Notes to Algorithm 1

Note 1: First aid, emergency examination and treatment

First aid
• Ensure your own safety
• Stop the burning
• In electrical injuries, disconnect the person from the source of electricity
• Cool the burn:
– cool with running tap water (8–15°C) for at least 20 minutes (no ice). Irrigation of chemical burns should
continue for one hour
– avoid hypothermia: keep the person with the burn as warm as possible, consider turning the temperature
of the water up to 15°C (tepid)
• Remove clothing and jewellery
• Cover the burn:
– cover with cling film or a clean, dry cloth
– avoid topical treatments until the depth of the burn has been assessed
• Administer analgesia.

Emergency examination and treatment

Primary survey1
Airway maintenance with cervical spine control
Breathing
Circulation with haemorrhage control
Disability – neurological status
Exposure + environmental control
Fluid resuscitation proportional to burn size

Fluid resuscitation
• Burns of >10% body surface area in children and >15% in adults warrant fluid resuscitation
• Give fluids:
– 24-hour requirement: 3–4ml crystalloid solution per kg per % burn
– plus maintenance fluids for children
– give half of the fluids over the first eight hours, the remainder over the next 16 hours.

Prevention of tetanus
There is a risk of tetanus following a burn injury. Refer to the guidelines on the prevention of tetanus following
injury, which are available from the Ministry of Health’s Immunisation Handbook 2006.2
Continued …

1. Reproduced from: Australian and New Zealand Burn Association Limited. Emergency Management of Severe Burns.
8th Edition; 2004.

2. Ministry of Health. Immunisation Handbook 2006. Wellington: Ministry of Health; 2006. http://www.moh.govt.nz/moh.nsf/
pagesmh/4617/$File/2006-immunisation-handbook-all.pdf.
5

ACC15028-Pr#7.indd Sec1:5 5/17/07 12:22:27 PM