Burns Prevention and Managing Minor Burns
This podcast is aimed at giving the audience an understanding of burn injury prevention and the management of minor burn injured patients. Information covered includes recognising what can burn and how these can be prevented; burn first aid; burn size and depth assessment; and management techniques. A great opportunity to have your burning questions answered.
Welcome to Smith and Nephew’s, Closer to Zero podcast, bimonthly podcast with leading experts in wound care, hosted by Smith and Nephew, helping healthcare professionals in reducing the human and the economic costs of wounds.
Hello, I'm Ruth Timmins from Smith and Nephew, and it's my pleasure to be here today for our special burns awareness month podcast. This episode focuses on managing minor burns and our special guest is Siobhan Connolly who is going to share her extensive knowledge in preventing and managing minor burns in the community setting. Siobhan has been working in burns for over 20 years and has been the burn prevention education manager of the ACI Statewide Burn Injury Service since 2005. Before this time she worked as a burn nurse specialist in the burn unit at the children's hospital at Westmead. Welcome Siobhan, thank you for joining us. I know many of us will have experienced a burn at some time or have had relatives or clients who've had a burn. I know sometimes managing burns can be confusing or we don't feel very confident in the best approach to take.
Hi Ruth and thank you for inviting me, there's nothing I like more than talking about burns.
That's great, well, you know, we know June is burns awareness month and we know prevention is always better than cure. So what is some of the risks and burns prevention awareness messages we should know about?
Yes, absolutely, prevention is definitely better than a cure. There are a lot of different types of burns, so we're probably looking at about eight different types, but the three main ones are scald, flame and contact, and there really are some simple steps for prevention of these burns. So scald are hot liquid, so it's often cups of tea and coffee, and mainly in small children and the elderly. And the simple steps that we can do are keep those cups of tea and coffee away from the edge and out of reach, so that they're not bumped or pulled accidentally. We want to make sure that we're supervising children, particularly when it comes to cooking. And we know in these times when there's a lot of children at home underfoot or at school home time, that there's a lot of two minute noodles and we want to make sure that the children are very, very careful and they're monitored and supervised during that time. Another thing that causes scald burns are hot water bottles, particularly in the cooler months. It's really important that people look at their hot water bottles, if they're using the same one from last year, make sure that it's still OK, but we actually recommend that people replace them every year. The next thing that causes burns are flames, so that's, especially in the winter, we have people with campfires, fire pits and home fires. Simple messages are things like staying a metre away from any heater or fire. And that means that particularly children, if you supervise them, they're not going to be able to get close so that they're going to cause issues. And of course, simple message never ever add an accelerant like a petrol, metho or anything like that to a fire, whether it's wet wood, you just wanna make the fire bigger. That actually makes it really volatile and the burn itself, the fire itself can actually explode and cause significant burns, not just to that person, adding the accelerant, but also to the people surrounding them. And then the contact burns are touching hot objects and unfortunately there's a lot of hot objects out there. Irons, ovens, those fireplaces indoors, and simple things like hair straighteners. A lot of people actually let their hair straighteners and curling ones cool down on the bed, on the floor, somewhere they think that it's an OK thing, but if they have a small child around then that child may come along, touch it, sit on it or anything like that. So never ever cool a hot object somewhere where somebody's going to step or fall onto it.
So that's some great advice there on trying to prevent burns, but as we know, unfortunately, accidents do happen and so if a burn is sustained, what's the current recommended first aid?
Yeah, so there's two main principles for burn first aid and they are stopping the burning process and cooling the wound. When we're talking about stopping the burning process, if the person is on fire, we stop drop, cover their face and roll. And that's something that every child will learn in school and that's the fire brigades will come in and teach that simple method. Again, something simple to stop someone getting burnt. For scalds, it's really important when, say for example, a child pulls a hot cup of tea or coffee on themselves, that clothing that they're wearing, and that includes nappies, socks, anything like that is removed. And that's because the clothing will actually soak up the hot liquid and it will continue to burn. So it's really important that we take everything off, make sure we've removed that heat and then we start cooling. It's important to remove the clothes so that we get rid of the heat and the other thing is if there's any jewellery, watches, anything like that, that can cause constriction or can continue the burning, it's really important that we take those off as well. And the other thing in regards to stopping the process is, if we've got a dry chemical on the skin that we brush that off before we irrigate, because we can activate that dry chemical. And then what we do is we cool the burn and the gold standard is cool running water for 20 minutes. And the good news is that you actually have up to three hours post-burn to actually give that cool running water. Soonest is better, so immediately is better, but you do have that window. It really is important when you're cooling the burn that you only cool the burn, not the patient. So keep everything else nice and warm, so that the patient doesn't become over cold. And the other thing to remember is when we're talking about first aid, is that cold burn, so reversed thermal burns caused by things like dry ice and LPG, we have the opposite first aid. So they're cold burns, they need warming as opposed to the hot burns that need cooling.
