Burn Management

Professor Hugh Grantham

It is well known that the old school sailors in the wooden ships feared fire at sea above all else!

Burns are a common problem at sea, where the constantly moving environment increases the risk of injury. Heat sources in the galley and engine room present significant hazards, even before considering open flames, chemicals, or electrical sources. This blog is an opportunity to ensure we all understand how to manage burns effectively—and why each step matters.

Heat Burns

Heat energy damages tissue, causing irreversible injury at the centre of the burn and inflammation around the edges. Immediate cooling reduces the amount of heat energy retained in the tissues and limits the depth and extent of the burn.

Specialist advice for first aid recommends cooling the affected area with cool, running water for 20 minutes. Water is an excellent conductor of heat, and moving water ensures maximum cooling. In practice, this might mean using a cold running tap or immersing the burnt area in a bucket of seawater while moving it about. At this stage, the priority is cooling the tissue—the benefit outweighs the risk of infection, even with murky seawater.

Showers or fire hoses can also be used to cool burns. Any hot, wet clothing should be removed as soon as possible. Rings and other tight jewellery should be taken off early, as swelling typically follows a burn and can rapidly make removal difficult.

Burn Dressings and Pain Management

Over the years, many substances have been applied to burns—such as butter, various antibiotic ointments, and more recently, commercial products based on tea tree oil. However, none of these are more effective than cool running water. Once the burn has been adequately cooled, covering it with a dressing that keeps air off the surface will help reduce pain. A simple and effective option is kitchen plastic wrap—if you discard the outer few layers, it is nearly sterile and readily available.

Burns are painful. The more surviving inflamed nerve endings there are, the more intense the pain will be. The bad news is that it hurts; the good news is that if it hurts, it is unlikely to be a full-thickness burn. Most burns involve areas of varying depth. A full-thickness burn destroys the nerves, blood vessels, and the layer of skin cells responsible for regeneration. A partial-thickness burn affects fewer layers and retains some nerve function and healing capacity.

Be generous with pain relief. Patients with serious burns often require much larger doses of analgesia than would be expected for other injuries—morphine doses may need to be many times higher than usual.

Bigger burns

Larger areas of burn can trigger a systemic inflammatory response affecting the entire body. This includes dilation of blood vessels, capillary leakage, and a drop in blood pressure. People with extensive burns may require significant volumes of additional fluid to maintain circulation and prevent burn shock. Even severe sunburn can cause enough inflammation to lead to this response.

As a general rule, any burn larger than 5 cm by 5 cm in a non-critical area, should be discussed with burn specialists. Burns involving difficult areas—such as the face, hands, groin, or circumferential burns (those that go completely around a limb)—warrant immediate consultation. Extra caution should also be taken in patients who are very young, elderly, or have underlying health conditions such as diabetes.

Chemical Burns

Chemical burns cause tissue damage by reacting directly with the tissue. The first priority is to remove the chemical as quickly as possible.

Start by brushing away any dry chemical powders, then wash the affected area with large volumes of water. The more thoroughly you wash, the less chemical remains on the skin—and the less damage it can cause. This is particularly important with eye splashes.

While dedicated eye wash bottles are useful, a shower or hose can often provide much more effective irrigation. The goal is to remove every trace of the chemical. Once the area has been completely cleaned, treat the injury like any other burn and cover it appropriately.

Electrical Burns

Electrical burns occur when electrical energy passes through the body, damaging tissue along its path. Unlike heat or chemical burns, the damage is often deep beneath the skin, following the path of least resistance where electrical conduction is most efficient.

As a general rule, 240 V domestic power on a 15-amp circuit with a trip switch usually does not produce enough energy or duration of contact to cause serious burns. However, as voltage, current, or contact time increase, the risk of deeper and more severe burns rises significantly.

One of the challenges with electrical burns is that they often look less severe on the surface than they really are, because the worst damage is internal. High-energy sources, such as power lines or lightning strikes, are more likely to cause substantial injury.

Another important consideration is the effect on the heart. Electrical currents can disrupt the heart’s rhythm, potentially leading to dangerous arrhythmias requiring defibrillation. This risk also increases with higher power and longer exposure. It is extremely rare for domestic electricity protected by trip switches to cause this.

Smoke and Hot Gas Inhalation

Exposure to smoke and hot gases during a fire presents a serious and distinct set of risks. One of the most urgent concerns is airway swelling. The first sign may be a change in the person's voice, followed by noisy breathing (stridor), and in severe cases, no breath sounds at all—a sign that the airway may be nearly or completely obstructed.

Suspect inhalation injury in anyone with burn marks around the face or mouth, especially if their voice has changed. This is a medical emergency and requires urgent assessment and intervention.

Inhaled gases also pose chemical risks. Fires in confined spaces may lead to carbon monoxide poisoning, while those involving burning plastics or synthetic materials may expose the person to cyanide and other toxic chemicals. These can severely affect oxygen transport in the body and may not be immediately obvious.

As always, recognise and share the concern early. Prompt recognition and escalation can be lifesaving.

Hopefully as you read this, you’ll be reassured by how much you do know and by how simple measures make a big difference.

By Professor Hugh Grantham - Chair of Emergency Medicine Foundation - Australasia (EMF), Chair of One and All tall ship board and Professor adjunct QUT (Queensland University of Technology) and Curtin University. He is one of the editors of Australian Boating Manual..

Have you ever experienced burns? We'd love to hear your stories and thoughts - share them in the comments!