Doom and Bloom Medicine: Burns, Part 1 – First- and Second-Degree

A wide variety of situations, both in normal times and disaster settings, put us in proximity with high levels of heat. If we’re knocked off the grid, it won’t be unusual to cook food over a fire of our own making, something very few do on a regular basis. As such, the survival medic will often be faced with burn injuries. Having the materials and knowledge to treat burns will be absolutely necessary in times of trouble.

Burns can be caused by contact with sources other than flames, including:

•             Scalds due to contact with hot water or steam.

•             Contact with electricity associated with lightning or another source.

•             Friction burns due to contact with hard surfaces such as roads (“road rash”), carpets, or hard flooring.

•             Skin exposure to extreme cold and winds. Yes, extreme cold can cause burns.

•             Chemical spills.

•             Radiation due to contact with energy emitted by x-rays and other medical testing or treatment, “dirty bombs,” or thermonuclear explosions.

In general, the different types of burns are treated similarly, although some burns, like those caused by electricity or radiation, may cause internal damage without destroying the skin. Inhalation of superheated air may cause damage to lung tissue. Off the grid, the lack of advanced care will make these cases a challenge for the medic.

The severity of a burn injury and resulting chance of death or disability depends, in part, on the percentage of the total body surface involved, as measured by the “rule of nines.”

Assessing the percentage of body surface area burned is standard practice and helpful in modern medicine. It may, however, have less practical benefit in austere settings where transport isn’t an option. In any case, knowing the “rule of nines” may give the medic an idea of the chances of recovery for a burn victim.

Burns to the face, feet, hands, genitals, and lungs are considered the most problematic. Burns that go completely around a body part, say, an arm, cause constriction that may affect circulation. Areas with a lot of scar tissue may have limited mobility.

BURN DEGREES

Besides total surface area involved, an important factor is the amount of penetration of the burn. This is usually measured in degrees.

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