OK, that's a, that's really interesting there to learn about that three hour window, maybe some of us weren't aware of that. So that's really good advice, but obviously cool running water is the ideal, but what if that's not readily available? You know wherever you're out and about or something that's not to hand. So what's your advice in that scenario?
Yeah, a lot of burns actually happen out in the bushland when people are camping and they don't necessarily have running water. So if we have a small amount of water, putting it into a cup is really hard to cool hands or small burn area. And we say, if you've got two cups of cool water, you can put the burn over one and dribble from the top down to the next one and then alternate. So in all, in essence, you get the running part of that. But it's not as good trying to put something into a bowl means that the water itself is probably going to warm up. So it's not going to be as effective in the cooling, unless you have a really large area. So if you're next to the ocean or a river or something like that, it's a large area, it's got that cooling, so that would be OK. Stagnant dams may cause infection, they might have bacteria in there or any microorganisms, so it's not as good, but of course that's going to cool the burn a bit.
OK, so that's some great advice, but OK, so what if there isn't a way to capture the water, if you've only got a small amount of water available, what about wetting a cloth or a towel? Is that a reasonable thing to do?
Yeah, absolutely but we need to remember that, you can't just wet a towel and then put it on the wound because it will actually heat up very, very quickly. So what we normally say is if you can you wet two clothes or you fold up the cloth and wet a folded area, so that you can alternate, because if you just put one cloth on it heats up, if you alternate it, you leave them time to cool down in between, or if you rotate then you can actually get that cooling on there as well.
OK, well, that's some really great information on the first day that's recommended. So, we do know there is a lot of old wives tales and myths and misconceptions perhaps about what we should use on, on a burn. So what should we not use on a burn?
Basically everything else, but seriously, we've done a lot of research and we know that that cool running water is the best thing, that what we actually need, but there are so many old wives tales or what people learn when they're growing up from other cultures or from other countries. And they are things like toothpaste, butter, honey, creams, none of those are actually going to cool the burn down and that's what we're trying to do, we're trying to cool that and stop that burning from happening and causing damage. Things like ice can actually make the burn worse, because it can cause a cold burn, but it could also stop the blood flow to the area, which is something that we really don't want. We have a lot of things out there on the market that are ointments or hydrogels or something that have generally got tea tree oil in them and they are promoted has burn first aid, but we don't recommend them as first aid. They might be OK for dressings, but they're not good for first aid because they don't have that constant cooling for them.
OK, that's food for thought and probably a lot of people would be surprised at some of those and that we shouldn't use. So what are your thoughts on using plastic film wrap? Often we see or hear that perhaps on the television or something, so is that suitable after the first age component as a dressing?
Yeah, so plastic film wrap, isn't a first aid, but it's a really great dressing to use to protect the wound bed. If people are going to see a pharmacy or a GP to find out what to do with their burns, they can put a simple little bit of plastic wrap, glad wrap, whatever you want to call it over the wound, we don't wrap it tightly because that can actually cause problems if there's any swelling. So they can cover that and it helps with pain, with fluid loss and is actually more comfortable for the patients. When we've got our large burns, we actually recommend that they do put the plastic wrap on the patients because it can help with all of those sorts of things, pain, heat, loss, fluid loss. But it really is important that we never, ever wrap circumferentially because it can cause constriction.
OK, so that's great information about the immediate first aid and that window of three hours for the cool running water. What's your advice say perhaps it's after the three hours window and that a customer or patient presents perhaps in a pharmacy or a clinic setting what, what's the best treatment at that point?
It really depends on what sort of burn they have, so when we're talking about small burns, it doesn't always mean that they're going to be easy to treat. It's really important that we assess not just the size, but also the depth, small, deep burns may still need surgery to heal and long-term scar management, but thankfully, most burns aren't too serious. We're probably looking about 90 plus percent of most burns out there, only in that small, not very serious category, which is great. So one thing to check is if there are blisters, if there are no blisters and the skin is just red, then a simple moisturiser and by simple moisturiser, I mean something that's easily absorbed and doesn't clog the pores, that's the perfect thing to use for it. If there are blisters, it means that there's dermal damage and the burn needs a really good dressing. Now blisters are controversial, people say pop, don't pop, what do we do? The general rule is if they're smaller than 5mm, or you're sending them to a burn unit or a GP or somewhere for definitive treatment, then you can leave them intact because wherever they get to, they're going to be treated or they're so small that they don't need to be taken off. So for pharmacists, we would say leave all of those blisters intact and send that patient, if you're concerned about it being over 5mils. For GPS and clinics, if it's a simple burn with a blister and you're going to manage it, it's generally better to remove the blister, so that you can assess the wound bed and dress it appropriately. But remember if you're going to remove the blister, make sure the patient has good pain relief because it's going to hurt.
