Burns

Let’s talk about the first aid management of burns- what is recommended, and works; and what is not recommended, and doesn’t.

Firstly, let me tell you what the Australian Resuscitation Council recommends, based on evidence, for the acute management of burns outside of hospital.

The summary is as follows:

The Australian Resuscitation Council recommends that First aid should consist of cool running water, applied as soon as possible after the burn injury has occurred and for 20 minutes duration as this treatment has been shown to significantly reduce tissue damage, improve wound re-epithelialisation, and decrease scarring.
Ice should not be applied to a burn as it has not been shown to promote healing and may in fact cause frostbite.(www.awma.com.au/journal/1801_01.pdf)

So that is current best practice. Cool running water over a burn for 20 minutes, which reduces pain, limits further tissue damage and promotes healing. Most people do not hold the burn under running water for as long as 20 minutes, but this is the optimal time in order to have the long- term benefits just stated. The other major consideration in treating a burn is attempting to not introduce infection. Keep that in mind as you read the following:

The earliest known records of the treatment of burns comes from the Ebers Papyrus, an Egyptian medical papyrus of herbal treatments dating to c.1550 BCE.  In here is listed mud, excrement, oil and plant extracts on different days after the burn injury has occurred, as well the application of frogs boiled in oil or of fermenting goat dung.
In the 4th Century BCE, Greek and Roman treatments included dressings infused with rendered pig fat, resin and bitumen – a mixture of honey and bran followed by cork and ashes and in the first century AD, or CE, a lotion of wine and myrrh for burns. The Greek physician and philosopher Galen, in the second century CE, is reported to be the first to advise the application of cold water for burn treatment.

So, as in history, even today, many different things are used for burns, despite the fact that we now know that there is good evidence for running water and not much else.

 

3d image of metal tap and running water

 

Burns can be difficult enough to treat in the pre-hospital environment without people applying home remedies prior to ambulance arrival. Let me recount a particular incident which describes how difficult a large body surface area burn can be to manage. This particular patient that myself and my partner attended had sustained partial thickness burns from neck to knees. As you can imagine, the patient was in an enormous amount of pain and distress. The priority was to get the patient under cool running water for the reasons already discussed- but because it was such a large area this meant the shower rather than a tap. Cannulating a patient who is screaming in pain under cool water that is soaking the both of you is no easy task, as the veins become difficult to find as a result of both the cold water and the patient going into shock. Thankfully, cannulation was successful and Morphine and fluids were administered with good effect, but the patient was on the verge of hypothermia by the time we got out of the shower. Losing such a large area of skin and having it exposed to cool water for 20 minutes means that hypothermia, as well as infection, are significant complications and concerns for burn management. To avoid these complications as best you can, avoid putting the burnt area in a container or bath of cool water- these containers are generally not sterile for starters, and if it is a significant burn, the water will just heat up around the burn, making that treatment less effective- there is some evidence in the literature that the cooler the water is, the more effective it will be, especially in the case of smaller burns, where hypothermia is not a concern. Try to run the water over just the burnt area itself, whilst keeping the rest of the patient warm. Avoid putting any gels or lotions on burns. Aloe vera and the like can be used for superficial burns such as sunburn where the skin has remained intact, and after application of water.

Horrible burns on female hand isolated on white

So now to the strange alternative treatments for burns that are out there.
Firstly. Butter on burns. Many in my classes report their grandmothers or mothers using this on them when they were kids. This treatment originated from a Surgeon General Friedrich von Esmarch in the 19th Century. He wrote a handbook on battlefield medicine, and recommended that burned surfaces should be covered with an oil, grease or butter- the idea being to seal the burn off from the air, keeping it clean and helping it to heal. There is no evidence for the healing properties of butter on burns. The coolness of the butter if it were refrigerated (doubtful on a battlefield) may help with pain relief, but there are no other benefits known.
Here are some other purported treatments for the acute treatment of burns- none of which have any evidence behind them: toothpaste, soy sauce, cold yellow mustard. Vanilla extract. Mayonnaise. Milk. Peanut butter. Raw pork fat. Sliced potato. Sliced tomatoes. Raw onions. Baking soda. Sour cream. Vinegar. Haemmorhoid cream.

I’m going to guess that all these remedies have been tried because many burns happen in the kitchen, and these products are close at hand. Well- haemorrhoid cream may be kept in the bathroom I suppose, but still- not too far away to apparently give it a whirl. Perhaps some of these have been perceived to be successful if they came straight out of the fridge. Again- no evidence. Water is best.

