First aid for self-harm resource: burns

This resource contains information which may be useful for performing care or advocacy work, or describes overall policy and principles.

This protocol is a draft. It has not yet been accepted as protocol and may be incorrect or poorly cited. Please do not use this in your work until it has been accepted.

Please see #protocols on Slack to discuss this protocol further.

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This is a resource for people who are self-harming, or people who are supporting someone who self-harms. It covers some basic first aid tips for treating burns caused by self-harm. See the other first aid for self-harm resource pages for information about other kinds of injury.

You may also want to see our 'Safer self-harm resource' for discussion of how to reduce the risk of serious injury.

This is not a substitute for first aid training and does not qualify anyone to describe themself as a ‘first aider’.

This guide sets out signs that an injury may present an urgent/potentially life-threatening risk, requiring an ambulance. It also covers situations where the injury is likely to deteriorate and risk further damage unless you go to A & E or seek other urgent medical treatment. You can still call an ambulance in these scenarios if you don’t feel well enough to travel to hospital.

We recognise that many people may be concerned about the potential consequences of going to hospital after self-harming. This resource is intended to help you assess when the risks of not getting medical help may outweigh the risks of doing so.

If you are supporting another person to treat their injuries, it’s also important to remember the risks of disease transmission, and wear gloves while handling any bodily fluids.

Burns

How to treat

Cool the burn with water, remove any tight jewellery or clothing, leave blisters intact, and dress with clingfilm. Chemical burns require special treatment.

1. Cooling
   • Hold the burned area under cold running water for at least 10 minutes.
   • Don’t use ice, as this may stick to the skin and cause further damage.
2. Removing constrictions
   • If you have burned a large area, remove any jewellery (e.g. rings) or tight clothing from the limb, in case it swells.
   • Don’t pull away any clothing stuck to the burn itself - this will need to be removed in hospital.
3. Blisters
   • Try not to pop or damage blisters, as this will increase the infection risk.
   • If you can’t avoid this, rinse the burn under running water again to clean it before dressing, or use an alcohol-free saline wipe.
4. Dressing
   • Don’t use standard plasters, as they may stick to the burn. If you don’t have a specialist burn dressing, you can dress it with clingfilm.
     • Unroll and discard a couple of rounds before cutting your piece, to make sure that it’s clean.
     • Cut a square to cover the burn and tape it at the edges. Don’t wrap it all the way around the limb - this might constrict circulation if the burned area swells up.
   • Alternatively, you can dress the burn with a clean, unused plastic bag.

Chemical burns

Chemical burns are particularly risky and need special treatment.

• Rinse them under running water for at least 20 minutes, tilting the burned area so that the contaminated water does not drip onto other parts of your body.
• Don’t try to ‘neutralise’ them with another substance - if one chemical reacts with another, this is likely to cause further damage.
• Don’t try to dress them at home: they will need hospital treatment.

Call an ambulance if...

• You have burns on your face or throat which are affecting your ability to breathe.

• You have burned a large area and notice any of the following symptoms
  • You feel weak, dizzy, sick or confused.
  • Your skin feels cold, but clammy and sweaty.
  • Your skin looks paler than usual (lighter skin) or has a greyish tone (darker skin).
  • This is called ‘shock’, and indicates that there is not enough fluid in your body to allow proper blood circulation. (Though burns don’t bleed red blood, they ooze fluid, which can have the same effect as blood loss.) Call 999 urgently and lie down with your feet propped up on a chair.

Go to A & E/get urgent medical help if...

• The burn was caused by a chemical
  • You may not be able to remove all traces of the chemical, so it may continue to cause damage.

• You have burned yourself with electricity
  • Even if the burn on your skin looks small, the electricity may have damaged your internal tissues and organs.

• The burn is larger than the palm of your hand.
  • Large areas of burn present a high risk of infection.

• Part of the burned area looks either white, brown or charred black. (This may be surrounded by a larger area of less severe burn).
  • This means you have burned through all the layers of skin - it’s unlikely to heal without specialist treatment and may need a skin graft.

• The burn goes all the way around your arm, leg, finger or toe.
  • If the burn swells, it could affect the blood circulation to the limb.

• The burn is on a hand, foot or joint (e.g. an elbow)
  • If left to heal on its own, the burnt area is likely to contract, which may leave you with restricted movement.

Infected wounds

Cuts and burns may both become infected, in which case they will require treatment with antibiotics.

Go to A & E/get urgent medical help, if...

• You see any of the following signs of infection, but aren’t otherwise feeling ill
  • dark yellow or green pus (however, non-infected burns may exude some fluid which leaves a pale yellow stain on dressings)
  • bad smell from the wound
  • skin around the wound feels hot
  • increased pain around the wound
  • increased swelling around the wound
  • on lighter skin, visible redness expanding out from the injured area

Call an ambulance if...

• The wound looks infected and you start to feel seriously ill in any way, including but not limited to:
  • Feeling feverishly hot or extremely cold
  • Feeling confused or sleepy
  • Shivering or muscle pain
  • Fast breathing or breathlessness

• These are possible signs of sepsis, a life threatening condition when your body responds to infection by attacking its own tissues and organs.