The kitchen burn

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Scene 1 · Opening

20.15. Your father is draining the pasta. The pan tips sideways and the boiling water goes over his forearm and his wrist.

He swears, he backs away, he holds his arm against himself. The skin goes red very fast, over a good hand's width.

Scene 2 · The first reflex

The sink is a metre and a half away. The cupboard above it has a bit of everything in it.

He says it is burning more and more.

What do you do?

• Right move : I turn the hob off and take him straight to the sink, under the tap.
  How fast you act decides everything : The first reflex is to cool the area that has been burnt. Every second of waiting lets the heat go deeper into the skin. Everything else comes after the water.
• Mistake : I get a cream out of the cupboard and put some on the burn.
  You have just sealed the heat under a layer of grease : Nothing goes on a burn before the water, and above all nothing greasy. No harsh antiseptic either, and no cotton wool, whose fibres would stick to the wound.
• Not the best choice : I go looking for the toothpaste, my grandmother used to do that.
  Your grandmother has plenty of other qualities : The tube in your hand is for cleaning your teeth. The thing you need is behind you, it is made of metal, and it runs.

Scene 3 · Under the tap

His forearm is over the basin. The tap is yours.

How do you run it, and for how long?

• Right move : Tepid water, gently, running above the burn, and I leave it there at least ten minutes.
  At least ten minutes, ideally twenty : Tepid water between 15 and 25 degrees, at low pressure, running ABOVE the burn so that the jet does not land straight on it. That relieves the pain and limits how far the damage spreads. Ten minutes feels very long: it is the minimum.
• Mistake : Iced water and the ice tray, the colder the better.
  The water has to be TEPID, not iced : The guidance says tepid water, between 15 and 25 degrees. Ice adds a cold injury to skin that has already been destroyed, and the shock of it does more harm than good.
• Mistake : Thirty seconds of water, then I wrap the arm in a tea towel with some butter.
  Thirty seconds cools nothing : It takes at least ten minutes, ideally twenty. And nothing greasy goes on a burn: it holds the heat against the skin, which is the exact opposite of what you are trying to do.

Scene 4 · What comes off

The water has been running for four minutes. He is wearing a wedding ring and a watch, and the sleeve of his polo shirt is stuck to him in places.

A blister is starting to form, wider than half his palm.

What do you take off?

• Right move : The ring and the watch straight away, and I leave the sleeve where it is stuck.
  Whatever is not stuck comes off : Take off clothing and jewellery if they are not stuck to the skin: it is going to swell, and a wedding ring becomes a tourniquet. Anything that has stuck, you leave alone, and you cut around the clothing if you have to.
• Mistake : I pull the sleeve away to clear the whole area.
  The skin came away with the fabric : Never pull off clothing that has stuck to a burn: it would tear the skin away and make a bigger open wound. You cut around the clothing if you need to.
• Mistake : I burst the blister with a sterilised needle so it does not get in the way.
  The blister is a barrier: it stays shut : Blisters work as a natural barrier against infection. Bursting them raises the risk of infection. You do not touch the burn with unwashed hands either.

Scene 5 · Is this serious?

The blister is now clearly bigger than half his palm, and it sits on the wrist, right over the joint.

He says he is fine, that he will get it looked at tomorrow.

What do you do?

• Right move : I call 15 while keeping his arm under the water, and I describe the blister and how big it is.
  Two markers of a serious burn, so you call : A burn is serious as soon as a blister is bigger than half the casualty's palm, or sits over a joint, the face, the neck, the hands or near a natural opening of the body. As soon as a burn is serious, you call for help immediately.
• Mistake : We will see in the morning, he seems all right.
  It is not for him to decide whether it is serious : A blister wider than half the palm, sitting over a joint: those two markers make a serious burn, and a serious burn gets called in immediately. 15 judges, you describe.
• Mistake : I clean it with surgical spirit and put a tight dressing on it.
  No spirit, and nothing tight : You do not use harsh antiseptics such as alcohol or hydrogen peroxide. You cover the burn with a dressing or a clean cloth, laid on without tightening, and you call for help because it is serious.

Scene 6 · While you wait

The dispatcher tells you to keep the water going and wait for the crew.

What do you do until they get here?

• Right move : I keep the tepid water running, then I cover the burn with a clean cloth and put nothing on it.
  Water, a clean cloth, and nothing else : Cover the burn with a dressing or a clean cloth. No cotton wool, whose fibres would stick to the wound, nothing out of a bottle, nothing greasy. And wash your hands before you touch it.
• Mistake : I turn the water off so he does not get cold and wrap him in a blanket.
  The cooling is not finished : It takes at least ten minutes of water, ideally twenty. If you are worried about the cold, cover the REST of his body and leave the burn under the water: the heat goes on doing damage under the skin until it has been drawn out.
• Mistake : I rub the area gently to clean it before they arrive.
  Rubbing means opening the blister : You do not rub a burn and you do not burst its blisters: they are the natural barrier against infection. Tepid water is enough, and cleaning it is not your job.

Scene 7 · The crew

Blue light turns across the kitchen cupboards. Two people come in, look at the arm, look at the tap still running, and say that is good.

They put a clean dressing on him, write down the time of the burn and how long it was cooled for, and take him away.

All you did was hold a tap open for a very long time. It is the most boring action in the game, and one of the most useful.