Home Accidents and Emergencies: Burns and Scalds

Burns and scalds injuries are a cause of public health concern, and the fourth leading cause of preventable trauma, worldwide. According to World Health Organization, burns and scald cause over 265,000 deaths, ever year. Over 90% of burn injuries occur in the least developed countries with undeveloped health care systems to meet the demand. Yet, burns and scalds can be preventable, emotional drains averted, and the social-economical stresses from lost productivity and cost of care avoided. To bridge the health gap, we shall look at the causes of burns and scalds, classification, burns, and scalds in children and adults, home management of burns and scalds (First Aid), prevention tips, burn-related complications, and some policy considerations.

Burns and scalds

A burn is an injury to the skin caused by contact with hot flames or fires, hot objects like water pipes, and hot liquids and oils spills.

A scald is a form of burn to the skin caused by hot water.

Classification of burns and scalds

Burns and scalds are classified according to the depth of the injury appearance of the burnt area, skin change, loss of sensation, and pain. Burns are classified according to the degree of the extent of their effect on the skin layers as;

First-degree burn.

Refers to the superficial burn, involving the top layer of the skin, and is the most common form of burn. The surface is pink or red. The burn does not form blisters, and the skin is dry. Superficial burns heal within one to two weeks and do not cause scarring.

Second-degree burn

Second-degree burns affect the upper and lower layers of the skin. It is painful because nerves ending and cells are destroyed. A second-degree burn causes redness on the skin, swelling, blistering, and is painful.

Third-degree burn

Third-degree burns is the most severe form of burn. It affects the outer skin layers and deep fatty tissues, hair follicles and sweat glands, and damage to nerves ending. The burnt area is painless as nerves ending are destroyed, painful edges, and may appear black or silvery. This type of burn has a risk of getting an infection because the skin, the body’s protective layer is destroyed, predisposing to contamination.

Risk factors for burn and scalds

• Women

Inherently, women interact with open fire and flames than any other gender in their daily chores. Poor cooking amenities and open fires increase the risk. Women catch fire when their clothes come in contact with flames while bending over cooking stoves. Moreover, women suffer more violent-related burn injuries compared to men.

• Children 

Burns and scalds are a common cause of injury among children below the age of five years. Most children at this age are closest to the maternal figure providing care. Children get scalded more often from hot liquids placed on tables tops by hot fluids (tea, porridge, milk, hot water) or from the hot bathwater. Burns from open flame is less common. 

Older children get burnt from starting unsafe fires to imitate adults’ activities like burning waste in the compound.

• Elderly

Older citizens get burns and scalds from direct contact with hot surfaces or fluids. Women face high risks of burn that occur in the home environment. Some of these burns and scalds happen in the kitchens and bathrooms from open flames and hot water, respectively.

• Workers

Burns and scalds are prevalent in the work environment and have consequences and costs implications. High-risk workplaces such as the hospitality industries with constant high exposure to thermal energy from open flames, ovens, and hot water systems.

• Existing medical condition

Underlying medical conditions. Epileptic people suffer more severe burns than ordinary persons. Burns in an epileptic person is characteristic because burns result from prolonged contact with the thermal source during an epileptic fit. Open flame is the most common cause of burns injury in epileptic persons, and they tend to have prolonged hospital stays.

• Drugs of leisure abuse

Substance abuse interferes with brain faculties, and drug intoxication increases the risks of burn and scalds and worse treatment outcomes of deaths and illnesses. 

• Quality of cooking methods

According to World Health Organization burn data registry, kerosene is the leading cause of severe burn injuries of large surface areas.

• Low social economic status

Low social-economic status increases the risks of burns and scalds through volatile cooking methods. Examples are overcrowded dwellings, large households, low education levels, and poor income.

Home management of burns and scalds (First Aid)

Several factors dictate how the burn is managed. The severity of the burn or scalds depends on the depth, the temperature of the hot object or liquid, the time it takes to remove the burnt part, and the length of time it takes to cool the burnt surface.

Therefore, to manage a burn or a scald successfully, the following first aid activities are fundamental;

• As a first aider, ensure your safety
• Quench off the thermal source, either by telling the victim to roll on the ground so that fire on the clothes can be put off or throw a blanket on the fire to remove oxygen and stop the burning process
• Assess for the ABC of first aid (airway, breathing, and circulation). Check if the airway is clear and breathing is consistent, and has a pulse. We shall cover more on this in a later article.
• Remove clothes from the burn victim, ensure that you do not hurt further the injured part. Remove pieces of jewelry, belt, and any clothes that can be restrictive. Burn injuries swell very fast.
• Pour running water or let the burnt part cool in the water for some time. Do not extend beyond 30 minutes to prevent lowering the body temperature.
• Never place ice cubes on burnt areas as it can cause more harm by deepening the burnt area.
• In chemical burns, dilute the strength of the chemical by watering the area with a large amount of water.
• Assess the surface area, if it’s more than the palm of their hand, seek medical attention immediately.
• Loosely wrap the burnt area with a clean cloth or a bandage to keep the air off the burn, relieve pain and protect the broken skin from infection.
• Do not apply any cream, jell, or any other substance to the wound unless directed by a health provider. 
• Raise the burnt area slightly above the heart level to relieve pressure and reduce swelling.
• Depending on the severity of the burn, take appropriate action. A minor burn may require no further care if the burn is large and deep. Seek medical attention promptly.

Complications of severe burns and scalds

• Dehydration. Loss of fluids from blistering of the skin.
• Bacterial infection. The large open surface area on the skin makes it susceptible to microorganism.
• Scarring. 
• Contractures. Often occur when scars are mature, thick, and restricting movement over joints.
• Disability. Loss of function of a body part following burns and scalds.
• Low body temperature (hypothermia) when a large surface area is burnt and exposed.

Prevention of burns and scalds;

At home

• Children account for the most patients with burns and scalds, keep them out of the kitchen.
• Handles of saucepans, kettles, and other cooking devices should face away from open space. 
• When an oily pan catches fire, do not lift it off the cooker, turn off the fuel source, and cover the pan with a wet cloth.
• Place cups and pots with hot liquids at the center of the table away from children who can pull and spill the hot content.
• To prevent burns and scalds in the bathroom, a common occurrence among the elderly, place non-slip mats.
• A small child should never be left alone in the bathroom where the bathtub contains hot water. Children love to play with water and is likely to put their hands in.
• The elderly should not sit too near the fireplace to warm themselves, they are likely to fall asleep and get burnt.
• Place a fire blanket in the kitchen that can come in handy whenever a fire breaks out, a bucket with sand, or a fire extinguisher, and know how to use it.

At workplace

• Ensure that occupation fire safety measures are vibrant at the workplace and the staff is conversant.
• Conduct periodic capacity training on fire safety and first aid, have basic first aid kits at hand.
• To assess emergency preparedness, conduct annual fire safety drills, identify gaps and work on areas of weaknesses.
• Prepare for mass evacuation and referrals in high risks occupations that are prone to fire outbreaks.
• Place warning stickers on hot surfaces

Policy considerations

• Set up a burn registry to analyze actual incidences of burns, their effects, and their impact on planning emergency care.
• Strengthen health capacities to treat burns and scalds to reduce disabilities.
• Establish public health literacy on risks, susceptibility, first aids, prevention, and long-term rehabilitation services.
• Promote fire safety, focusing on fire-prone environments, industries, and dwellings in informal settlements where fire outbreaks can be catastrophic.
• Strengthen operational research to inform policy decisions on innovative ways to increase fire safety in the general population.