[at-l] The Burn and FSN/Cotton/Rules

[thornel@attglobal.net (W F Thorneloe)]

What to do if you (in general, not _you_ specifically) aren't prepared for 
a burn? Off list, I had a similar message, suggesting that the advice to 
debride and clean the wound was a bad idea prior to arrival at ER. The 
writer noted that the blister serves as a wound cover, I suppose much as 
the blister with a foot friction event. I am not sure that is correct 
management if the blister has broken (and is likely to be broken with any 
significant second degree burn), or if there is neighboring skin 
disruption. In such a case, the dead tissue and fluid may act as a 
opportunity for infection. I would still encourage cleaning the wound just 
as for abrasion or laceration or fractured bone.

If you do not pack Silvadene, I'd still caution against use of Triple 
antibiotic cremes due to the risk of injury from systemic exposure to 
Neosporin. I'd suggest cleaning the wound, perhaps using Betadine or 
dissolved iodine diluted, and covering the wound with the cleanest cloth 
you have available. I then would send the victim to the ER. Since you 
probably don't carry latex gloves and have exposed yourself to their blood 
and other fluids, accompany the victim to the ER as you may need care, also.

I question why anyone would carry Bandaid and leave a roll of gauze at 
home. I can do more with gauze than a Bandaid anytime. A 4 inch by 4 yard 
roll of cotton gauze, perhaps with a non-stick pad cover can't weigh 2 
ounces. I could tie it, use duct tape, clip with a diaper pin (my zipper 
pull of choice) or use real tape if I wanted to.

If I did pack Silvadene, I'd ask about infections and medical problems as I 
also got the victim's name and address. I'd do that while putting on my 
latex gloves that contained my first aid kit. Unless there was an obvious 
problem regarding immune suppression (HIV, cancer chemotherapy, or other), 
I'd use the Silvadene in an emergency and feel confident as a Good 
Samaritan. I'd encourage and assist the victim's transport to more 
definitive evaluation and care, as well as leave my name and address. 
Frankly, I'd rather be sued for my actions, not for my neglect.

I recognize that as a medical person, I am likely to be the most proficient 
physician on the scene in a crisis in the woods. I consider it my 
responsibility to consider such emergencies, and try to encourage others to 
do likewise. I think that if you carry gear, including first aid, you 
should be familiar with the purposes and limitations of your gear. Do that 
Wilderness First Responder course, or some first aid course if you hope 
that someone will be competent to attend to your injuries out there. Do not 
put prescription medications in your first aid kit without understanding 
the use of that gear. Do not bring over the counter medications if you 
aren't familiar with their use and problems.

OrangeBug
<And of course, discuss contents of the first aid kit with a real world doctor>

At 10:47 AM 6/13/2001 -0400, rick boudrie wrote:
>Thanks for the info on burn treatment.  What would you do if you aren't 
>packing the Silvadene burn treatment?  Just skip that step or apply 
>something else?
>
>One reason I am disinclined to add Silvadene to my own first aid kit is 
>the practical and moral dilema of providing aid to someone other than 
>myself or wife who might be in need of it.  As a prescriptive drug, I 
>would be afraid that I might do some harm with the Silvadene to a person 
>whose medical history is unknown to the prescribing physician. ...