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Cool burns cautiously and avoid applying ointments

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Burns are one of the most devastating types of injuries. Remarkable improvements in burn care over the past 50 years have occurred.

Each year more than 2.5 million people experience burn injuries in the United States. Most burns are of limited extent (more than 85 percent involve less than 20 percent of the victim's total body surface area); however, more than 60,000 people require in-hospital care, and about 5,500 die from their injuries.Burn severity is determined by its depth and the amount of the victim's total body surface area involved. Burned injuries are classified as first-degree (superficial), second-degree (partial-thickness), or third-degree (full-thickness). The depth depends both on the temperature of the burning agent and the length of exposure.

A superficial burn affects only the outermost layer of skin and will appear red and be painful when touched. A nonblistered sunburn is an example of a superficial burn.

A partial-thickness burn penetrates the entire epidermis and varying levels of the dermis. It will have blisters and be very painful. Sometimes, blistering will not be evident in the first 24 to 48 hours.

For most burns, the extent of a burn injury can be calculated quickly using the "rule of the palm" that is, the victim's palm size is about 1 percent of his or her total body surface area.

First aid should begin immediately. The burning process must be stopped without injuring the rescuer. It is important to remove any rings, watches and other jewelry to prevent additional heat damage. They can act as tourniquets as swelling occurs.

Cool burns with caution. It is important not to cool adult victims with more than 20 percent (small children 10 percent) of the total body surface area since hypothermia could result. Use cool water or cool wet packs but not ice.

Do not apply salves, ointment, grease, butter, cream, spray, home remedy or any other coating on a burn. Later, there are ointments that can be used but only after the burn has been cooled. For example, after cooling a first-degree burn, aloe vera can keep the skin moistened and help prevent itching and peeling. For a second-degree burn that has been cooled, the over-the-counter medication known as bacitracin can be effectively used.

Avoid using anesthetic sprays because they may sensitize the skin to "caine" anesthetics. Relieve pain and inflammation with either aspirin or ibuprofen if the victim can tolerate it. Acetaminophen, recommended for children, relieves pain but not inflammation. The American Burn Association has established criteria for deciding when a burn center is needed. These criteria are for physician use and involve emergency medical services.

Minimal criteria requiring a burn center:

- Second- and third-degree burns greater than 10 percent of the total body surface area in victims younger than 10 years or older than 50 years; 20 percent total body surface area in victims between the ages of 10-50 years.

- Third-degree burn greater than 5 percent total body surface area in all age groups

- Circumferential burns of the extremity or chest.

- Second- and third-degree burns involving the face, hands, feet or joints.

- Electrical burns, including lightning injuries

- Inhalation injury in association with burns

- Burn victim with associated trauma or pre-existing illness

Utah and the Intermountain West have one of the best regional burn care centers in the United States. It is the Intermountain Burn Center at the University of Utah.