Pot water on the fire, tourists kettle on hot campfire.
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Knowing what medical issues you may contend with in various scenarios is the first step to being an effective “survival medic.” Armed with medical knowledge, the medic can accumulate the supplies and skills that will save lives in the uncertain future. In this series, let’s examine some important medical issues for which the off-grid caregiver must prepare. This time, we’ll discuss burns.

Various Burns

Fire is needed for heat and cooking off the grid, and this puts the inexperienced at increased risk for burn injuries. Children are especially fascinated by fire, and often get too close for their own good. Burns are categorized in a number of ways based on the depth of damage, the surface area affected, and the agent that caused the burn (hot water, acid, the sun, a lightning bolt). For our purposes, let’s concentrate on depth:

First-Degree Burns: Simple “sunburn” type injuries that only affect the superficial layer of the skin, known as the epidermis. A large surface area may be affected, causing lots of dry, red skin and pain without becoming life-threatening. Scarring is rare.

Second-Degree Burns: Second degree injuries are more significant, affecting the deep layer of the skin known as the dermis. These burns tend to be swollen and wet, with red, shiny skin that weeps watery, yellowish or cheesy, whitish material. Blisters are common, and can be quite large. Some scarring is common. If a large surface area is affected, a second-degree burn can be life-threatening.

Third-Degree Burns: These are severe burns that go through the epidermis and dermis and into subcutaneous fat, muscle, tendons, or other tissues. Remaining skin often appears charred, but could be a waxy white or leathery brown. Edges may exhibit second-degree-burn damage. The breach of the skin means easy access of pathogens (disease-causing organisms) into the body, leading to a life-threatening systemic infection called sepsis. While the bugs are coming in, precious fluids are going out, causing severe dehydration. Scarring is significant; without skin grafts and other advanced care, even small scars may lead to restricted movement of nearby joints. If just 10 percent of the body surface is involved, the survival of the victim is in question.

Treatment

Burns should be treated by running cool water over them for 15 to 30 minutes, depending on the severity. Avoid ice, as it may contract blood vessels that provide circulation to what is already traumatized skin. First-degree burns may be treated with anesthetic sprays and meds for discomfort and perhaps itching, but usually resolve over the next 48 hours with no treatment at all.

With second degree burns or worse, remove rings, bracelets, and other jewelry as soon as possible to avoid their becoming stuck due to swelling. Avoid breaking all but the largest blisters that would clearly burst on their own. Antibiotic creams are acceptable to prevent infection. Some people use raw honey when nothing else is available. Butter, however, is not a good natural alternative; it traps heat and may worsen the situation.

Third-degree burns are a real dilemma for the medic in austere scenarios. Other than the strategies for second degree burns, little can be done other than covering the injury for protection, giving fluids to prevent dehydration, and antibiotics to prevent infection.

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