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Interviewer: What would you do if you get burned and help isn't coming soon? We'll explore that next on The Scope.

Announcer: Medical News and research from University Utah physicians and specialists you can use for happier and healthier life. You're listening to The Scope.

Interviewer: Annette Matherly is the outreach and disaster coordinator for the Utah Burn Center. What should you do if get burned and help isn't coming soon, say you're out maybe hunting or backcountry camping, or something like that? Is there anything a regular person can do or are they out of luck?

Dr. Matherly: No, absolutely. There are so many simple things that can be done when you get burned and help isn't coming. So I like to keep it simple. I think of the four Cs. The four Cs are cool it, clean it, cover it, and call for help.

Number one, cool it. If you get burned with some kind of hot fluid, and to cool it and take that heat out of your tissues would be incredibly important and that's because the longer that heat stays in those tissues, the deeper your injury will become. So to take that heat out over a five or 10-minute period would be really important.

Number two would be to clean it because who knows what you've been rolling around in, or what you've got on your fingers or your toes, or wherever it is that you've been injured. So you want to keep that clean. And so just having some regular soap and some water, preferably nonperfumed because the perfume will make it sting a little more, but just your common soap and cleaning that wound to get all those bacteria off of that open area. Because if you have that top layer of your skin missing, now you can have bacteria in the environment. Bacteria that's crawling around on our bodies, by the way, those gram positives that are all over us, now they can get into that opening into our bodies and can make us sick.

Interviewer: So for number one and number two, cool and clean it, what about stream water? Should I avoid that?

Dr. Matherly: If that's all you have, then you use stream water. You've got to take out that burn. And is it optimal? No, but there's not many of us, you know. Or maybe we have bottled water hanging around and we can get our soap out and open that bottled water or we're trying to save the universe, we can get out our little reusable bottle and pour it over. So another good reason to carry those around with you.

Interviewer: Yes, so that's optimal. Stream water, though. If you have to, you've got to do these things.

Dr. Matherly: Absolutely.

Interviewer: All right. So we've got cool it and clean it. Number three?

Dr. Matherly: So number three is cover it because now we have this opening into our body. The skin is kind of a coat of armor. And what we want to do when we lose that piece of the armor is we want to still cover that area that has the opening. So now we want to cover it and we want to use something that won't stick because if you don't have any skin in that area, then it's nice, and oozy, and weepy. And you don't want to put something on it will stick, but sometimes you may not have that option.

So hopefully, in your backpack because you've been thinking this through before you went on your trip, you've got some Bacitracin, or some Polisporin or some Neosporin or something that will have some kind of bacterial coverage. You pop that on that opening and you'll cover it hopefully with something non-stick, but if all you've got is a t-shirt of a friend, then you put a clean t-shirt of a friend over that opening and you make sure that nothing else can get into that opening.

Interviewer: What if you don't have such a clean t-shirt? Still covering it with that is better than not covering it?

Dr. Matherly: Yes.

Interviewer: You have to cover it?

Dr. Matherly: Covering it is better than leaving it open because if you think about as you're walking through the forest or the amount of times that your hand comes into contact with something, then again, it's picking potentially picking up bacteria on mold, or spores or something from the environment. So you want to keep that area as covered as possible.

Then number four would be your call for help if you need help. Now, obviously, that might not be very timely, depending on how deep on the woods you are, but as soon as you're able to make a call and to seek assistance, especially if it's something larger, then that has to be done because even a small injury can cause an infectious process that can make somebody very sick.

Interviewer: When does that infectious process start? How long after the burn?

Dr. Matherly: Well, the burn is pretty clean, right? Let's think about the ideology of burn injury. It involves something hot touching the skin and what that means is it's just burned off all the existing bacteria, so you've got a little while before that bacteria starts to multiply again. We usually say that about 24 hours is a safe bet. So after 24 hours if a patient has a temperature, then now they're growing some kind of bacteria that can be associated with the burn injury. So before that, it was probably something that the patient came in with.

Interviewer: So if I'm not in the middle of nowhere and I get that burn, as long as I do some of these steps, I've got 24 hours before I need to really start worrying about something setting in if it's going to set in?

