Stop Cooling Those Burns

• Tweet

• Tweet

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.