To whom does this guideline apply?

This guideline applies to adults, children and infants. 

Who is the audience for this guideline?

This guideline is for use by bystanders, first aiders and first aid training providers.

Summary of Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations:

1. Remove the person from danger if safe to do so [Good Practice Statement].
2. ANZCOR recommends to commence cooling of burns with running water as soon as practicable [CoSTR 2015, strong recommendation, very low certainty of evidence].^1-4
3. Duration of cooling should be at least 20 minutes [Good Practice Statement].^2,5
4. Cooling should be commenced as soon as possible, but may help if started up to 3 hours after the burn [Good Practice Statement].^3,6
5. For chemical burns, thoroughly irrigate with water then call Poisons hotline (Australia
   13 11 26 and New Zealand 0800 764 766) and refer to safety data sheets [Good Practice Statement].⁷
6. Send for an ambulance for significant burns.

Abbreviations

A burn has been defined as an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or chemicals.⁸ A significant burn for the purpose of this document is one with any of the features described in the Appendix 1.⁵

• Ensure safety for rescuers, bystanders and the person.
• Send for an ambulance if significant burn or any doubt if this is a significant burn.
• Do not enter a burning or toxic atmosphere.
• Stop the burning process:
  • Stop, Drop, Cover and Roll
  • smother any flames with a blanket
  • douse with water if safe to do so.
• Move away from the burn source to a safe environment as soon as possible.
• Maintain an open airway and assess if the person is breathing normally. If not breathing normally, treat as described in ANZCOR Guideline 8.
• Check for other injuries if safe to do so.
• If safe, and if trained to do so, give oxygen to all people with smoke inhalation or facial injury, following The Use of Oxygen in Emergencies (Refer to ANZCOR Guideline 9.2.10).

The aims of first aid treatment of burns should be to stop the burning process, cool the burn and cover the burn.  This will provide pain relief and minimise tissue loss.²

• These include flame, scald, blast (hot gas), inhalation injury and direct heat contact.
• ANZCOR recommends to cool burns as soon as practicable with cool running water [CoSTR 2015, strong recommendation/low quality evidence]¹. Cool for at least 20 minutes,^2,6 up to 3 hours after the burn, the sooner the better.³  Use any clean cool liquid, for example beer or soft drink, if water is not available. Use commercial cooling gels only after a minimum of 20 minutes of cool running water, or if no cool water is available.  Cooling is effective up to 3 hours after injury.³
• If possible, remove all rings, watches, jewellery or other constricting items from the affected area without causing further tissue damage.
• Remove wet, non-adherent clothing as clothing soaked with hot liquids retains heat.
• Cover the burnt area with a loose non-stick dressing, preferably clean material e.g. plastic cling film. Place the cling film over the burn but do not wrap around a limb. Do not use cling film on the face.
• Cover unburnt areas and keep the person warm to reduce the risk of hypothermia particularly small children who may develop hypothermia quickly.
• Where feasible elevate burnt limbs to minimise swelling.

DO NOT peel off adherent clothing or burnt substances.

DO NOT use ice or ice water to cool the burn as further tissue damage may result.

DO NOT break blisters.

DO NOT apply lotions, ointments, creams or powders.

Australian and New Zealand Burns Association (ANZBA)

Prof Fiona Wood, Australian Honour, Member of the Order of Australia (AM) 

A significant burn for the purpose of this document is:⁵

• A burn greater than 10% of total body surface area (TBSA) which in an adult is approximately the size of the arm or half the leg
• burns of special areas—face, hands, feet, genitalia, perineum, and major joints
• full-thickness burns greater than 5% of TBSA
• electrical burns
• chemical burns
• burns with an associated inhalation injury
• circumferential burns of the limbs or chest
• burns in the very young or very old
• burns in people with pre-existing medical disorders that could complicate management, prolong recovery, or increase mortality
• burns with associated trauma.

All infants and children with burns should be medically assessed.

ANZCOR Guideline 2 Managing an Emergency

ANZCOR Guideline 8 Cardiopulmonary Resuscitation

ANZCOR Guideline 9.2.3 Shock

ANZCOR Guideline 9.3.3 Hypothermia and Cold Injury First Aid management

ANZCOR Guideline 9.5.1 First Aid management of Poisoning

ANZCOR Guideline 9.2.10 The Use of Oxygen in Emergencies

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