By Laurie Sullivan
Red hot motorcycle mufflers… petrol-soaked skipping ropes at Full Moon parties… bare feet on baking sand… flaming cocktail drinks. There’s a long list of ways to get a burn on an overseas holiday.
And, they’re not the exclusive province of young travellers: Friction or ‘gravel rash’ burns from a fall onto a roadway or concrete footpath are even more common.
Together they add a whole new meaning to ‘travel hotspot’.
On average there are 50,000 burns-related hospital admissions in Australia each year, with more than 2500 patients treated in 17 specialist burn centres across Australia and New Zealand. Among them are scores of overseas travel mementos.
Burns can range from the minor and common to severe and life-threatening. According to the Australian and New Zealand Burns Association, most superficial burns heal in 10 to 12 days with no complications, but acute burns often require emergency first-aid and surgery, followed by a lengthy period of nursing and rehabilitation.
Even burns that appear minor can become serious in a matter of days. Every burn is a portal for germs to enter the body and if left untreated or treated ineffectively, they can quickly multiply and cause an infection that requires a stay in hospital or, at worst, skin graft surgery.
20 minutes of cool water is critical
Director of the Perth’s Fiona Stanley Hospital Burns Unit, Professor Fiona Wood and colleagues examined data from more than 2320 patients admitted to burns units in the two countries between 2009 and 2014.
The researchers found that running cool water over the burn for 20 minutes within 3 hours of the injury was the critical first step in treatment. It reduced the average hospital stay by more than 2 days, and meant that requiring a surgical repair (grafting) procedure was much less likely.
For travellers, the correct initial treatment could mean the difference between an easily managed wound and one that requires specialist treatment in a hospital overseas or back home, according to one of the co-authors of the Perth-based study, Assoc Prof Dale Edgar.
A clinician at Fiona Stanley Hospital, Assoc Prof Edgar is also an associate professor at the Burns Injury Research Node of The University of Notre Dame in Fremantle.
“We see a steady stream of travellers who return home with burns that can be challenging to treat,” he told Travelvax Australia during a telephone interview.
“They dismiss the injury as minor and don’t bother with first aid. But, if a burn isn’t cleaned, treated and dressed correctly it can end up badly infected a few days later.
“Exhaust pipe burns are especially problematic because there’s little skin coverage around the lower leg and ankle, and sometimes tendons and bones can be exposed if the wound is neglected or becomes infected. They can turn nasty in the blink of an eye.”
Bacteria invade tissue, bloodstream
Epidermal (surface) burns which blister generally require a light secondary dressing. But, deeper ‘dermal’ wounds may ooze fluid and require an absorbent secondary dressing secured by tape or, preferably, with a bandage.
Once the skin is broken – particularly over a large area – bacteria living on the surrounding skin can easily invade tissue or enter the bloodstream. Germs from the environment, such as the roadway or footpath, can also enter.
Flushing the wound with water is the first line of defence against germs.
As well as helping to remove any debris, water serves to cool the affected area.
While 20 minutes is the optimum time, even 5-10 minutes can be beneficial, Assoc Prof Edgar said.
One of the surprising findings of the study was that more water is not better. Indeed, it could make things worse: Prolonged cooling beyond 40 minutes could cause either hypothermia or vasoconstriction, a narrowing of the blood vessels.
Tap water overseas may introduce germs
But, what about using water from a tap in a developing country?
It‘s a golden rule of travel not to drink tap water without boiling or treating it, so should you use water straight from the tap on a burn or other wound?
“I would definitely avoid murky looking water,” Assoc Prof Edgar said.
“But, even if the tap water looks clean, chances are you will introduce some microbes into the wound. These could challenge your immune system and may impair the healing process.
“But, a traveller may not have a choice overseas. So, wherever you are, it’s also best to follow the water with broad spectrum antiseptic ointment to minimise the risk of wound infection.”
Among the most popular is Betadine ointment, but silver sulfadiazine cream or other ionic silver preparations and dressing systems are also options.
How to treat a burns wound
The ointment should be applied using sterile gloves in either of two ways:
- Directly onto the wound, covering its entire surface and edges, or
- Onto a sterile non-stick pad. This should then be laid over the whole wound.
The non-stick pad should be followed by:
- A second sterile pad big enough to entirely cover the non-stick pad.
- A compression bandage long enough to cover not just the wound, but also the limb on either side. (If the wound is on the lower leg, the bandage needs to start at the toes and finish at the knee. If on the forearm, bandage from the knuckles to the elbow.)
“After germs, the other danger with a burn is swelling,” Assoc Prof Edgar explained.
“The wound and sections of the arm or leg on either side need to be wrapped firmly, but not too tightly.”
The ointment and dressing process should be repeated every day initially, at least until the wound can be assessed by a doctor.
Dangers of using antibiotics
For more serious burns in particular, Assoc Prof Edgar advised seeing a qualified medical professional as soon as possible.
“A medical assessment is important for any wound that requires dressing – whether you followed the correct first-aid procedure or not,” he said.
“With burns wounds, things can go pear-shaped pretty quickly within the first 48-72 hours.
“But, if you’ve managed to keep infection in check, you give yourself a better chance of ensuring that the wound will heal without requiring surgery.”
Assoc Prof Edgar cautioned against taking oral antibiotics to treat a burns wound unless advised by a reputable medical professional.
“The over-use of antibiotics has contributed to the rise of multi-drug resistant germs, which has become a major global public health issue,” he said.
“We see travellers return with infected burns who are already taking antibiotics. Typically, they see a chemist overseas in places like Bali and buy antibiotics over the counter.
“Not only do the drugs not clear up their infection, taking them adds to the growing problem of germs becoming resistant to antibiotics.”
* Travelvax Australia (1300 360 164) stocks a comprehensive range of first-aid kits which can be tailored to each traveller’s itinerary and planned activities. Equip Health Systems, supplier of our first-aid kits, has designed a supplementary Burns Kit to manage burns. It contains: An Emergency Action Card, protective gloves, Burn-Aid gel sachets (x2), Open Weave Adhesive Dressing, moist burn pads (x2), and Aloe Vera.