A third-degree burn, often called a full-thickness burn, is the most severe classification of burn injury. This trauma destroys the entire thickness of the skin, including the epidermis and dermis, and may extend into fat, muscle, or bone tissue. The affected area often appears white, leathery, charred, or dark brown. Pain may be absent because the heat energy has destroyed local nerve endings. This absence of pain can be dangerously misleading, as the extensive tissue destruction necessitates immediate medical intervention. Since these burns cannot heal on their own, first aid efforts must focus on stabilizing the victim until professional medical help arrives.
Initial Steps and Safety Assessment
The first priority in any burn incident is ensuring the safety of both the victim and the rescuer. Immediately remove the person from the source of the injury, whether it is heat, flame, or chemical. If clothing is on fire, smother the flames, ideally with a blanket or by having the person stop, drop, and roll.
Once the immediate threat is neutralized, activate the emergency medical system by calling the local emergency number. This initiates the professional response required for a third-degree burn. While waiting for help, remove any clothing or jewelry not stuck to the skin, as these items retain heat and can constrict the body if swelling occurs. Chemical burns require flushing with large amounts of cool water for at least 20 minutes to dilute and remove the corrosive agent.
Check the victim’s level of responsiveness after the burning process has stopped. A quick assessment of their awareness—such as whether they are alert, respond to voice or pain, or are completely unresponsive—provides a baseline for the arriving medical team. Maintaining a calm and authoritative presence is important to prevent panic.
Immediate Local Wound Care
Immediate care for the localized burn site focuses on stopping heat transfer and protecting exposed tissues from infection. If the burn is small, the wound should be cooled with cool, running water for a short period, ideally not exceeding five minutes. This action helps reduce residual heat and minimize tissue damage.
Applying water to large areas of full-thickness burns is strongly discouraged because it can rapidly induce dangerous hypothermia. The cooling effect is lost quickly, and the major risk shifts from the burn itself to the profound loss of body temperature. Never use ice, ice water, or extremely cold compresses on any burn, as this causes further tissue damage and impedes blood flow through vasoconstriction.
The burn should be covered with a dry, sterile dressing, a clean sheet, or a non-fluffy cloth to protect the open wound from environmental contamination. The covering must be non-adherent and applied loosely to prevent further trauma. Never apply any ointment, cream, butter, or home remedy to a severe burn, as these trap heat and interfere with medical treatment. Do not attempt to break any blisters that may have formed around the edges of the burn, as the intact skin provides a sterile barrier against infection.
Managing Systemic Life Threats
Severe burns pose several systemic threats, including airway compromise, shock, and hypothermia. Airway assessment is paramount, especially if burns involve the face or neck, or if the injury occurred in an enclosed space. Signs like singed nasal hairs, soot, hoarseness, or noisy breathing (stridor) suggest a potential inhalation injury, which can cause rapid and life-threatening swelling of the throat. If breathing is difficult, position the victim upright and continuously monitor the airway for obstruction.
A severe burn can trigger hypovolemic shock due to the massive shift of fluid from the bloodstream into the burned tissue. To manage shock, keep the victim lying down. If there are no spinal injuries, their legs may be elevated slightly to promote blood flow to the core organs.
Maintaining the victim’s core body temperature is equally important, as the damaged skin can no longer regulate heat effectively. The loss of the skin barrier, combined with the body’s reaction to the trauma, makes the victim highly susceptible to hypothermia. Cover the victim with a clean, dry blanket or sheet over uninjured areas to conserve body heat, ensuring the burn wound remains protected by its sterile dressing.
Monitoring and Preparing for Handover
While awaiting emergency medical services, care shifts to continuous observation and documentation. Continuous monitoring of vital signs is necessary to detect any deterioration. Regularly check the victim’s breathing rate, pulse, and level of consciousness, noting any changes. This ongoing assessment helps identify early signs of worsening shock or impending airway closure.
Documentation is a crucial, non-treatment intervention that significantly aids professional care. Make a mental or written note of the time and cause of the injury, the interventions performed, and any changes observed in the victim’s status. Preparing for a precise handover ensures continuity of care. Clearly communicate the circumstances, the estimated size and appearance of the burn, and the victim’s response to first aid.