Burn treatment in SHTF

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Burn Treatment when SHTF

Apparently this is a thing now. People on Youtube are dousing themselves in rubbing alcohol and setting themselves on fire. I guess Cinnamon wasn’t much of a challenge. People have to light them selves on fire now? This is proof we are heading for a collapse of society.

Your body has this miraculous over shield and it is quite awesome. It is the largest organ your body has. It regulates your temperature. It prevents infection, It keeps water and harmful chemicals out. Any breach of that shield can be devastating. I speak of your skin of course. Nothing is more devastating to your skin than a burn. Because burns totally wreck your shit. So don’t play with fire especially on youtube. If you are going to learn a piece of anatomy inside and out it should be your skin.

Here are some protective measures you can use. So if you are wielding a flamethrower or out in wild fire country here are some tips. Wildland fire fighters wear Nomex suits. You can also wear those flight suits. They are fire not proof so don’t be an idiot while wearing them. They are fire resistant. The next thing you can do is avoid wearing anything with nylon or synthetic fibers. That shit will melt to your skin. Wildland fire fighters also wear boots with stitched up soles because glue will melt faster than a 10 year old girl at a puppy convention. They also use leather laces. The best piece of protective gear is avoidance.

Burn Classification

Burns are classified by the layers of skin they penetrate. They are Superficial (formerly known as 1st degree AKA sunburns), Partial Thickness (AKA 2nd Degree), and Full Thickness (AKA 3rd Degree). Now you may and probably will have all three types. Partial Thickness is the most painful. You don’t feel Full Thickness because your nerves are burnt. There is complete burns or 4th Degree burns… Those are rare and will fuck your shit up.

Burn Types

Thermal AKA HEAT from flashes, scalds, flames, or touching hot metal.
Electrical treat as a thermal burn. There should be an entry and exit to the burn. So… check the feet. If the electricity goes across the heart it may cause cardiac arrest. So do CPR. Along with Near Drowning it is the only time CPR is done in Wilderness or SHTF settings.
Chemical. For acids apply sodium bicarbonate aka baking soda. For Alkali apply vinegar. If you don’t have them flush with water.
Radiological. Water-Jel (25 ct 2% Lidocaine $14.95) makes a product called Radiaderm for treatment of Radiological burns. It is used for patients of chemotherapy. If you are prepping for a nuclear exchange you might want to get this. It won’t help you from dispersed radiation.

The Rule of 9’s

Total Body Surface Area or BSA for short can be calculated by the rule of 9’s. Each area is 9% With your bullocks being the very important 1%. Now the palm of the burn victims hand is roughly 1%. So if you forget everything you can use that as a rule of thumb… or in this case palm.

Google the Rule of 9s and set the search to images. Now you will see that the rule of 9s varies from Infant, to child, to adult. The 1% rule is still in effect.

Burn Treatment Rule of Nines

It is important to know the BSA.

Burn Treatment – 2nd and 3rd Degree Burns

  1. Remove burn source from skin. If that is Tar, Napalm, or Willy Pete AKA white phosphorous it means with a knife. If it is with a power chemical brush it off don’t blow on it… the last thing you need is to get that shit in your eyes. Liquid Chemical burns wash it off. It is best to consult the MSDS or Material Safety Data Sheet prior to dealing with chemical burns.
  2. Apply Burnjel or Waterjel dressings. These are expensive. You should have them none the less. What they are is a sterile, non adhesive dressing, that is soaked in a emulsified water and tea tree oil mixture. It will not stick to the skin and washes right off. What it does is stops the burning process, protects the skin, and helps regulated the temperature. You know that old first aid training you got from the Army or Red Cross that tells you not to put anything on a burn except dry sterile dressings? Yeah this is the exception to that. There is an awesome video on their website where the CEO places a water jel dressing on his arm and then takes a blow torch to it. Awesome.
  3. Prophylactic Antibiotic use: DON’T! No evidence supports the use of prophylactic use of Antibiotics in burn patients is helpful and may actually increase the risk for MRSA. Don’t use silverdine, topical antibiotics, or that Fish Mox. DON’T DO IT!