Then I came across this disturbing incident in an online forum, describing an incident with a little girl who had spilled boiling tea over her legs.

“I knew that tea tree oil was good for burns, and since I had some in my bag, I offered to apply some to her legs. I had to assure my friend, and especially her daughter, that it would definitely be of some help. They did not even know what tea tree oil was, so they were hesitant. But clearly ANYTHING that could help would be welcome, because the girl was screaming uncontrollably at this point.

We took her out of the shower and dried her legs as best we could. Then, I put some oil in the palm of my hand, rubbed my hands together, and rubbed the oil on her legs. For a brief moment, everything was okay. But then she started screaming like you wouldn’t believe, saying it was hurting her even more.

Admittedly, I was a little surprised myself, because I had not experienced a reaction like that before [neither from myself, nor from any of my children]. My friend was alarmed, and asked me if that was normal. I told her I had never seen that type of reaction, but that I thought it was because her legs were wet and her pores were open.

I asked her daughter to be patient and wait, and that it would soon get better. She tried her best to wait in out, but she was unable to bear the pain. At this point she was jumping up and down begging us to take it off of her.

I felt really bad because she was clearly in a lot of pain because of ME, but I didn’t really know what to do because I thought that water would only push the oil deeper into her her skin. After briefly discussing it, my friend decided to try washing it off, because doing something was better than doing nothing.

After washing her legs off with soap, like a much welcome blessing from God, she stopped crying. 23 loooooooonng minutes, and she finally stopped crying! She said it still hurt a little, but that it felt much better.

My friend took her daughter home, and the next morning she called me to let me know that there was not a single mark on her daughter’s legs. It was as if nothing had happened!

Perhaps the 23 minutes under the shower may have contributed to this miraculous result.

Now. To the ever more frightening.

Homeopathic first aid kits on the internet.

(If you are not familiar with the principles of Homeopathy, click here for a good run-down- or for the TL;dr version, don’t use homeopathy for first aid treatment of ANYTHING). For about $64 AUD on eBay, you can get 18 small vials of sugar pills at a 200C potency, which claims to treat the following ailments: Bruises, Burns, Scalds, Bites, Stings, Sprains, Strains, Splinters, Wounds, Whiplash, Bleeding, Shock, Trauma, Distress, Fainting, Fractures, Concussion, Hypothermia, Chill, Sunburn, Heat stroke, Poisoning, Diarrhoea and Allergic reaction.

Homeopathy pills

Homeopathy pills

One homeopathy website describes several homeopathic preparations that they claim are useful for the acute treatment of burns- a worry, if they are advocating homeopathy for burns over cool running water.

One homeopathic treatment for burns is called ‘Sol’ – “This remedy is made from potentised sunlight.” Captured sunlight in a bottle that has been diluted somehow. “It is useful in sunburn both as a preventative in those who are extremely sensitive to the sun and as well curative in overexposure. May be useful reducing the amounts of UV radiation in the skin.”
One more disturbing claim for the acute treatment of burns:
This person, a.k.a ‘the fire burn doctor‘,  comes from a group of acolytes of a Dr. Phillipe Sauvage. The claim of the FireBurndoctor is this: free, instant burn recovery when you call or text a phone number within 30 minutes of the burn occurring.  This healing is claimed to be done remotely- over the phone. Information to be sent is the person’s name at birth, date of birth, and place of birth- or alternatively, text a picture or any photograph of the person. In the ‘about’ section on the website is this:

In that ‘computer context,’ I would define myself as ‘Bio-Matrix Hacker’ and my technique as the way to break into the ‘Bio-Fields Continuum’ (the ‘Matrix’) that interconnects us all with one another (and with all living organisms ultimately) like a global ‘bio-internet’…. Then, when an individual computer (a person…) is experiencing troubles, bugs, crashes or an accident (as for instance with a burn injury), all that I am doing is ‘writing’ a specific bio-program with appropriate bio-algorithms to resolve and correct the problem, then ‘hack’ the bio-matrix to be capable to upload it. It will be then automatically downloaded to the individual ‘computer’ (the person) that has experienced a crisis to fix the specific software conflict or problem.

They claim to have taken away all pain and all traces of the burn of many people. However on the main page of the website is this “Call within the first 30 minutes, on your way to hospital. Free processing is in addition to normal medical procedures and is done in a minute.’
So, the patient undergoes normal medical procedures in the first 30 minutes- that is the application of water.

Cool, running water over a burn is the best, and only evidence-based treatment for the acute management of burns.

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