Preserving quality of life after burns – lessons in burn care

Guest blogger Kristina Stiles, Head of Clinical Services at The Katie Piper Foundation and co-creator of the Burns Game, explains how appropriate first aid can significantly improve outcomes for someone with a burn injury:

Most people have experienced a burn injury at some point in their lives and can appreciate the pain and distress such injuries can cause. Luckily, most of these are usually minor and do not require specialist treatment or surgery. And with increasing health and safety regulations and the reduction in dwelling fires, there are fewer injuries sustained as a result of a burn. So surely - that’s good news?

Burns are considered low incidence – high cost injuries. The clinical flip side is that the low volume of burn injuries means clinicians may not have the competence, confidence and capacity to effectively treat burn injuries. The general public also lack awareness on the basic first aid interventions for burns. And the ultimate cost is often the greatest for the burn survivor and their quality of life after a life-changing injury.

The simple question we all should ask of ourselves is “would I know what to do if I, my family member or my patient experienced a burn?”

The British Burn Association advises that cooling the burn wound with tepid water for 20 minutes within three hours of injury is the most important factor in reducing burn wound severity, yet this is still not widely known by the public.

Cooling reduces swelling and depth of injury, provides pain relief, cleans the wound and improves healing, which prevents burn wound progression and will result in a more superficial burn that heals with less scarring. This simple action can prevent the wound from increasing in size and can offer much better outcomes for the individual – and it is something that we can all do, regardless of whether we have healthcare knowledge or not.

Burns first aid: the burn wound healing timeline

Cooling

20 minutes

Early application of cool water is the most important factor in reducing burn wound severity and has been shown to reduce wound damage and increase wound healing. Use cool tap water (8-20°C) for 20 minutes.

This removes heat, reducing swelling and depth of injury, provides pain relief and cleanses the wound.

Delay

3 hours

Applying cool water as soon as possible is best – but doing so within 3 hours will continue to have a beneficial effect.

Progression

3 days

Burns evolve over time and exhibit a phenomenon known as burn wound progression, which peaks at three days. Superficial burns can progress into deeper wounds if left untreated.

Healing

21 days

Burn wounds that heal within 21 days are less likely to result in hypertrophic scarring (thick, raised scarring) – making appropriate early management of the burn wound essential.

Unfortunately, only 39% of adults and 48% children with a burn injury receive appropriate first aid. The pain and distressing nature of burn injuries can lead to poor or inappropriate first aid.

The use of toothpaste, butter, cream, eggs or ice to soothe the burn wounds is frequently witnessed by specialist burn services - none of these “treatments” are beneficial to burn wound healing. In fact, any oil-based substances, like butter or cream, can trap heat in the wound, and ice may cause a frostbite injury, leading to deepening of the burn, which may require surgery and result in a scar. Jewellery can compromise blood flow to the injury area; clothing and nappies can retain heat and therefore all should be removed as early as possible.

Whilst bystanders and caregivers often provide some immediate cooling when a burn injury occurs, healthcare professionals should be mindful of the fact that the recommended treatment of 20 minutes can seem like a lifetime and may be an unrealistic expectation - especially when dealing with traumatic and distressing injuries. The first attending clinicians should administer appropriate first aid, including cooling.

Many burn injuries are cared for by clinicians who are not burn specialists – such as in the community or emergency departments. Lack of exposure to burn injuries and minimal training/education on burn injury first aid leads to limited knowledge and confidence in the management of burns - it is not surprising that non-specialist healthcare professionals often feel out of their depth in caring for burns patients.

Evidence-based courses and resources are now being offered to support advancement of burn care knowledge and expertise, which were not previously available. By raising awareness and expertise of burn prevention, first aid and initial management, we are collectively improving the overall quality of burn care and are delivering better quality of life outcomes for burn survivors.

Courses/Resources: