Identify the proper procedures for treating a casualty with burns.

Given multiple-choice examination items pertaining to burns.

Score 70 or more points on the 100 point written examination.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

11-1. INTRODUCTION

This lesson is basically divided into three areas: classifying burns, stopping additional injury, and treating existing burns.

When you first discover the burn casualty, you should eliminate the source of the burn (if still present) in order to protect both the casualty and yourself. Once this has been done, make sure the casualty is breathing, any major bleeding has been controlled, and measures have been taken to 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.

Burns can be classified by their cause and by their severity. Burns can result from thermal, electrical, chemical, or radiant sources. They are usually rated as being first, second, or third degree in severity.

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

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. The burn may not appear to be 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 an 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 are caused by contact with liquid or dry chemicals such as ammonia, caustic soda, quick-lime, or white phosphorus (WP).

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, and microwaves). The primary danger is damage 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 retinas at the back of his eyes. Laser burns cause a decrease in his sight. The injury may not cause pain.

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

First Degree Burns. First degree burns cause the skin to be red and painful (like a sunburn), but does not produce blisters.

Second Degree Burns. Second degree burns are more serious. The skin is red and painful and blisters are present.

Third Degree Burns. Third Degree Burns. Third degree or full thickness burns destroy skin and extend down through underlying tissue to bone. The third degree burn area may not be painful because the nerves have been destroyed, but the surrounding second and first degree burn areas may be painful.

If the casualty's clothing is on fire, cover the casualty with a large piece of nonsynthetic material, such as a wool or cotton 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 flames until the flames go out.

CAUTION: Do not use synthetic materials such as nylon and rayon because they may melt and cause additional injury.

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

a. Stop the Current

If the electrical current can be turned off quickly, such as flipping a nearby switch, turn off the current first. If it will take more time to turn off the current than to separate the casualty from the electrical wire, cut off the electrical current after you have removed the casualty from the current and have administered aid.

Remove Wire 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 nonconducting object, such as a dry wooden pole, to move the wire away from the casualty. Then, gently lower the casualty to the ground.

FIGURE 11-2. REMOVING AN ELECTRICALWIRE FROM UNDER A CASUALTY

Remove Casualty from Wire. If you cannot remove the wire (no other soldier to help, for example), then remove the casualty from the wire.

Use nonconducting material to drag the casualty from the wire. Do not let your body come into contact with the casualty during the process.

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 wire. Administer mouth-to-mouth resuscitation to the casualty if needed.

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

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 nonflammable fluid to flush the area.

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, flush the area with as much water or other nonflammable liquid as possible.

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

Burns caused by radioactive particles sticking to the casualty's skin are treated by brushing the particles from the casualty and flushing the skin with water. Take care to keep the radioactive particles and contaminated water from coming into contact with your skin or your clothing.

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 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.

A radiant energy burn to the eye will affect the casualty's vision. Keep the casualty from looking at the light source and/or remove him from the path of the radiation. Protect the soldier from additional exposure to the radiant energy source and keep the casualty out of bright sunlight.

The casualty's eyes do not need to be bandaged. The casualty may feel more comfortable if a cloth is placed over his eyes. If a bandage is applied, only bandage the involved eye. Do not place anything over his eyes if he needs to walk or continue to perform his mission.

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

At the time of the burn, apply copious amounts of water to the burn site.

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.

If the casualty is wearing jewelry on a burned arm or hand, remove the jewelry and put it in the casualty's 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.

Apply a field dressing over the burned area, unless the area is on the face or genitalia, and secure the dressing using the attached tails. The dressing will help to prevent additional contamination. Tie the tails tight enough to hold the dressing in place, but not so tight as to put undue pressure on the injury. If a field dressing is not 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.

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

Do not break any blisters that have formed.

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

If the burn is an electrical burn, find and dress both the entry and the exit wounds.

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

Fluid lost due to a severe burn can result in shock. Take appropriate measures to prevent shock 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. If second and third degree burns cover over 20 percent of his body surface, an intravenous infusion (I.V.) should be started by the combat lifesaver or the combat medic. Initiating an I.V. is taught in IS0825.

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