First-Degree Burns. Limited to the outer layer of the skin (epidermis). The skin is red and tender and there may be swelling without blistering. Not generally considered serious.

Second-Degree Burns. Involve both the epidermis and underlying dermis. In addition to redness, tenderness, and pain, significant blistering occurs. These burns are not serious unless a large area is involved or secondary infection takes place.

Third-Degree Burns. Involve destruction of the full thickness of the skin and also may damage underlying tissue. Skin may be blackened or white and leathery feeling. Although these burns are always serious, there often is no pain because the nerves have been destroyed.

BURNS REQUIRING MEDICAL TREATMENT

• All widespread burns, including extensive sunburn.
• All second-degree burns greater than 2 to 3 inches in diameter or those involving the hands, face, or genitals.
• All-third degree burns regardless of size.

MINOR BURNS
Minor burns include first-degree sunburn and small scalds or burns from hot objects.

TREATMENT FOR FIRST-DEGREE BURNS

• Flush the burned area with cool water from a tap or use cool, wet compresses applied to the skin.
• Cleanse the burned area. Aloe vera cream, aspirin, or ibuprofen may alleviate pain. Usually, further medical care is not necessary.

TREATMENT FOR SECOND-DEGREE BURNS LESS THAN 2 TO 3 INCHES IN DIAMETER

• Rinse the area with cool water, gently wash with soap and water, and rinse again. Spray with an antiseptic spray and cover with sterile dressing.
• Do not apply ointments, petroleum jelly, margarine, grease, oil, butter, or other home remedies.
• Avoid breaking blisters, which increases the risk of infection. If blisters become infected, seek medical attention.

MAJOR BURNS
TREATMENT

• Remove the victim from the fire or other source of injury. Douse flames or flush chemicals off the skin surface.
• If clothing is ignited, lay the victim down and extinguish flames with water or by covering with a blanket or coat, or by having the victim roll over slowly. Do not allow the victim to run. Running fans the flames and spreads the burns to the upper body and face.
• All larger second-degree burns require medical treatment. In the case of extensive burns, check for respiration, circulation, and signs of shock, and treat appropriately. Then look for other serious injuries and treat.
• Apply cool compresses briefly to bring skin temperature back to normal. Avoid prolonged cooling of a large area because it can lead to excessive body cooling.
• Wrap the victim loosely in a clean sheet and call 911 for an EMS rescue team or, if not available, transport to an emergency room.
• Do not try to remove burned clothing or objects that adhere to the burned area, and do not apply any ointments or other medication.
• Loss of body fluids, pulmonary complications, and infection are major dangers of extensive burns. All extensive burns should be treated in a medical treatment center with a specialized burn facility.

CHEMICAL BURNS
TREATMENT

• If the chemical container contains first-aid instructions, follow them.
• Start treatment immediately by placing the burned area under cool running water and continue flushing for at least 15 minutes or longer.
• If the chemical has splashed into the eye, irrigate the injured eye with cool water. Make sure the eye is open and the head is positioned so the water will not run into the other eye. (If both eyes are involved, flush them simultaneously by tipping the head back and pouring water into both.) Irrigate for at least 15 minutes, then cover the eye with a sterile compress and take the victim to a hospital emergency room.

Note: Not all chemical injuries are burns. Some injuries, such as those caused by liquid hydrocarbon (e.g., Freon), cause freezing. In these cases, the person should be treated for frostbite (see information on frostbite in "Overexposure" later in this chapter). Other chemicals are absorbed through the skin and produce a toxic reaction. When working with hazardous chemicals, wear protective work gloves and other safety clothing. If the skin is exposed to chemicals, wash the exposure area immediately and thoroughly and call your local poison control center for further guidance. (See appendix C for a listing of poison control centers.)

ELECTRICAL BURNS
Electrical burns are often deeper and more serious than they seem.

TREATMENT

• First-aid treatment is the same as for other types of burns. All electrical burns should be examined by a physician.
• Victims of electrical burns should be evaluated for other injuries. When a person is struck by lightning or comes in contact with a high-tension wire, respiratory muscle paralysis, cardiac arrest, and bone fractures may result. These serious injuries must also be cared for.