Burns Society of Kenya — Clinical Practice Guidelines Based on British Burn Association First Aid Guidelines (2018) & ABLS Standards

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1. THERMAL BURNS

Stop the Burning Process

• Remove the patient from the source of injury once the scene is safe
• Extinguish burning clothing with water or the Stop, Drop and Roll method
• Isolate electrical sources before attempting rescue
• Avoid chemical cross-contamination to rescuers

Remove Clothing and Jewellery

• Remove all burnt, contaminated, damp, or constricting clothing promptly
• Remove jewellery, nappies, and contact lenses near the burn
• Leave any clothing that is melted or adherent to the skin — do not pull it off

Cool the Burn

If water is available:

• Begin cooling immediately — do not delay
• Cool running tap water for 20 minutes, commenced within 3 hours of injury
• Do not exceed 20 minutes of active cooling — risk of hypothermia, especially in children, the elderly, and large burns

If water supply is limited:

• Apply a cool, wet, lint-free compress and change it frequently over 20 minutes
• If no water is available at all, cover with cling film and cool at the earliest opportunity within 3 hours

Do not use:

• Ice or ice-cold water — causes vasoconstriction and worsens tissue damage
• Toothpaste, butter, ghee, cooking oil, flour, or any traditional topical remedy

Warm the Patient

• Cool the burn, but warm the patient
• Cover all non-burnt areas to prevent hypothermia throughout the cooling process
• Children and the elderly are at highest risk of hypothermia and require active warming

Cover the Burn

• Cover the cooled burn with loose longitudinal strips of cling film, or a clean lint-free non-adherent dressing
• Do not wrap cling film circumferentially around limbs
• Do not apply cling film to facial burns

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2. CHEMICAL BURNS

Early and sustained decontamination is the priority — duration of chemical contact directly determines burn severity.

• Wear PPE before assisting to prevent rescuer cross-contamination
• Brush off any dry powder or solid chemical fragments before wet decontamination
• Remove and safely discard contaminated clothing
• Irrigate immediately with cool running water, normal saline, or Hartmann’s solution for a minimum of 20 minutes
• Continue irrigation until pain subsides or the patient reaches a burn specialist
• Do not attempt to neutralise the chemical — this causes an exothermic reaction and worsens injury
• Do not irrigate dry lime, phenols, concentrated sulphuric acid, or elemental metals with water
• Where available, consult a poisons/toxicology reference for agent-specific management

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3. ELECTRICAL BURNS

• Confirm the power source is isolated before approaching the patient
• Manage life-threatening conditions first per standard ATLS protocol
• Cool the entry and exit wound sites with cool running water for 20 minutes within 3 hours
• Monitor cardiac rhythm — if there is no history of loss of consciousness, cardiac arrest, or dysrhythmia and ECG is normal, prolonged cardiac monitoring is not mandatory
• Always transfer to facility capable of full assessment — electrical burns frequently have deep internal injury disproportionate to the surface wound

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4. TAR AND BITUMEN BURNS

• Cool the tar and the wound with cool running water for 20 minutes within 3 hours
• Do not attempt to remove hardened tar in the field
• Once cooled, tar removal can be deferred to a burns unit using liquid paraffin or oily solvent — it is not an emergency

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5. COLD BURNS / FROSTBITE

Uncommon in Kenya but relevant in highland and high-altitude environments (Mt. Kenya, Aberdares)

• Prioritise management of hypothermia and major trauma before addressing local cold injury
• Begin rewarming only if refreezing during transit can be prevented — refreezing causes significantly worse tissue damage
• Rewarm in circulating water at 37–39°C with a mild antibacterial agent (povidone-iodine or chlorhexidine) for at least 30 minutes within 12 hours of injury
• Do not use dry heat, massage, or apply pressure to the affected area
• Elevate the injured area to reduce swelling

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6. CRITERIA FOR URGENT TRANSFER TO A BURN FACILITY

Transfer urgently to a burns-capable unit when:

• Total body surface area burn is significant or difficult to estimate in the field
• Burns involve the face, hands, feet, genitals, perineum, or major joints
• The burn appears deep (white, waxy, brown, black, or painless)
• The patient is a child under 5 or an elderly adult
• The burn was caused by electricity or chemicals
• There are signs of inhalation injury (singed nasal hair, hoarse voice, carbonaceous sputum, respiratory distress)
• Circumferential burns of the limbs or chest are present
• The patient has significant comorbidities

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KEY REMINDERS FOR PREHOSPITAL PROVIDERS

✅ DO	❌ DO NOT
Cool with running water for 20 minutes	Use ice, iced water, or cold packs directly
Warm the patient while cooling the burn	Cover the entire patient with wet material
Remove loose clothing and jewellery	Pull off adherent or melted clothing
Cover with cling film or clean lint-free dressing	Apply toothpaste, butter, oil, or any home remedy
Seek urgent transfer for high-risk burns	Delay transfer to attempt wound management in the field
Wear PPE for chemical burns	Neutralise chemicals on the skin

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Burns Society of Kenya Developed in alignment with: BBA First Aid Clinical Practice Guidelines (2018) | ABLS Handbook (ABA, 2011)

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