Fluid Replacement

Parkland Formula. (4 x Patient’s weight in kilos x Percent of body area with second and third degree burns) = Amount of fluid to administer in the first 24 hours after burn injury. Fluid to administer in first 24 hours divided by 2 = fluid to administer in first 8 hours. Fluids as in Ringers Lactate or if you do not have it then Normal Saline. That means you will have to start an IV. That means you will have to know how to start an IV. If the patient is conscious and can drink liquids and you don’t have an IV then yeah have them drink. They might not tolerate it well so do so SLOWLY. The last thing you want is a patient vomiting or downing on you. Don’t give oral liquids if they have inhalation burns… duh.

Red Flags

Circumferential burns. This may cause swelling that will cut off circulation to the burn area. If you cannot get that person to an ER you might need to perform a fasciotomy. You have performed a fasciotomy if you have ever put cheese into a hot dog. The Fascia layer you want to cut is the superficial layer. Like the skin on a hot dog. It prevents severe swelling and compartment syndrome. It should only be done if there is NO circulation. You can tell if there is no circulation because there will be numbness or tingling in the lower extremity, no capillary refill, pitting edema, Use a Number 20 scalpel and sterile technique.

Burns of the Genitals

Get them to an Burn Center ASAP. That will suck and post SHTF it will suck even worse. I don’t want the visual of what a penis fasciotomy would look like because pretty much that is torture just thinking about it.

Inhalation burns

Singed nose hair and burns inside the mouth and around the lips are huge red flags. It might require a surgical airway being placed. Monitor the SP02 and hook them up to O2 if needed.

Secondary Infection

Any of these burns probably will cause an infection secondary to the burn. It may or may not be bacterial in nature so that is why I don’t recommend just throwing antibiotics at it unless you know what you are doing.

Tissue Debridement

When Dead Tissue or Necrotic Tissue forms… It can be bad juju. There are ways to deal with this dead tissue.

  • Autolytic debridement – This requires you re hydrate the skin and place an occlusive dressing over it. This takes a long time but it is way less painful it will also require you to have lots of occlusive dressing and monitor for anaerobic bacteria growth.
  • Mechanical Debridement – AKA placing a dressing and ripping it off or flushing it with high pressure. NOT FUN! Requires lots of gauze.
  • Surgical Debridement – AKA cutting out the dead tissue. Do this if the tissue gets infected.

Post SHTF we are not going to have access to long term wound care. A burn is going to go through a lot of dressing changes. You are going to need LOTS AND LOTS of gauze to treat a serious wound. There will be no skin grafts or anything high tech. You might need to get creative in how you address this issue and people can and will die from severe burns.

The information presented is what to do if you have no alternative and no access to modern medicine. You should always seek out proper medical care for all burns. Do not attempt anything you are not trained to do. But all of this information is easily found by google so don’t blame me if you do something stupid with it.

Protip

Waterjel burn dressing are EXPENSIVE. The most expensive part is the liquid. So you can extend the use of the liquid it comes with by having extra Tefla dressings that you can dip into the solution.

If you run out you can make your own post SHTF but it won’t be cheap or easy. You will need Tea Tree Oil, Distilled Water, and an emulsifier like Xanthan Gum. Tea Tree Oil is from a tree in Australia so and is expensive in it’s own right. So making this mixture on your own might turn into a Legend of Zelda fetch quest.

Tea Tree Oil can be found in GNC, Health food stores and Pharmacies.

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About David Black

Trained and Certified: National Registry EMT, Wilderness EMT, US Army 68W, Tactical Combat Causality Care (TCCC), Basic Life Support for Healthcare Workers, Advanced Cardiac Life Support, Pediatric Advanced Life Support, US Coast Guard Medical Person In-Charge, Pre-Hospital Trauma Life Support. International Trauma Life Support. HAM Radio Technician. Trained and Certified to Instruct: Combat Life Saver Instructor and Community Emergency Response Team Trainer. CPR, AED, First Aid.

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