There are three levels of burns. First-degree burns affect only the outer layer of the skin. They cause pain, redness and swelling. Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling and blistering. Third-degree (full thickness) burns extend in to deeper tissues. They cause white or blackened, charred skin that may be numb. Before giving first aid, evaluate how extensively burned the person is and try to determine the depth o f the most serious part of the burn. Then treat the entire burn accordingly. If in doubt, treat it as a severe burn. By giving immediate first aid before professional medical help arrives, you can help lessen the severity of the burn. Prompt medical attention to serious burns can help prevent scarring, disability, and deformity. Burns on the hands, feet and genitals can be particularly serious. Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns. Burns in children are sometimes traced to parental abuse. In case of a fire, you and the others there are at risk for carbon monoxide poisoning. Anyone with symptoms of headaches, numbness, weakness or chest pain should be tested. Burns can be caused by dry heat (like fire), wet heat (such as steam or hot liquids), radiation, friction, heated objects, the sun, electricity or chemicals. Thermal burns are the most common type. Thermal burns occur when hot metals, scalding liquids, steam or flames come in contact with your skin. These are frequently the result of fires, automobile accidents, playing with matches, improperly stored gasoline, space heaters and electrical malfunctions. Other causes include unsafe handling of firecrackers and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns to your airways can be caused by inhaling smoke, steam, superheated air or toxic fumes, often in a poorly ventilated space. Symptoms of burns include blisters, pain (the degree of pain is not related to the severity of the burn—the most serious burns can be painless, peeling skin, red skin, shock (watch for pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness), swelling, and white or charred skin. Your airway can burn, as well. Symptoms of an airway burn include: charred mouth, burned lips; burns on the head, face, or neck; wheezing; change in voice; difficulty breathing; coughing; singed nose hairs or eyebrows; and dark, carbon-stained mucus. First Aid First aid for minor burns is as follows: If the skin is unbroken, run cool water over the area of the burn or soak it in cool water bath (not ice water). Keep the area submerged for at least 5 minutes. A clean, cold, wet towel will also help reduce pain. Calm and reassure the person. After flushing or soaking, cover the burn with a dry, sterile bandage or clean dressing. Protect the burn from pressure and friction. Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling. Do NOT give aspirin to children under 12. Make sure the person is up to date on tetanus immunization. Minor burns will usually heal without further treatment. However, if a second-degree burn covers an area more than 2 to 3 inches in diameter, or if it is located on the hands, feet, face, groin, buttocks or a major joint, treat the burn as a major burn. Major Burns Major burns often occur as a result of fire. If someone is on fire, tell the person to stop, drop and roll. Wrap the person in thick material to smolder the flames (a wool or cotton coat, rug, or blanket). Douse the person with water. Call 911. Make sure the person is no longer in contact with smoldering materials, however, do not remove burned clothing that is stuck to the skin. Make sure the person is breathing. If breathing has stopped, or if the person’s airways are blocked, open the airways. If necessary, begin rescue breathing and CPR. Cover the burned area with a dry sterile bandage (if available) or a clean cloth. A sheet will do if the burned area is large. Do NOT apply any ointments. Avoid breaking burn blisters. If fingers or toes have been burned, separate them with dry, sterile, non-adhesive dressings. Elevate the body part that is burned above the level of the heart. Protect the burn area from pressure and friction. Take steps to prevent shock. Lay the person flat. Elevate the feet about 12 inches and cover the person with a coat or blanket. However, do NOT place the person in the shock position if a head, neck, back, or leg injury is suspected or if it makes the person uncomfortable. Continue to monitor the person’s vital signs until medical help arrives. This means pulse, rate of breathing and blood pressure. Do NOT apply ointment, butter, ice, medications, cream, oil spray or any household remedy to a severe burn. Do NOT breathe, blow or cough on the burn. Do NOT disturb blistered or dead skin. Do NOT remove clothing that is stuck to the skin. Do NOT give the person anything by mouth if there is a severe burn. Do NOT immerse a severe burn in cold water. This can cause shock. Do NOT place a pillow under the person’s head if there is an airways burn. This can close the airways. Call 911 if the burn is extensive (the size of your palm or larger); the burn is severe (third degree); you aren’t sure how serious it is; the burn is caused by chemicals or electricity; the person shows signs of shock; the person inhaled smoke; physical abuse is the known or suspected cause of the burn; or other symptoms are associated with the burn. Call a doctor if your pain is still present after 48 hours. You should call your doctor immediately if signs of infection develop. These signs include increased pain, redness, swelling, drainage or pus from the burn, swollen lymph nodes, red streaks spreading from the burn or fever. Also call immediately if there are signs of dehydration: thirst, dry skin, dizziness, lightheadedness or decreased urination. Children, elderly and anyone with a weakened immune system (for example HIV) should be seen right away. To help prevent burns, install smoke alarms in your home and check and change the batteries regularly. Teach children about fires safely and the hazards of matches and fireworks. Keep children from climbing on top of a stove or grabbing hot items like irons and oven doors. Turn pot handles toward the back of the stove so that children can’t grab them and they can’t be accidentally knocked over. Place fire extinguishers in key locations at home, work and school. Remove electrical cords from floors and keep them out of reach. Know about and practice fire escape routes at home, work, and school. Set temperature of water at 120 degrees or less.