A very painful experience I am sure. Burns are simply one of those injuries that seem to induce pain out of all proportion to their size so I can imagine that these were very painful. In terms of treating burns there is a lot of rubbish advice out there and it is about time some of the myths are dispelled. Burns are unique injuries and in the outdoors they can be particularly difficult to deal with especially if they are extensive burns. They are broken down into varying degrees of tissue damage ranging from superficial sunburn to deep full thickness involving muscle and sometimes bone. The deeper burns are often described as being painless because the nerves are destroyed by the causative mechanism, however in over 30 years as a medic I have not once encountered any burn that was completely pain free. This is because every burn tends to have zones of varying degrees of depth penetration surrounding it, and it is usually, but not always the centre of the burn that tends to be painless. In terms of treatment specifically, the burn requires cooling, this is mainly to take the heat out of the tissues, but has the effect of also reducing pain, at least for as long as the cooling is taking place. Pain is caused by air movement over the exposed pain nerve receptors and so once cooled in order to reduce the pain you need to find a material which will prevent this air movement. Food wrap is pretty good but is a pain to work with however it is the recommended first line treatment following cooling.
To cool a burn requires copious amounts of water applied almost continuously for about 20 minutes. Depending on the extent of the burn this could just be from using water from a spring or stream, do not worry too much about the infection as this can be dealt with in hospital later. Of course use the cleanest water available. You could also use urine, sounds disgusting but as long as you are well hydrated, urine is sterile. Its also warm and this is an important consideration if the burn is extensive as it is easy to tip someone over the edge and into hypothermia. The most recent advice is to used cool water not ice cold, especially with extensive burns. This is the reason I always carry a Watergel burn blanket on an extensive wilderness trip. Watergel has the amazing ability to cool down a burn over a prolonged period of time without causing hypothermia and, the anecdotal evidence suggests an improved cosmetic outcome. They are ideal for use where water is likely to be limited and they can be used immediately. I highly recommend them. They can also be cut down to use on areas which are traditionally awkward to treat such as the face. A knife or scissors will quickly cut slits for the eyes, nose and mouth to make a face mask if needed. Carry a heavy duty ziplock bag so that you can replace the unused parts of the Watergel once you have finished the initial application.
Once this has been on for a while and the heat is gone from the wound then layer your food wrap over the burned area. I would also use a light dressing to hold it in place. For hand burns place the hand inside a plastic bag sealed at the wrist or first available clear area and encourage the victim to move their fingers to maintain mobility. This is because cooked flesh acts very much like any meat does when heat is applied and will shrink. This movement helps to prevent the tissues from healing in a cramped position.
On any area of burn on a limb there is likely to be some swelling so it is vital that any constricting bands such as rings, watches or bracelets are removed. Leave blisters intact as these act as a protective covering. Do not rip off clothing if it is stuck, remember also that extensive burns often have accompanying hypothermia because the bodies ability to cool and to retain heat is destroyed over the burned area.
Do not apply creams..... I will say this again... do not apply creams. Cream achieve nothing in the first instance and may prolong the burn by acting as heat retaining barrier, particularly if the heat has not gone from the burn. Even creams sold as burns dressing such as Flamazine are not good for field use and should be reserved for hospital or perhaps home use. They are designed as wound healing creams for use much later in the treatment continuum, and they are impractical for all but the smallest of burns because you need to layer these products on to a depth of at least 0.5cm, so you can see that a small tube of 30g of Flamazine will not go very far.
In a true wilderness then one could apply the Baux Score to predict mortality. This is based on the percentage of body surface area burned plus the age. If this is over 140, then the victim will not survive. If there is an inhalation injury also then you add 17 years to the age (or 17% burned area). You can use this method how you will and I offer no advice about how to proceed in a true wilderness emergency, this is for you to decide.
In summary:
1. Safety of yourself and remove victim from harm - BE CAREFUL not to become a victim yourself.
2. Put out the fire.
3. Manage ABC life threatening conditions.
4. Treat the burn by cooling for 20 minutes with water or Watergel dressings. Remove constricting bands. Once the heat has dissipated apply food wrap in layers and fix in place with a loose bandage.
5. If the burn is extensive and more than superficial, wrap the victim in an appropriate manner to prevent hypothermia.
6. Arrange evacuation in the most appropriate manner if the burn is greater than 10% total body surface area burned, there is burns to the hands, feet, genitalia, eyes, or inhalation (although this would be quite rare in the wilderness setting unless in an enclosed cabin).
Hope that you find something of use within this. For more info contact me here or on
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Dave C