Dr. Matherly: Absolutely.

Interviewer: It's not going to set in after eight hours necessarily?

Dr. Matherly: Well, they can start, right? I mean, bacteria are so small and we're crawling with it. With that it's all over us so can it start? Absolutely. Is it likely to make us sick right away? No, it won't. So we'll be maintaining enough that we can do what we need to do to get us somewhere safe, hopefully, and then we can have somebody else take care of business for us.

Interviewer: Physical activity okay? Getting that hurt rate up, that's not going to affect the burn in any way?

Dr. Matherly: No. Obviously your heart rate's going to increase because this burn is going to be painful. So if you have some over the counter medication that you take with you, that might be great because that will help decrease the pain so that you can hike out or you can walk out. But, other than that, we encourage activity in all patients that have been burn injured. You don't want to splint something, you want to keep using the body parts so that it kind of won't contract in place. That's the worst thing possible so you want to keep moving that area that's been burned, which will decrease the inflammation and will help it to be useable.

Interviewer: What about the skin? The skin gets tight, that's going to hurt, isn't it?

Dr. Matherly: Absolutely.

Interviewer: But still keep moving it?. That's more important? Okay. Any final thoughts if you get burned and help is not coming soon?

Dr. Matherly: I think that what's most important is to remember how resilient we are as human beings. We can do anything. That fight/flight response is absolutely amazing. We have seen people coming with some really large burn injuries that have driven themselves down from the getting burned, walked into the emergency department, and they have still been okay. So remember, your catecholamine response to injury is huge and you can do it and you can get out if you're stuck somewhere, even if you may have a pretty significant injury.

An exception to that would be your airway, so hopefully your airway will not occlude That's really important. But on other body parts you usually have some time.

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Interviewer: What to do if your child gets scalded. We'll talk about that next on The Scope.

Annette Matherly is with the University of Utah Burn Center. Scald injuries, of course prevention is always the best thing you can do, is you want to prevent a scald injury because they are devastating, they're painful, and they can last a lifetime. But if you can't prevent it, if something happens, what do you do? We're going to find out right now. First of all, scald injuries, they're pretty common right? Is that the burn injury?

Annette: It is. In fact it's the top burn injury for those under the age of five. But scalds are on the gamut of age, so there's no one safe from hot liquids.

Interviewer: Under five, really important you pay attention. But just kids in general, they're all getting them.

Annette: Absolutely.

Interviewer: So why are scald injuries so terrible? What makes them so bad?

Annette: Well, I think it's because you don't realize that things are so hot. In fact, we teach our children that hot liquids burn like fire. But when you have a hot frappuccino or your beverage of choice in your hand, you don't think that it's 160 Fahrenheit, and that can cause a burn injury in just one second in a child. If you think about the water that comes from your tap, if you haven't turned your hot water heater down, then that water is about 146 which would cause injury in a couple of seconds. So it's these things that we use every day that we don't think are dangerous that absolutely can cause devastating injury.

Interviewer: Yeah, I think that's because most of the time when you think scald injury you go back to school and they taught the pot of boiling water that's the thing that you got to watch out most for, but that's not even the case really, is it? I mean, it's dangerous but, some of these other things are more dangerous.

Annette: Absolutely. I'm not knocking the scalding water on the stove, because of course we should keep our pan handles in and cook on the back burner, and we have lots of children that come in that way too. And so, that's really important, that whole circle of safety around the stove. So to make sure there's about three feet that your child doesn't enter when you're cooking anything. So that's a cause of injury too but the bathtub scalds, the "I'm drinking a hot drink" scalds. In fact, the other thing that we say is, have a kid get a lid. So we want you to use lids on your travel mugs so that we can keep those injuries from occurring to small children.

Interviewer: Because those liquids we can handle drinking gets on young skin and it's just terrible.

Annette: Absolutely. They're so curious. They just want to reach up and they want to pull that cup down.

Interviewer: Prevention again, the most important thing you can do as far as you know, you just don't even want it to happen. But what should a parent do at that point?