OK, yes, so that's understandable, it may be quite painful, but yeah, as you say, it means you can sort of assess the wound properly and treat it properly. So moving on then to ongoing treatment, what's the ideal type, you know or characteristics of a dressing to then cover the burn?
So burns are often dressed with a silver dressing, cause that protects against infection and helps with inflammation and longer term dressings are generally better cause they give the wound time to heal itself. For superficial burns anti-microbials aren't generally needed, so we will use a simple dressing. And when I say a simple dressing, it would be an impregnated gauze, a hydrogel, a silicone dressing, all of those are quite good. Dressings that actually go on easily, come off easily, don't cause any damage to the wound bed. You can use hydrocolloids but remember that they do have a stronger adhesive. So elderly with fragile skin may get a little bit of skin slippage, skin damage around the area. So maybe steer away looking at the patient and how it is. Obviously waterproof dressing is actually gonna help with compliance because if you put on a dressing and say to someone, you can't have a shower that actually impedes their daily living quite significantly. So if you can use a simple Island dressing over that area and make it waterproof, that's generally a good idea and remember that you have to remind the patient to keep moving it. We don't want them to heal in a contracted position because if it's slightly deeper, it will affect their function and movement later down the track.
Functional and that's really great advice there and I guess once the burns healed, we know that even minor burns can leave scars, which can impact the person. So what's your advice for scar management and what role does silicone gel sheets plays such as sick or care?
Yes, so as we've spoken about, smaller burns can be deeper and they can cause scarring and contracting, which can cause movement restrictions, and also cause lumpy scars that the patients are often concerned about. So burns teams will often use pressure and silicone to reduce those side effects of the scarring. The silicone will actually soften the scar and that it may cause a little bit of irritation when it goes on, so it does need to be monitored. So if somebody needs some form of scar pressure or silicone, or anything like that, we generally recommend that they contact a burn unit and just get a little bit of advice and they can be through your GP. The GP can write a referral, even if they haven't been treated with the acute burn, they can be sent through just for a review there.
OK, well thank you so much for sharing your expertise with us Siobhan and it's been really informative and I'm sure this has helped to dispel some myths around how to manage minor burns. But what would be your top three tips we should take away from today's podcast?
Well, obviously my big tip is prevention, prevention, don't get a burn at all. So, you know, promoting good safe behaviour is my main tip, but if we're talking about, if a burn has happened, my three main tips are really good first aid. So the good first aid helps the reducing the size and the effect of the burn. Simple dressings, 'cause that allows the body to heal in a protected way. And if you're worried about anything, call the burn team, that's what they're there for.
Well, that's great information, thank you again, Siobhan, and thanks to our listeners for joining us today. Be sure to tune in for our next podcast.
Smith and Nephew are proud to support clinicians in the prevention and treatment of burns to ensure positive patient outcomes. Our diverse burn portfolio ensures that we are able to treat burns in any care setting, whether it is a minor burn and managed at home or a major burns treating hospital. Our range includes Solosite to hydrate and soothe burns, a wide range of dressings to cover and protect the wound and also Cica-care silicone gel free, the treatment of scars. For more information, contact your local Smith and Nephew representative, or email us at ProfEd.ANZ@smith-nephew.com. The information presented in this podcast is for educational purposes only, it's is not intended to serve as medical device. Parts listed outline of care are examples only. Product selection and management should always be based on comprehensive clinical assessment. Detailed product information include indications for use, contraindications, precautions and warnings. Please consult the products applicable, instructions for use prior to use. Helping you get close to zero wound infection.
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Siobhan has been working in burns for over 20 years and has been the Burn Prevention/Education Manager of the ACI Statewide Burn Injury Service since 2005. Before this time she worked as a burn nurse specialist in the Burn Unit at The Children's Hospital at Westmead. She has completed a Bachelor of Nursing and Masters of Nursing Science (Burns Nursing). She is a Key Coordinator for the Emergency Management of Severe Burns (EMSB) course run by the Australian & New Zealand Burn Association (ANZBA). Teaching through Australia, New Zealand, Bangladesh, PNG, Fiji, Nepal, Indonesia and Timor Leste for the last 13 years. She is also a member of the Board of ANZBA. She is Chair of the ANZBA Burn Prevention Committee since 2008. She has co-authored multiple papers and developed numerous resources for burn management and prevention.