Burnshield and the Treatment of Burns
On the Arrive Alive website, we have shared several pages of content focusing on the threats to safety presented by fire, electricity and other factors contributing to burn injuries. We have recently partnered with burns expert Burnshield to gain more insights, and would like to share the following interview which we transcribed for our viewers:
“Good day and welcome to another exciting live stream event proudly brought to you by Arrive Alive and Burnshield.
We asked the public to submit all their burn-related questions which we will answer on this page.
So let me introduce you to the man who will be grilling Burnshield, Mr Johan Jonck from Arrive Alive South Africa. And in the hot seat, Managing Director of Burnshield, Mr Joel Levy.
So, Johan without further ado, fire away!
Overview of Burnshield:
Well from my side I think the timing is perfect, yesterday we had quite a few roads crashes in South Africa and two of those road crashes the vehicles were in flames, burnt out. We often find burn injuries from fiery road crashes.
On the Arrive Alive website, we have several pages of content specifically dealing with safety from a vehicle fire, and through the collaboration with Burnshield, we can share more information on burns and how to treat burns.
Joel, thanks a lot for joining me for this. Can you perhaps as a start just give us a brief background on Burnshield, the company, how everything started and your areas of focus?
Answer: So Burnshield started 30 years ago. The primary reason was we found there was a need for a good, simple, effective treatment for burns. Many beliefs about what you should and what you should not do for burns were around in the market and I think everybody put something on a burn to make it better and not to make it worse.
Often, this results in the outcome of the burn being marginalized ineffective, in effect, so we decided to do the burn dressing, a water-based burn dressing which will cool and soothe, offer some pain relief and shock reduction and minimise the infection. So, we started this 30 years ago, the product range has developed over the years from a quality point of view. The basis of the gel formulation has remained consistent.
Just the range has developed, the quality of the outer packaging has improved and of course, we have always maintained our focus on all the international accreditations that are required.
So really, our focus has remained on the emergency care for burns and how to treat it very quickly and effectively from whether you're a qualified trauma nurse, whether you're a trauma doctor, whether you're a mom at home. With some simple messaging to say put the dressings on as quickly as possible, cool and soothe and offer relief to the patient.
The International Reach of Burnshield:
We can say that Burnshield is a proudly South African success story. Perhaps share with the audience to how many countries do you export, how many other countries use Burnshield burn gel?
Answer: So Burnshield is of course produced in South Africa. We often get asked the question "are we the agent for Burnshield?". Burnshield is produced in South Africa in Johannesburg 30 years. We supply the local market of course in across all aspects of the local market and now up to between 42 and 44 countries worldwide that we export to.
Misperceptions about the Treatment of Burns:
There are a lot of misperceptions about the treatment of burns. What would you regard as the biggest misperceptions? I know a lot of people say, “You must put your arm once burnt under water or flowing water’.
Are there specific risks? Is it always safe?
Answer: Well cool running water is the principle of cooling and the Burnshield formulation being 96% water actually supports the fact of cooling. And often it’s the case of how much cooling do you effect, what do you do, and is it practical to take the patient to the water source.
We bring the water source in the form of Burnshield gel to the patient. So, we don't over cool, we just cool the affected area and we make sure that the patient receives pain relief, shock reduction and infection control.
And we take away the myths of the oils and fats and greases and many people will tell you Coca-Cola, condense milk, mielie meal, toothpaste, full cream, honey, potato skins, chilli powder etc.
These are all myths that have been doing the rounds. There are many reasons why we don't advocate the use of those products. They seal the heat, they keep the heat in the wound and they don't allow the heat to evaporate out of the wound, so, therefore, the burn continues to progress, the heat stays in the wound. The damage that is normally inflicted, well that is infected is now aggravated because you're using those types of products which are not ideal for any burn wound management.
Different Types of Burns:
When we think of burns, we normally think of fire, but there are many different types of burns. Can you perhaps explain to our listeners or followers the different types of burns that you find and would Burnshield be effective for all those types of burns?
Answer: So, most burns are heat burns. We find the majority of burns caused are heat burns from direct flame, hot water, steam scalds etc. 70% of burns in South Africa are domestic. 50% of burns worldwide are domestic so a large portion of burns happens at home. So, what you tend to find is that for most heat burns: flame, fire, hot water, steam, scalds, you can use any Burnshield product.
The two exceptions that we tend to specify or highlight most are electrical and chemical burns. Electrical burns, the advice, the protocol is to switch off the power source first. If you don't and you touch the patient, he will remind you that you've forgotten to switch it off.
So, switch off the power source first. Remove the patient away from that particular electrical source. Look for the entry and the exit points for that electrical flash and often you will find that people make the mistake, they'll only treat the entry and the exit point. For electrical burn, you have to treat the entry and the exit and everywhere in between. Then you treat it as a normal heat-burn.
With chemical burns, the protocol is to flush the patient to get rid of the chemical, be it the acid or the alkaline that is in place - get rid of it, flush it out with some running water. Extra time should be spent on the eyes in the facial area. So normally about 10 minutes from all normal areas of burns and an extra two or three minutes if it's on the facial burn.
