First aid is an essential part of caring for injured patients; first aid applied appropriately saves lives, while that which is applied wrongly can worsen the patient’s condition or even cause death. Wrongly applying first aid may also cause harm to the one offering the help.
In the month of June thus, we will focus our attention on applying first aid in various circumstances. The first installment in the series focuses on burns.
According to the WHO more than a quarter-million people die from complications of burns annually. The majority of these fatalities are caused by thermal (heat), chemical and electrical burns, and basic knowledge in applying first aid for these situations can save many lives.
Thermal burns are the commonest kind of burns and children wandering unattended in kitchens are usually the victims. Thermal burns may result from contact with hot liquids (e.g. hot water or boiling soup), hot solids (e.g. a pressing iron), or flames. In all cases, the longer the contact time, the more severe the injury. As such, the first action is to remove the person from the source of injury. This is particularly important in fires, since the accompanying smoke inhalation can be more devastating than the burn itself.
Next is to immerse the affected part in water (preferably, cool tap water) for about 30 minutes. This is crucial, since cooling is known to inhibit some chemical mediators in the body that cause further damage after the burns. Do not use ice water or ice cubes, as this causes frostbites and also promotes hypothermia, a condition where the body temperature goes dangerously low, inhibiting optimal function.
While this is being done, all jewellery and other constricting items should be removed since tissue swelling may make it difficult to remove later. Items that are stuck to the skin, however, should be left in place.
It is advised that balms, ointments and concoctions not be applied before leaving for the emergency room, as this may contaminate the wound. Rather, the person should be covered with a clean sheet or blankets, an action that also provides much needed warmth. Cellophane may be used to cover the burn before covering with the sheets to protect the wound from contamination and help ease the pain.
Acids (like battery acid and industrial acids) and bases (like household bleach and drain cleaners) are the main causes of chemical burns. Most cases are accidental, but deliberate acid attacks are also common.
First responders to the victim of a chemical burn should take care to protect themselves from injury by wearing utility gloves, or covering the hands with a towel
After this precaution is quickly taken, remove the victim from the source of ongoing danger. Subsequently remove all contaminated clothing and jewellery, and gently irrigate the affected part with water continuously for at least 10 minutes. Do not immerse the affected part in water; though this may dilute the chemical at the site, it will expose surrounding areas to chemical injury as well.
Be sure not to allow run-offs from the irrigation process to touch unaffected skin, as this may spread the area of the burn.
In the case where the agent is ingested, do not try to induce vomiting. Do not administer diluents like water or milk in cases of ingestion of liquid acids or bases, as this may induce vomiting, re-exposing oral and oesophageal tissues to further damage.
In the very few cases where metallic lithium, sodium, potassium, or magnesium is present at the burns site, do not irrigate with water as this can cause an explosion or worsen the reaction. Rather soak the burnt area in baby oil or other mineral oil before sending patient to the hospital.
Electrical burns are usually suffered by electricians who receive electrical shocks while working on live wiring, or children playing with house wiring.
The most important action in managing electrical shocks is breaking the electrical contact with the person. It is advised that this is done by switching off the mains. If the mains switch is not readily accessible, prod the person away from the electrical source with a DRY piece of plastic or wood e.g. long broom, ceiling brush or pestle. Be careful in doing this; never use a metal rod and make sure the object used is not wet or even moist. Wearing rubber-soled shoes and standing on a dry wooden board provides extra safety.
After this, the person should be sent to the emergency room for management of the electrical burns and all other abnormalities.
Be careful about judging the severity of the wound of electrical burns; a very severe electrical burn may have just two small wounds at the entry and exit points of the electrical current. Do not assume that such a wound is not serious, as the real damage may be hidden from sight.
Arrhythmias (abnormal heart rhythm) may also occur as a result of electrocution. As such, promptly send all electrocuted patients to the hospital.
Prevention is always better than cure and although certain events are just unfortunate accidents, doing the following can help make burns less likely in your house:
Keep children away from the kitchen and never leave them by a source of heat or naked flame (like a candle) unattended.
Point the handles of cooking utensils towards the back of the stove.
Never store dangerous chemicals like bleach and acid in containers that are not clearly labelled as such, and keep such chemicals safely stored, preferably under lock and key.
Tuck away all naked wires in the house and ensure the mains is switched off before any work is done on the electrical connections in the house.
Ensure that all naked flames, like lit candles, are never left unattended.
Keep a well maintained fire extinguisher in or close to the kitchen.
Test smoke detectors at least once a month and change them every 10 years.
With these preventive strategies, we should be able to limit the incidence of accidental burns, and if they do occur, we should be able to apply first aid appropriately and effectively.