Annette: Probably the easiest thing to remember is, the four C's. And those stand for cool it, so you want after the injury has occurred, you want to quickly take your child or take whoever's been injured and cool that injury under cool but not cold water for about 5 to 10 minutes. Take that heat out of the tissue, remember to remove any diapers or any clothing that the child has on because those can also retain heat.

The second thing that you want to do is clean it, and that includes the sticky noodles, the pieces of carrot or potato that are on the child, or inside the diaper. So you want to cool it, you want to clean it. And then, you want to keep your child warm.

So one of the most important things to do after you've cooled and cleaned it, is to cover your child in something that will cause them not to be cold, because we want to get heat to that area and open up those blood vessels, and allow perfusion to occur that's happened to an area of injury. So wrap a blanket or wrap a towel around the person that's injured, and then call for help. And that's much simpler I think than people imagine, because you can call from the community directly to the burn center and have your needs addressed right over the phone.

So if you have a child that's been injured you can call 801-581-2700, talk to one of our charge nurses that's on call 24 hours a day. Be linked in with a physician who can get you immediate assistance, whether that be being admitted to the burn center or an outpatient appointment, or hopefully just being able to take care of it at home with some simple instructions on what to do. And we've received many calls from the community and helped them.

So good rule of thumb to remember is, if its life threatening, then call 911 and get the help that you need. If it is a minor injury, even if you don't think it perhaps needs to be seen, then it's a good idea to call the burn center. We're on call 24 hours a day and at least run it by us, and we can help figure out if it should be seen or not. Because sometimes it doesn't look significant, but it can cause injury that maybe you wouldn't have thought of.

updated: February 6, 2023
originally published: February 4, 2015

Interviewer: What should you do if you're trapped in a burning building? We'll examine that next on The Scope.

Announcer: Medical news and research from the University of Utah. Physicians and Specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: So if you remember back when you were a little kid stop, drop and roll. You touch the door to see if it's hot. What should you do if you're trapped in a burning building? Are those still the same steps or is there something else we should know? Annette Matherly is the Outreach and Disaster Coordinator for the Utah Burn Center.

I'm caught in a burning building, whether it's at home or at work. What do I do? Are those basics I learned in school still good or what?

Annette: Absolutely some things never change; you just try and make them right? So let's just say I'm in my bed, I'm snoozing away and the smoke alarm goes off. I wake up but I'm kind of still sleeping. It's dark, right? But is it dark because there's smoke in my room or is it dark because my eyes aren't open yet or is it dark just because it's night?

Well, I don't know the answer to that and so I roll out of bed and I drop to the floor. My door is closed because remember we're supposed to keep our doors closed when we sleep at night and that's because if there's a fire outside our room, if our door is open and we open the windows so we can escape out the window then it will cause this draft which will pull the heat and smoke into our room.

So that's why we leave our door closed. So I'm crawling across the floor, I'm heading to the door. I use the back of my hand to feel the door. Is it hot? No, I can't feel it. I put my hand up and I feel the knob and the knob is hot so that means there's some fire, something hot outside my room. So now, man, I can't get out of my door. I know that I've got to stay in my room.

So what I want to do is I want to make my way to the window. I'm safe to open it if the doors closed but what if I'm on the 5th floor? What if I'm on the 25th floor? I can't jump out of my window now.

Interviewer: I don't like this scenario you're painting at all. What am I going to do? Tell me.

Annette: Well, so now I know I can't jump so I'm kind of stuck in my room for a while. So what I want to do is pull the sheets off my bed and I want to stuff them right underneath that crack in the door and around the door so I stop that smoke from coming in as quickly as I can. Obviously my first thought is for my safety so I want to get somebody's attention so they can get me out of this burning building as quickly as possible.

It is safe to open the window because your door is closed, it's not going to cause that draft and pull the heat into the room. So I want to get somebody's attention by being at that window. Now obviously if I'm smart I'll also have a flashlight by the bed but I can use the lights if the electricity works to get peoples attention. If not, then to have a flashlight and signal for help and yell and scream out the window so those firefighters who know how to do this, who are experts, can get up to me.