Once you have done that, you use Burnshield as normal.
The Treatment of Friction Burns
During the past week, we shared content on the Arrive Alive website about emergency first aid kits for motorcyclists. An expert from the motorcycle safety academy also gathered insights from another colleague in Dubai to compile the content for us.
They also included some examples, and I was pleased to see that Burnshield was also mentioned as one of the products that you must have in your emergency first aid kit. What exactly are friction burns? And are friction burns one of the reasons why Burnshield is advised for your motorcyclists? I also see that in the Levtrade sports bag, there's also Burnshield in there. If you are a hockey player, rugby player, a netball player on a hard surface where you play, what exactly would you say are friction burns and why would Burnshield also be effective in treating friction injuries?
Answer: Friction burns are in the form of a heat-burn, so if you have an accident on the road and the body makes contact with the tar, the tar is immovable, it's solid. But you tend to slide across it and get a bad friction burn or a bad graze caused by the scraping of the body over that particular surface.
When it comes to sports injuries, most, for example, occur on hard surfaces and Astroturf. A lot of these injuries takes place as a result of the body sliding across that rubberized surface.
It causes friction and you treat them as you would a normal heat burn. If you find a friction burn taking place, whether it's in a motor vehicle accident or a sports injury on the sports field, you treat it as you would normally treat a heat burn. What you’ll do, if you can without any further danger to the patient, try and remove any excess grit, dust, small stones, sand, that would have embedded itself in the wound. then you apply Burnshield directly afterwards.
Emergency Response in the First Hour after a Burn:
During the recent fires in the Free State, I actually reflected back a few years ago. I had the unfortunate experience to have been at the airport in Bloemfontein awaiting a young farmer who was trapped by a fire in the Eastern Free State. I was there when they did the emergency air evacuation. Sadly, his organs gave up on him a few days later.
When we talk about road crashes, we always refer to the first hour as the golden hour. How important is that first hour? When you see that somebody has been injured, has been burnt, what do you need to do in that very first hour?
Answer: The First hour is always critical, in fact, the first 10 to 15 minutes are important. If you apply the wrong treatment to the burn you can certainly aggravate the wound, the burn goes deeper and the wound gets bigger. So, if you apply Burnshield in the first minute to 30 minutes you have the opportunity to release the heat from the wound and therefore you minimise the damage.
Unfortunately, depending on the nature of the injury or the extent of the injury, sometimes Burnshield will not be able to save that person's life, the injuries will be far too extreme for Burnshield to be effective, but at least you will give some relief to that particular patient.
But, generally speaking, most burns are superficial or of partial-thickness which is the old first and second-degree burns. If you treat them correctly, if you use cool running water or if you have Burnshield available to be used immediately on site, the outcomes generally are far greater in favour of the patient than if you just left the patient untreated at all. So, the sooner you get Burnshield on, the more effective it becomes.
The Need to Consult a Doctor for Medical Treatment:
I know parents and teachers can treat normal small burns but what would be the signs that you need medical advice and that you need to go to a doctor or hospital for more treatment?
Answer: Well, if you look at some of the burns that take place at home, generally speaking, are superficial to partial-thickness burns. It can be severe sunburn, you could be falling off your bicycle, having a friction burn, it can be hot water, steams, scald, fire and flame. Those burns tend to be treated or are able to be treated at home by using Burnshield.
When you find that the burn tends to blister extensively or that the burn looks infected, you can just see by the nature of the wound and you find that the burn itself is not responding 100% to the initial treatment. I think good common-sense should always prevail. If you see after the first hour that the burn is still progressing at quite a rate, or the patient is in distress, then you should leave. You leave Burnshield on and you should take the patient to the hospital as soon as possible to seek further medical attention.
But the signs of a first-degree burn are the normal reddening of the wound, some blistering may occur.
When it comes to a secondary burn, definitely blisters will appear, and you'll see also by the nature of the burn, the intensity of the heat that is retained within the burn itself. Normally with Burnshield being applied, after the first 30 to 40 minutes, the heat would have been dissipated out of the wound and therefore the progression of the burn would have been stopped. Now you're just treating the wound which happens to be caused by heat, flame or steam or scalding. So those are the two key issues.
Of course, the full-thickness burn, which is the old third-degree burn, tends to be charred or blackened and less painful because all the nerve endings have now been destroyed. If you find that the patient presents himself or herself with that level of burn, without responding much to pain reactions, you can tell that all the nerve endings have been destroyed. It is a sign to really get that patient to the hospital as quickly as possible.
When to Use the Variety of Burnshield Products:
There are a lot of products on display. Can you explain to us what is the difference between the dressings on display and when would you use each of these products?
Answer: So, when it comes to first aid in general, the kits that we produce cover four basic factors: Cuts, Burns, Bleeding and CPR.
So, if you look at the burns aspect where Burnshield is involved the dressing is the number one product of choice. You need to respond to any burn, any wound which has occurred as a result of an incident, where protection to the skin has been destroyed. When you apply the dressing over the wound, you not only cover and protect the wound, you also protect anything from the outside getting into the wound.
