LESSON 13
PERFORM FIRST AID FOR BURNS
(TASK 081-831-1007)

TASK:

Identify the proper procedures for treating a casualty with burns.

CONDITIONS:

Given multiple-choice examination items pertaining to burns.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCES:

STP 21-1-SMCT, Soldiers Manual of Common Tasks: Skill Level 1.
FM 21-11, First Aid for Soldiers.

NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htmfor up-to-date task information.

13-1. INTRODUCTION

This lesson is basically divided into two major events--stop the casualty from suffering additional burns and treating existing burns. When you first discover the burn casualty, you should eliminate the source of the burn in order to protect both the casualty and yourself.

Once the casualty has been protected from further burns, take measures to ensure the casualty is breathing, stop major bleeding, and control shock. Exactly when the burn wound is treated depends upon the seriousness of the injury and upon other injuries which the casualty suffered. A burn with serious bleeding should be treated quickly. If a burned area is on a fractured limb, the burn should be dressed and bandaged before the limb is splinted. Minor burns on a casualty with a life-threatening injury may not need to be treated until the casualty is seen by medical personnel at the medical treatment facility.

13-2. CLASSIFY BURN AS TO TYPE

Burns can be classified by their cause. Burns can be thermal, electrical, chemical, or radiant.

Thermal Burns

Thermal burns are caused by heat. They can be caused by coming into contact with a flame, a hot object, a hot liquid, hot gas (such as steam), or the fireball from a nuclear explosion.

Electrical Burns

Electrical burns are caused by an electrical current passing through the body. They can be caused by coming into contact or near contact with a charged ("live") electrical wire or lightning. Electrical burns can be deceiving. It may appear that the burn is not serious because only a small area of skin is burned. In reality, however, a great deal of damage may have been done to the casualty's body. Electrical burns involve both an entry burn where the current entered the body and exit burn where the current left the body. An exit burn may appear on any part of the body and can be in a quite different location from the entry burn. The sole of the foot is a common location for the exit burn.

Chemical Burns

Chemical burns are caused by contact with either liquid or dry chemicals such as ammonia, caustic soda, quick-lime, or white phosphorus (WP). Blisters caused by a blister agent are actually burns.

Radiant Energy Burns

Radiant energy injuries are caused by bright visible light (such as lasers and electric welding arcs) or other forms of light energy that are not visible (such as ultraviolet light, infrared light, microwaves, and radar waves). The primary danger is to the eyes.

Laser Beam. A person who looks directly into a laser (light amplification by stimulated emission of radiation) beam can receive damage to the retina at the back of his eye. Laser burns cause an immediate decrease in his ability to see, but are not painful.

Welding Arcs. A person who looks directly at a welding arc can receive burns on the surface of his eye which result in severe pain and sensitivity to light. The pain and sensitivity to light may last until the burn has healed two or three days later. Mild symptoms may appear even if the person did not look directly at the welding arc.

13-3. PUT OUT FLAMES

FIGURE 13-1. SMOTHERING FLAMES

If the casualty's clothing is on fire, cover the casualty with a large piece of nonsynthetic material such as a blanket and roll the casualty on the ground until the flames are smothered. If nonsynthetic material cannot be obtained quickly, get the casualty to the ground and have him roll on the flame until it goes out.

13-4. REMOVE A CASUALTY FROM ELECTRICAL CURRENT

If the casualty is still in contact with the source of the electrical current (lying on a "live" electrical wire, for example), separate the casualty from the source of the current before administering buddy-aid. Assume that any electrical wire is live (carrying electrical current) and can be a danger to yourself as well as to the casualty.

Stop the Current

If the electrical current can be turned off quickly (such as flipping a switch), turn off the current first. However, if it will take more time to turn off the current than to separate the casualty and the source of the current, cut off the electrical current after you have separated the casualty and have administered buddy-aid.

Separate Casualty and Current

Remove Source of Current from Casualty. Loop a dry rope, dry clothing, or other material which will not conduct electricity under the casualty's body and lift the casualty from the wire. Have a second person use a wooden limb or other long, nonconducting object to move the wire a good distance from the casualty. Gently lower the casualty to the ground after the wire has been removed.

FIGURE 13-2. REMOVING AN ELECTRICAL WIRE FROM UNDER A CASUALTY

Remove Casualty from Current. If you cannot remove the source of the current from the casualty, then remove the casualty from the source of the current. Use nonconductive material to push or drag the casualty from the current source. Do not touch the casualty during the process.

