Types of burn

First degree (superficial) burns affect the top layer of skin only. The skin looks red and is mildly painful. The top layer of skin may peel a day or so after the burn but the underlying skin is healthy. It does not scar. Sunburn is a good example.

Second degree (partial thickness) burns cause deeper damage. The skin forms blisters and is very painful. However, some of the deeper layer of skin (the dermis) is unharmed. This usually means the skin can heal well without scarring unless the area of the burn is large.

Third degree (full thickness) burns damage all layers of the skin. The skin is white or charred black. There may be little or no pain as the nerve endings are also destroyed.

Electrical burns can cause damage inside the body even if there is little damage to the skin.

First aid for burns and scalds

• Cool the burnt area immediately with cold water. Put the burnt area under a running tap. A shower or bath is useful for larger areas.
• Continue cooling with water for at least 10 minutes.
• Remove rings, bracelets, watches etc from the affected area. These may cause tightness or constriction if any swelling occurs.
• After cooling, remove clothing from the burnt area. However, do not try to pull off clothing that has stuck to the skin. This may cause damage.
• A cold compress such as a tea towel soaked in cold water may be soothing over the burnt area. This can be applied after the initial cooling under cold water.
• Paracetamol may help ease pain for small burns.
  
  Do not do the following
• Prick any blisters.
• Apply creams, ointments, oils, grease, etc. (The exception is for mild sunburn. A moisturiser cream or calamine lotion may help to soothe this).
• Put on an adhesive, sticky or fluffy dressing.

Home care and when to seek medical help

See a doctor or nurse if you are unsure about what to do after a burn. Some people are happy to manage small, mild (first degree) burns at home. Mild sunburn or small, mild burns or scalds are best left uncovered. They will heal quicker left to the fresh air. Even a small blister or two may be best left uncovered to heal. A dry, non-adhesive, non-fluffy sterile dressing can be used if the blisters burst. This will soak up the weeping blister and stop dirt and germs getting into the wound. The following gives some general guidance on when to seek help.

See a doctor or nurse as soon as possible for the following

• If the burn becomes infected. Infection causes a spreading redness from the burn that becomes more painful.
• If you are not up to date with tetanus immunisation.
• If blisters occur. Some people are happy to deal with small burns with one or two small blisters. However, a blister means a second degree burn and it may be best to see a doctor or nurse.
• Go straight to casualty (after cooling with water and first aid) for the following.

Electrical burns
Third degree (deep) burns, even a small one. These are burns causing white or charred skin.

Second degree burns (partial thickness) on the face, hands, arms, feet, legs or genitals. These are burns which cause blisters.

Any burn that is larger than the size of the hand of the person affected.

A non-fluffy, non adhesive material should be placed over larger or more serious burn before going to casualty. Cling film is ideal and is also soothing.

Tips on preventing burns - particularly to children

Preventing fires

• Fit smoke alarms in every floor of the home and check them regularly.
• Fireguards should be used for fires and heaters. Do not dry or air clothes on fireguards.
• Shut all doors at night. This prevents any fire spreading.
• Store matches away from children. Teach older children how to use matches correctly and safely. Don't just let them experiment and find out for themselves.
• Have a fire blanket in the kitchen.
• Chip pans should not be left unattended and should never be more than a third full with oil.
• Preventing scalds and burns

Keep young children out of the kitchen unless they are fully supervised.
The front of the oven and even the washing machine can become hot enough to burn a young child. Keep them away.
Use the back rings of cookers when possible. Turn pan handles towards the back and away from where a child may reach and grab.
Never drink hot drinks with a baby or child in your lap.
Never let a child drink a hot drink through a straw.
Teach older children how to boil kettles and how to use the cooker safely. There is no right age for this. Every child is different. However, it is important to teach them correctly when the time is right rather than let them experiment and find out for themselves.
Never heat up a baby's milk in a microwave. It may heat the milk unevenly and some parts may become very hot. Stir baby food well if heated in a microwave.
Put cold water in the bath or sink first and bring up to the required temperature with hot water.
Do not set the thermostat for hot water too high in case children turn on the hot tap.

Preventing sunburn

• Keep children out of hot sun particularly between 11am and 3pm.
• When out in the sun remember Slip, Slap, Slop - slip on a shirt, slap on a hat and slop on some high protection sunscreen.

Extract from Mentor Plus copyright OUP, EMIS and Authors 1999