makes a hot surface safe in seconds.

Check that the person's clothing for cooking and for sitting near heaters is close-fitting, with no loose sleeves or trailing scarves. Loose fabric can catch fire quickly and is hard to put out.

Check that you know where the fire blanket and the fire extinguisher are kept, and what your workplace's fire procedure says. A first aid course and your workplace's fire training together help you to act quickly and calmly.