Check for Breathing

Electrical shock often renders the casualty unconscious and causes difficulties in breathing and heartbeat. Check the casualty's respirations after you have separated him from the current. Administer rescue breathing to the casualty if needed.

13-5. REMOVE CHEMICALS THAT CAUSE BURNS

Chemicals that attack the skin should be removed as soon as possible.

Liquid Chemicals

Pour as much water as possible over the burned area. (This is commonly called "flushing" the area.) Use water from a canteen, Lyster bag, or water trailer if it is available. If a sufficient amount of water is not available, use any fluid that is drinkable (potable) to flush the area. When flushing an affected eye, ensure it is lower than the other eye to prevent contaminants from entering the good eye.

Dry Chemicals

Use a clean dry cloth to brush off loose particles of the dry chemical. Take care to avoid getting the particles on your body. After brushing off the particles, if a large quantity of water is available, flush the area with as much water or other drinkable liquid as possible. Small amounts of water applied to a dry chemical may cause a chemical reaction transforming the dry chemical into an active burning substance.

White Phosphorus

White phosphorus is used in marking rounds and grenades. It begins to give off heat and light when exposed to air. Quickly smother the flame with water and cover the area with wet materials or mud. The wet material or mud will keep air from getting to the white phosphorus and thus keep the particles from burning. Keep the materials covering the phosphorus wet. If the materials dry out and air reaches the phosphorus, the phosphorus will start to burn again.

Get medical help or evacuate the casualty. Appropriate medical personnel can remove the phosphorus particles from the casualty's flesh. Do not attempt to remove the particles yourself.

Fallout

Burns caused by radioactive particles sticking to the casualty's skin are treated in the same manner as regular dry chemical burns.

Chemicals in the Eye

Chemicals can destroy the tissues of the eye. The eye must be flushed with water as quickly as possible.

Position the casualty's head so that the eye to be flushed is lower than the other eye. This keeps chemicals from the eye being flushed from flowing into the other eye.

Hold the casualty's eyelid open.

Pour the water gently into the eye. Pour from the inner edge of the eye (end closest to the nose) to the outer edge.

Continue to flush the eye with water for at least 20 minutes.

13-6. TREAT RADIANT ENERGY (LASER) BURNS OF THE EYE

A radiant energy burn to the eye will affect the casualty's vision. Keep the casualty from looking at the light source. There is no buddy-aid treatment for radiant energy burn other than to protect the eyes from additional exposure to the radiant energy source and to keep the casualty out of bright sunlight.

The casualty's eyes do not need to be bandaged. The casualty, however, may feel more comfortable if a cloth or loose bandage is placed over his eyes if he does not need to walk or continue to perform his mission.

Evacuate the casualty when the mission allows so he can be examined by medical personnel.

13-7. TREAT SKIN BURNS

Expose Burned Area(s)

Cut and gently lift away any clothing covering the burned area. Do not pull clothing over the burned area. Leave any piece of clothing that sticks to the burned area in place.

Dress and Bandage Burned Area(s)

Apply a field dressing over the burn wound and secure the dressing using the attached tails. The dressing will help to prevent additional contamination. The tails should be tight enough to hold the dressing in place, but not so tight as to put undue pressure on the injury.

If you do not have a field dressing available or if the burned area is too big to be covered by the dressing, use the cleanest material available to cover the burned area. Secure the material with strips of cloth.

An electrical burn casualty will have an entry and an exit wound. Dress both wounds. The sole of the foot is a common location of exit wounds.

Do not try to clean the burned area before applying the dressing.

Do not apply any grease, ointments, or medications to the burned area.

Do not break any blisters that have formed.

Do not place any dressings over the face or genitalia.

If the burn is caused by white phosphorus, keep the dressing wet.

If the casualty is wearing jewelry on a burned arm or hand and the jewelry can be removed easily, remove the jewelry and put it in his pocket. Burns often cause the limbs to swell and the jewelry may have to be cut off later if it is not removed now. Tell the casualty what you are doing and why.

Check for Shock

Fluid lost through burns is a cause of shock. Take appropriate measures to prevent shock (Lesson 11) if they have not already been started. If the casualty is not in shock and is not nauseated, you can give him small amounts of cool water to drink. Stop administering the water if the casualty feels as though he may vomit or if signs or symptoms of shock develop.

Get Medical Help

Seek medical help for the casualty or evacuate the casualty, if practical. Casualties with serious burns should be seen by medical personnel as soon as practical.