Stop Cooling Those Burns

Do you ever get the feeling that everything you learned in EMT class was wrong? If you haven’t yet developed that feeling, then you probably haven’t been around long enough. Stick around. Sooner or later (depending on whether or not you are paying attention) you’ll start to feel that every treatment guideline you ever learned was somehow flawed. I’ve been in EMS education long enough now to start to feel that everything I ever taught was wrong.

Such is medicine.

And now I’m going to throw another curve ball at you. Do you remember when we told you to aggressively flush burns with copious amounts of sterile water? Yeah, well…um, stop doing that too. I’m sorry. We were apparently wrong about that.

I know. It runs counter to everything we taught you, right? I agree. I learned about aggressively cooling burns over two decades ago in my EMT class. Stop the burning process and then cool the burn by flushing it with copious amounts of water. Keep flushing until you arrive at the hospital.

Years later the treatment guideline backed off a bit on the flushing. We started emphasizing stopping the burning process and also warned students to guard the burn patient against hypothermia. It seemed that our aggressive cooling techniques were delivering a ridiculous percentage of burn patients to the hospital mildly hypothermic. Hypothermia is apparently not conducive to healing in the burn patient population.

I was just as guilty as anyone of pouring massive amounts of saline on significant burns until it ran out the back door of the medic unit and the patient shivered like they were having a seizure. So we put away our garden hoses and buckets of cold saline and transitioned to more localized cooling. Patient warm, burn cool. Got it.

Apparently that is incorrect as well.

As it turns out, burns seem to heal better when they remain warm. Our burn centers are now recognizing that burns that are cooled seem to have more extensive tissue damage and heal slower than burns that are allowed to remain at or slightly above body temperature.

The theory behind the delayed healing of excessively cooled burns is that excessive cooling may promote vasoconstriction in the region of the burn that limits the circulation of lipids, white blood cells and proteins that are essential to the healing and reconstruction of damaged tissue. Maintaining a healthy blood supply to the effected region is apparently more important than cooling the wound.

This doesn’t mean to stop putting water on burns. You still need to halt the burning process. But after the burning is stopped, further application of cool water, while it may be soothing to the patient, does not promote healing. Wrap the wound. Keep them warm. Protect the airway and transport to an appropriate facility.

Comments

  1. Hmmm. Maybe we’ll go back to applying butter to burns. Who’d have thunk it.

  2. Steve,
    Could you provide the sources of this info? I am looking at presenting this info to our medical director to update or protocol for burns and am having trouble finding anything with this info.

  3. Steve Whitehead says:

    @G G! Don’t do it! Well…not yet anyway.

    @Drew Yes, I imagined that question might be coming. Thanks for being the one to say it.

    This recommendation came from a burn unit nurse from Denver’s University Hospital Burn Unit. They are some top notch folks who do great work for us here. I learned this during a lecture series called Clinical Masters but the instructor is also a primary instructor for Advanced Burn Life Support. This is consistent with their guidelines. If you are taking this up the chain, I would use the national ABLS guidelines as your reference. Also, if you are looking to update your burn treatment protocols, get an authority from your local burn unit and a local ABLS instructor to back you up on this and review the entire protocol. Let me know how it goes.

    Check out this power point from the ABLS course and notice on the slide that says “treatment guidelines” the first bullet point says “Stop the burning process” but there is no mention of cooling. This is where our instructor gave the information about room temperature burn treatment. http://theemtspot.com/2013/03/18/stop-cooling-those-burns/#

  4. Thanks Steve

  5. Pennsylvania BLS Protocols are pretty consistent with this. Special consideration is to be taken with fire, chemical, or electricity. Wrapping the wound and preventing hypothermia has been protocol for awhile.

  6. ABLS over 20 yrs has been advocating this.

  7. Alan Rose says:

    Hmmm. And in five years this will be barbaric. FWIW when I burn myself cooking, I immediately put ice on it for a few minutes. A burn that used to blister now never even gets red or painful. Bad sunburn? I coat my skin with vinegar. It causes shivering but takes the “burn” out and in my experience has no adverse effect on healing time. I imagine the gold standard in pre-hospital burn care has yet to be identified.

  8. In Canada after the burn is cooled we wrap with Saran Wrap .

  9. Ironic that you would publish this article. My son was just burned with hot grease two days ago and is a burn unit with 12% 2nd degree burn of both his hands, both ankles, both calves, both thighs and his butt. I have been in EMS since 1998 and we have changed our treatments and changed it back again. I have been picking the brain of the burn team and have been told that the trauma surgeon hates EMS’s treatment for burns. Maybe tme for protocol changes . . .

  10. We use Saran Wrap too in my area. Came right from the Doctors at UW Madison.

  11. My father in law told me about 10 years ago to hold a burn near a light bulb, He did a lot of welding and found this Technic, that it would help. I thought he was crazy! well to say the least I got a bad burn so I decided to try it and guess what it hurt like hell!! when i did it ( placed the burn near the lamp)but it worked SO for the last ten years I’ve been sharing that story about using heat instead of cold for a burn.

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