A third-degree burn, also known as a full-thickness burn, is one of the most severe injuries to the human body. This trauma extends through all layers of the skin, destroying the epidermis and dermis, and often involves underlying fatty tissue, muscle, and even bone. The damaged tissue may appear leathery, waxy white, charred black, or deep red. The injury site may be painless because the nerve endings have been completely destroyed. This burn demands immediate, professional medical intervention to manage systemic complications and prevent severe infection.
Activating Emergency Services and Stopping the Burn
The most important step is to contact 911 or local emergency services without delay, as advanced medical care is immediately required. While waiting for help, the primary focus must be on removing the person from the source of the heat or chemical to halt the burning process. For flame burns, instruct the person to “stop, drop, and roll,” or use a blanket to smother the fire, prioritizing the safety of the rescuer.
If the burn resulted from electricity, ensure the power source is completely turned off before touching the person to prevent electrocution. Quickly remove any jewelry, belts, or tight clothing from the burned area, especially on the extremities. This action must be performed before the onset of massive swelling, which occurs rapidly and can restrict circulation. If any clothing is melted or stuck to the skin, it must be left completely in place.
Immediate First Aid for the Injury Site
Once the burning process has stopped, the focus shifts to protecting the open wound from contamination. Unlike minor burns, a large third-degree burn should not be extensively cooled with water, as this carries a risk of inducing hypothermia. If the burn is small, a brief application of cool (not cold) water may be used, but this is secondary to covering the wound.
The injured area must be loosely covered with a clean, dry, non-adhesive material to prevent airborne bacteria from entering the tissue. A sterile gauze dressing is ideal, but a clean sheet or non-fluffy cloth can be used for large surface areas. The covering should not stick to the wound and must be secured gently without applying pressure to the burned skin. If possible, elevate the burned limbs or body parts above the level of the heart to minimize swelling.
Recognizing and Managing Circulatory Shock
Severe burns trigger a massive systemic fluid shift, leading to burn shock, a life-threatening condition. It is important to monitor for signs of this complication while awaiting emergency medical personnel. Signs of developing shock include pale and clammy skin, a weak and rapid pulse, and rapid, shallow breathing.
The person may also become confused, dizzy, or lose consciousness as the brain receives insufficient blood flow. To manage this situation, keep the person lying flat, unless a head or neck injury is suspected. If there is no suspicion of trauma to the lower body, raising the feet about twelve inches can help improve circulation to the core organs. Crucially, the person must be kept warm, as damaged skin cannot regulate body temperature and heat loss contributes significantly to the severity of shock.
Harmful Treatments to Avoid
Certain common practices must be avoided when dealing with a severe burn, as they can worsen the injury or introduce infection. Never apply ice directly to the burn site, as the extreme cold can cause tissue damage and increase the risk of hypothermia. Do not apply any household products such as butter, oils, ointments, lotions, or powder to the wound.
These substances can trap heat, promote bacterial growth, and make it difficult for medical professionals to clean and assess the wound. Avoid using fibrous materials like cotton wool, as the fibers can stick to the wound bed. Finally, resist the urge to break any blisters or attempt to peel off any clothing that has adhered to the burn.