Treatment of Brush Fire Burns
Immediately cool the burn with clean running water for 5-20 minutes, then clean the wound, apply a petrolatum-based dressing, and provide adequate analgesia while monitoring for signs of infection. 1
Immediate First Aid (Within First 3 Hours)
Active cooling is the single most critical intervention that determines long-term outcomes:
- Apply clean running water for 5-20 minutes to limit tissue damage, reduce burn depth progression, and decrease pain 2, 1, 3
- Running tap water or water from a clean container reduces infection rates and mortality compared to other water sources 4
- Remove all jewelry immediately before swelling occurs to prevent vascular compromise and constriction 1, 3
Cooling Parameters Based on Patient Age
- Adults: Cool burns covering <20% total body surface area (TBSA) if patient is not in shock 2, 1
- Children: Cool burns covering <10% TBSA if patient is not in shock 2, 1
- Monitor children closely for hypothermia during cooling, especially those <4 years old receiving whole-body cooling 2, 3
Critical Cooling Pitfall
Do not use ice directly on burns as this causes additional tissue damage 1, 3. While the evidence shows no specific optimal duration can be definitively recommended from controlled trials 2, observational data demonstrates that approximately 5 minutes of water application reduces infection, hospital length of stay, and mortality compared to longer durations 4. The 20-minute recommendation from some guidelines is based on evidence showing reduced need for skin grafting 5, but practical application of 5 minutes shows superior real-world outcomes 4.
Wound Care After Cooling
Clean the wound thoroughly before any dressing application:
- Use tap water, isotonic saline solution, or antiseptic solution 2, 6
- Perform wound care in a clean environment with adequate analgesia or sedation 2
Dressing Selection by Burn Depth
Superficial (First-Degree) Burns:
- Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 3
- Cover with clean, non-adherent dressing 1, 3
Partial-Thickness (Second-Degree) Burns:
- Apply thin layer of petrolatum-based antibiotic ointment 1
- Use non-adherent dressing such as paraffin gauze, Xeroform, Mepitel, or Allevyn 1, 6
- Avoid prolonged use of silver sulfadiazine on superficial burns as it delays healing 2, 1, 6
Full-Thickness (Third-Degree) Burns:
- Cover with clean, dry, non-adherent dressing 1
- All full-thickness burns require immediate medical attention regardless of size 1
Dressing Management
- Re-evaluate dressings daily 2, 1
- Change dressings every 1-2 days based on wound condition 6
- For circumferential limb burns, prevent tourniquet effect and monitor distal perfusion 2, 1
- Do not use external cooling devices (Water-Jel dressings) for prolonged periods due to hypothermia risk 2
Pain Management
Use multimodal analgesia titrated to validated pain scales 2:
- Short-acting opioids and ketamine are the most effective agents for burn pain 2, 1
- Titrated intravenous ketamine can be combined with other analgesics for severe pain 2, 1
- Over-the-counter acetaminophen or NSAIDs for minor burns 1, 3
- Inhaled nitrous oxide when IV access unavailable 2
- General anesthesia for highly painful procedures or extensive burns 2, 1
Antibiotic Management
Do not use prophylactic antibiotics or topical antibiotics as first-line treatment 1:
- Reserve topical antibiotics for clinically infected wounds only 2, 1
- Antiseptic dressings may be appropriate for large or contaminated burns 2
Mandatory Transfer Criteria
Immediate medical attention or burn center transfer required for 1, 3:
- Burns involving face, hands, feet, or genitals
- Partial-thickness burns >10% TBSA in adults (>5% in children)
- All full-thickness burns
- Signs of inhalation injury (soot around nose/mouth, difficulty breathing, singed nasal hairs)
- Burns showing signs of infection or excessive pain