First Aid for a Full-Thickness Burn (Third-Degree Burn)

What is a third-degree burn?

Third-degree burns, the most serious, involve all layers of skin. They are so deep that only the edges heal. Scars will eventually cover the rest of the burned area if skin grafting is not done.

What causes a third-degree burn?

Third-degree burns are usually caused by:

• clothing on fire
• immersion in hot water
• contact with flames, hot objects, or electricity
• corrosive chemicals.

What are the symptoms?

The skin may be white, or it may be black and leathery. There may be little pain in the burned area, but the areas surrounding the burn may be quite painful.

How is it treated?

All third-degree burns require medical treatment. Call 911 for emergency rescue if available, or transport the person to an emergency room. Assist a burned person as follows:

• If the person's clothes are burning, do not let the person run. Running can fan the flames so that they rise to the person's face. Smother the flames with a blanket, rug, or jacket, rolling the person on the ground if necessary.
• DO NOT remove clothing that is stuck to the burn.
• DO NOT apply ice water, lotions, ointments, sprays, or home remedies.
• Remove jewelry and tight clothing from the burned area before swelling begins. If you cannot do this, emergency rooms have special tools for removing jewelry or clothing.
• Immerse the burned area in cold water or apply cold moist cloths briefly to bring the temperature of damaged skin and other tissue back to normal. Leaving the burned area in cold water too long can cool the body too much.
• In extensive burns, check for these signs of shock:
  • decreased level of consciousness
  • rapid, shallow breathing
  • faint, rapid pulse
  • nausea, sometimes followed by vomiting.

  If the person is in shock, be sure you have called for medical help. Do not move the person unless you have to. The person should be lying on their side to prevent choking in case of vomiting. Unless the person has trouble breathing or pain, raise the feet. Cover the person with a blanket to conserve body heat. Keep him or her as calm as possible.

• Wrap the person loosely in a clean sheet if the burned area is extensive. Otherwise, apply dry, nonfluffy loose bandages, such as a pillowcase or clean disposable diaper.
• Raise a burned arm or leg higher than the person's heart. However, keep the head and shoulders raised slightly if the person is burned on the neck or face or is having trouble breathing.
• If the person is conscious and not vomiting and if medical help is more than 2 hours away, give small sips of water or clear juice. If the person is in shock, however, and asks for water, moisten the lips but do not allow drinking. Drinking may cause vomiting and choking.
• DO NOT give the person alcohol.

For chemical burns follow these steps, making sure you avoid contact with the chemical:

• Remove any clothing and jewelry on which the chemical has spilled.
• Flush liquid chemicals from the skin thoroughly with running water for 15 to 30 minutes. Avoid splashing the chemical in the eyes.
• Brush dry chemicals off the skin. Water activates some chemicals, so keep dry chemicals dry unless very large amounts of water are available. Be careful not to get any chemicals in the eyes.
• Cover the burn with a dry, loose bandage.

For electrical burns:

• All electrical burns must be examined by a healthcare provider. An electrical burn may appear to cause minor damage, but it can extend deep into tissues beneath the skin. The damage may not be obvious for several hours.
• Cover the area of the burn with a dry, nonfluffy, loose bandage. Do not apply any ointments or other substances to the burned area.

How long will it take a third-degree burn to heal?

Third-degree burns may require hospitalization for a few days or for many weeks. Scars may require several operations by a plastic surgeon, depending on the severity of the burns. Extensive burns are usually treated at a burn center.