How to Treat Thermal Burns on Board

12 June 2009 By Robin Drake, R.N, MedAire, Inc.

Whether your yacht is at sea for three days or three weeks, accidents can and do happen. Crew's close proximity to and interaction with onboard machinery and cooking equipment mean that burn accidents are likely to occur at some point.

So what, exactly, is a thermal burn, and what can you do to treat one? Skin contact with hot metal, scalding liquids, steam or flames can cause thermal burns. Even electrical malfunctions, sun exposure and medical radiation can cause thermal burns.

When treating a burn, the number one priority is to cool the burn area in order to stop or lessen the continuation of injury to tissue. It should be noted, however, to never apply ice directly or indirectly to any burn, as it may cause further tissue damage.

Follow these important first steps:
1. Remove all loose clothing around the burn, but do not attempt to pull off any clothing or other material that appears to be attached to the skin.

  • 2. Allow cool water to move across the burn area, preferably running water.
  • 3. Using a shower, or even submerging the affected parts, is acceptable as long as the water is cool (but not icy), and the temperature can be maintained.
  • 4. Applying a cool, clean cloth is recommended if running water is not available.
  • 5. Continue cooling for at least 15 to 20 minutes.

Once the burn has been cooled, a series of assessment techniques will help you determine the severity of the burn before proceeding with a treatment plan.

  • Inspect the burned area to determine the burn level:
    • Look for blistering (never break the blister, as it is a protective measure by the body) – which indicates a “partial-thickness burn” (the less-severe variety)
    • Look for red, white or black areas, leather-like skin, or skin with powdery-like substance – which indicates a more severe “full-thickness” burn.
    • Inspect for burns that continue completely around an appendage or trunk of the body, as these may lead to extreme pressure and tissue damage.
  • Ask about pain level, using a pain scale of one to 10, with 10 being the highest.
  • Assess for airway and breathing.
  • Check for other injuries, wounds, and possible damage to bones, other underlying body parts and tissue.

For adult burn victims, determine total burn surface area by comparing the adult palm to the area of burn. Each area of burn covering the approximate diameter of the palm is equivalent to one percent. An area approximately the size of five palms would represent a five percent burn, for example.

Your ability to provide this assessment insight to a remote telemedicine doctor will expedite treatment and determine whether additional shoreside medical attention will be needed – and how quickly.

Once the patient’s condition has been assessed, the first responder should proceed with a treatment plan. Small areas of minor burns without blistering may be left uncovered to help with cooling and to allow for quicker healing. Larger, blistered areas should be treated accordingly:

  • If needed, treat pain with over-the-counter pain relief medications, such as Tylenol or Motrin, prior to cleaning or dressing a blistering burn.
  • Cleanse the area using tepid water and mild soap, but do not rub the affected area.
  • Place layers of clean, sterile gauze (if available) on the burn, covering odd-shaped wounds and protecting blistered, raw skin.
  • Once the clean, dry dressing is applied, continuous gauze should be applied. The head, arms, legs and trunk of the body all may be wrapped in this fashion, but care should be taken not to wrap any extremities too tightly. Doing so may compromise circulation, which is vital to burn healing.
  • The use of first aid creams and medications is best left to medical professionals.

Burns of all shapes and sizes should not be taken lightly. When the severity of a burn is called to question, and the ship is far away from medical care, crews should always consider consulting an expert medical opinion.