approaching a person who has burns, are essential
for personal protection from bloodborne
pathogens as well as to prevent BACTERIAon the
responder’s hands from causing INFECTIONin the
burn wounds.
First response actions If the person’s clothing is
on fire, get the person on the ground and smother
the flames by rolling or covering with a blanket,
rug, jacket, or other object that can block the flow
of air. Burns require specialized care from medical
personnel trained in burn care. The most appro-
priate actions for an untrained responder first on
the scene are to keep the person warm and com-
fort the person until medical personnel arrive.
Most important:
- Do notput anything on the burns.
- Do notpull clothing or debris from the burns.
- Do notpop BLISTERSor pull the SKINoff blisters
that spontaneously rupture.
Cool water, such as from a water faucet, is
appropriate first aid to soothe small, minor burns.
Promptly cooling a small first- or second-degree
burn relieves PAINand reduces swelling. However,
the burn may still require medical attention.
Follow-through A health-care provider should
evaluate and treat most second- and third-degree
burns as well as first-degree burns that cover 36
percent or more of the body. Infection is a signifi-
cant risk with second- and third-degree burns; any
indications (FEVER, increased pain or swelling)
require prompt medical assessment.
See also SITE AND SITUATION ASSESSMENT; SUNBURN;
SYMPTOM ASSESSMENT AND CARE TRIAGE.
closed fracture A broken BONE that does not
protrude through the surface of the SKIN. A closed
FRACTUREmost commonly results from a blow that
delivers intense energy to small or limited area,
causing the bone beneath to break. The bone ends
may remain relatively aligned or may cause signif-
icant soft tissue damage even though the ends do
not penetrate through the skin. Although the ends
of the bones with a closed fracture do not break
the skin, they may still do considerable damage to
tissues and structures around the area of the
break. Fractures require prompt evaluation and
treatment from a health-care provider.
Do notmove a person who may have a
FRACTUREof the back or neck. Brace the
person with rolled towels and blankets
or other objects and keep him or her
still until emergency medical personnel
arrive.The most appropriate action for the responder is
to immobilize the limb, as well as the joints above
and below the point of the fracture when possible,
and obtain immediate medical attention. Splints
are effective for fractures of the fingers, arms, and
legs. Commercial first aid kits may include soft or
inflatable splints. As well, the responder can use
many common objects to fashion an improvised
splint: towels, pillows, cardboard, and folded news-
papers or magazines. A sling to support the arm on
the side of the injury helps immobilize a fractured
clavicle (collarbone) or shoulder blade (scapula).
Scarves, belts, towels, and even a long-sleeve jacket
or shirt with the sleeve pinned to the upper part of
the garment are among the items the responder can
use to make a sling.
See also ACCIDENTAL INJURIES; ATHLETIC INJURIES;
OPEN FRACTURE; SYMPTOM ASSESSMENT AND CARE TRIAGEdislocations Injury to the ligaments at a JOINT
that allows the ends of the bones to separate.
Often the responder cannot determine whether an
injury is a dislocation or a CLOSED FRACTURE; FIRST
RESPONSEtreats them the same.Do notattempt to “pop” a dislocated
JOINTback into place.The primary first response action is to immobi-
lize the joint using a splint, or, in the case of a dis-
located shoulder, a sling. A health-care provider
should evaluate a dislocation to determine if there
is a FRACTURE (which requires an X-RAY) and
whether surgery is necessary to repair the liga-
ments.
See also ACCIDENTAL INJURIES; ATHLETIC INJURIES;
BONE; LIGAMENT; SPRAINS AND STRAINS; SURGERY BENE-
FIT AND RISK ASSESSMENT.impalement A wound in which an object pene-
trates a part of the body and remains embedded364 Emergency and First Aid