What are Burns and Scalds? 

A burn is used to describe the damaging of the skin by heat. A scald is simply a specific type of burn, caused by wet heat.

Burns can be categorized by cause into 5 separate areas:

1. Dry Heat - e.g  hot metal surfaces, fire, friction
2. Wet Heat (sometimes known as scalds)- e.g scalds from hot liquids, steam, fats and oils
3. Chemical e.g. bleach
4. Radiation- e.g- sun
5. Electrical e.g being electrocuted

Burns are also categorized according to depth of skin damaged. The skin is comprised of three layers:

• the epidermis - the outer layer of skin
• the dermis - beneath the epidermis, and containing hair follicles and connective tissue. This lies on the
• the deeper subcutaneous layer, or hypodermis, which is made up of fat and connective tissue.

A superficial burn only affects the outer epidermis and most commonly occurs from scalds or sunburn, these burns look red, feel sore and are swollen.

An Intermediate burn affects both the epidermis and the dermis layers of skin and will looks raw and blisters will form.

A full thickness burn will have the layers of skin burned through to the subcutaneous fat layer and beyond. These burns may look pale, waxy and charred and nerve endings may have been burned away, leading to the casualty not feeling any pain in these areas. This is misleading as to the severity of the burn.

Consider the following factors when assessing burn injury:

The Size of the Burn

The skin is the largest organ in the body and so the larger the area of skin damaged the more severe the burn. Burn size is given as a percentage of the body's surface area. 1% of the body area is equal to one side of the casualty's open hand (fingertips to wrist). Anything larger than about 1inch (4.5cm squared) may need further medical treatment.

The Cause

Causes of burns may affect their severity, for e.g an electrical burn may cause the heart to stop or cause deep internal burns.

The Age of the Burn

The age of the burn can affect both severity and recovery rate for burns.  Children burn at a lower temperature than adults. However the very elderly may be more prone to infection and take longer to heal than a younger person. Burns in children should be looked at by healthcare professionals.

Location

Some areas of the body are more vulnerable than other to burn injury. Burns to an airway can stop a a person breathing. Those to the face may stop breathing or cause blindness; those that go all the way around a limb may constrict blood flow to the rest of the limb. Severe burns to hand and feet may result in the loss of use of fingers or a difficulty in walking.

Depth of the Burn

The deeper the burn the more severe it is.

Seek advice for burns if the burn is :

1. larger than 1 inch square
2. Goes all the way round a limb
3. Affects hands, feet or genitalia
4. If the casualty is a child
5. Full-thickness, regardless of size
6. If you are at all unsure

First Aid Treatment of Burns and Scalds

The key treatment is to remove the heat source and to cool the burnt area to prevent further damage occurring.

Always ensure your own safety first, eg turn off power supplies if electricity is involved or protect yourself from chemical contamination.

• Cool the burn immediately with copious amounts of cool water for at least 20 minutes* or until the pain is relieved.
• Immediate cooling is best, but it is still beneficial to cool up to 3 hours after the burn occurred.
• Remove jewellery and loosen clothing if possible, although please leave it on if the clothing is stuck.
• Dress the burn with a non-sticky dressing such as clingfilm.
• Dial 999 or 112 if the burn is severe or if the casualty has breathed in smoke or fumes.
• Take care not to cause hypothermia (i.e. do not allow the casualty to get too cold). So cool the burn, but keep the casualty warm.

For chemical burns, irrigate the burnt area for 20 minutes at least, taking care not to contaminate yourself with the chemicals.

*Note: Guidance on cooling times increased from 10 minutes to 20 minutes in 2019.

Learning More

You can learn more about treating burns and scalds on several of our first aid courses. The Emergency First Aid at Work course will help you with the basics, while the Paediatric First Aid and full First Aid at Work courses go into greater depth. If you'd like any more details on any of those courses, feel free to drop us a line.