The other thing I might want to think about if I'm maybe on the 3rd or the 4th floor is they have some handy-dandy great ladders that can be used as a fire escape in an emergency situation. If I have one of those I can get out of the house but it's not very helpful if I'm on the 25th floor. I'm pretty sure they don't make ladders that long.

Interviewer: So I'm in my room, my door is closed because I've listened to you. I've checked, it's hot. I would imagine a lot of parents at this point would go, "What about the kids? I need to get out and help the kids." What's the answer to that?

Annette: This is a heart-wrencher, because as a parent of course you want to get your kids out. But we have also many people in saving the children and in saving the hamsters and in saving their dogs, they get severely burn injured. So the key thing is, and this is the kicker, is many people don't want to deal with this because it's kind of an iffy topic and people kind of shy away from things the things that scare us.

But if people practiced their fire escape plans, their home escape plans with their family and they practiced it in the day and they practiced it at night, and they practiced it with their kids and their kids could demonstrate competency in getting out of the house. That muscle memory, that second nature that kicks in when you have fight flight, if you have practiced that then your children are likely to get out of the house.

You may only have two minutes. What's really important is to think about it before. We should just talk about freely in our homes and in our families. Kids love to take responsibility. The kids can be the Fire Marshall and they can prepare the drills and they can have unexpected drills at 2:00 A.M. on a weekend so that parents and everyone can practice crawling out in the dark, going to a safe meeting place and rejoicing with everyone because everyone's got out safe.

Interviewer: You know the worse part about it is that I hear you say all these things and I'm like, "It's never going to happen to me. It sounds like a lot of work." I get totally what you're saying that it has to happen before. You're not going to save lives during, you're going to save lives before. How do you get over that "it's not going to happen to me" barrier?

Annette: Well you know as an ICU Nurse we hear that all the time. Unfortunately because nobody ever thinks it's going to happen to them. It's human nature to think... We don't want to think about bad things. But we need to be motivated enough to engage in preparation and prevention so that we can keep not only ourselves but our loved ones safe and secure. We can know if it happens, and tragedy does, that we did our absolute best that we can to change an awful situation.

Interviewer: I like your idea of turning it into a game to prep for the kids. I bet you the kids would absolutely love that. That's a good idea. What about having a plan where all right you've got the baby, part of the plan is everybody feels their door. If somebody doesn't feel the heat, they are the ones. Like before you plan, they are the ones to go examine to see if the baby's safe. Is that something you can do or is that a bad idea?

Annette: Sure, absolutely. Let's just take there are four people and three of them feel the heat and they're going to get out the window or they're going to stay and they're going to signal for safety. One person doesn't feel the heat. Now not feeling the heat doesn't mean not necessarily hot or dangerous behind the door, so you want to open your door very carefully and slowly because if there is something out there you want to close it really fast.

But if you don't see anything in the hallway and you have a baby next door to you, then you can obviously open up that door, run and grab the baby. Check those corridors because remember if you can see smoke then you need to get underneath it. The toxins that the smoke contains will get into your lungs. Many people don't die from the burn injury; they die from the toxins in the smoke itself. Because the unfortunate thing is it clouds your mind so you can't make very good decisions, so maybe you're not clear.

So you need to get underneath that smoke. You need to crawl either out of the house through your escape route with your child or if you can't escape, you've seen it, there is smoke at the bottom of your stairs and fire down through that exit way, you need to go back into your room and then you need to signal for help from your room. Do all those things under your door. Stuff your blankets underneath so that you and your child can stay safe as long as possible.

Interviewer: Keep your child's, keep your baby's door closed as well.

Annette: Absolutely.

Interviewer: Because then there might be a chance that you get out. The Fire Department shows up, they're still able to save the child.

Annette: Absolutely.

Interviewer: Wow, all right. So get out and practice those drills. Any final thoughts when it comes to what to do if you're trapped in a burning building?

Annette: The other thing that I would say is there's some amazing websites out there. The NFPA website, the Burn Prevention Network, the Safe Kids, they have some great tool kits, some great games for your kids. They have things for adults too but they have really basic important concepts that you can adapt into your homes and make a part of your every day life to make prevention just the same as can I have an egg and some toast in the morning. That's how prevention should be.

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