So, it limits the material, the growth, the colonisation of bacteria on that particular site. It keeps the burn very moist and covered.
So, the dressing is still the number one product to be used on the burn wound. Where the hydrogel spray comes in, it comes in in applications in three different places.
1) The "difficult to get to" areas. These include behind the ears, on the crease of the nose, under the arms, in the groin area.
These are difficult areas to attach a burn dressing. So, if you need to you can spray the hydrogel sway, spray it onto that affected area as long as the gel makes contact with the wound, cooling will start.
2) The sprays are to be applied to difficult to get to areas and are also used for severe sunburn.
3) The hydrogel spray is also used to rehydrate the dressings. If you put the dressing onto the wound and there's a tremendous amount of heat which is retained in the wound the dressing may start to dry out sooner than later, understanding that the dressing is a water-based dressing.
You can take the spray to rehydrate the dressing and continue using the same dressing as long as the dressing is not damaged or soiled.
So, the hydrogel spray is for rehydration, for difficult to get to areas and for severe sunburn.
Cooperation between Burnshield and Emergency Medical Services:
Do the paramedics or first responders, receive specific training on treating burns and using your product and burn gels?
In hospitals for instance, do you work closely with specific burn units? How does Burnshield get the products and the advances in technology and burns technology out there? Can the general public be at peace of mind that the ones that will treat them know exactly what to do?
Answer: Well, that's a professional point of view. So, all the paramedics, trauma nurses, occupational health nurses, we are fortunate in South Africa that these are very well, highly skilled, highly trained professionals. I've been privileged to work with a number of them over the past 30 years and I have to say that the level of nursing and the level of trauma and emergency advice given in this country, is really outstanding.
So, we really learn from the quality of those professional people. Right in the beginning when we started with Burnshield we did extensive in-service training in hospitals to trauma units and emergency care. We gave training to ambulance services and ambulance colleges. As the years have progressed, Burnshield, I am happy to say, has become a standard for burn care.
So, the level of updates that are now required is far less than in the beginning. But we do send out information, we do maintain our connection with the professional sector at all stages. From a consumer point of view, through our, social media we do make available very basic, simple, good information as to what you should and what you shouldn't do for burns should those injuries take place.
We share information about what you can and cannot do, who you should call, which emergency number you should call and where the product is available from.
General Burns Awareness amongst South Africans:
Do you believe the general public are safety aware enough to have a first aid kit in their vehicle at all times? Is the need to have a first aid kit at every home something we need to create a lot more awareness of?
I know you recently developed a very nice animation on the treatment of burns. As we head towards the festive season, we always find a lot of burns, especially in our informal settlements. Is a lot more awareness needed about the treatment of burns in South Africa?
Answer: Well, two parts to your question. Education and awareness are a continuous aspect of what it is that we do. So, when we are able to partner with you, with Arrive Alive, this sends out a very important message to so many different people. So that aspect of our business is something we work hard at and we make sure we give a lot of information at any stage very relevant to the general public.
When it comes to a first aid kit it is ironic that most people will buy a first aid kit or a burn kit once the incident has already taken place. They are very seldom prepared for that eventuality and they will tend to buy something once the incident/accident has already taken place.
So the information to educate, to make people more aware is ongoing. It is 100% correct what you're saying. The public need to be made more aware of safety. They need to understand that accidents don't only happen to other people, they happen to everybody. If you could prevent them you would not need any ambulance services and emergency departments. Accidents are those unforeseen circumstances for which we are not prepared.
So, the more information, the more the availability of product that gets made accessible to the public. We have our kits available in major retail outlets. Well-priced. Well-stocked. Good content and very easily and readily available to all people who need them.
Burns and Hyperthermia:
What is the relationship between burns and the risk of hypothermia?
Answer: Hyperthermia has been a question which has been around in my 30 years of being a seller, a promoter of Burnshield. It comes across at every given opportunity and it's very difficult to separate hypothermia from the burn itself. The number of doctors that I've spoken to have always given me some very good solid advice, certainly the trauma doctors here in South Africa and some overseas.
The first one is to treat the burn, not the patient. And the one good thing with Burnshield, because of the size of the dressing that you select, it will only then be effective in that area of the body.
So, in the old days, it was advised to cover the patient with as much water as possible. So, if you have a bad burn just on the arm or on the chest and you cover the patient with a huge amount of water, you're really increasing the risk of hypothermia whereas with Burnshield, you're only covering the affected area and therefore you reduce the risk of hypothermia. So, an important aspect is to cool the burn, not the patient.
The second aspect in any triage situation, they always tell you to treat the worst first. So, if a person has a burn injury and cannot breathe, there's no point treating the burn injury. The correct way and the priority are to open the airways, make sure the patient can breathe and then treat the patient for the burns. With hypothermia, it is the same as you treat the worst first! You treat the patient for the burns, and you address hypothermia as best as possible, and there are many methods and ways next that you can manage the risk of hypothermia.
Arrive Alive and the Commitment towards Burns Awareness
There are so many questions that we can still ask, but Cara, it is now over to you for some more questions.
We are committed to an increased focus on all our social media portals and to provide the best possible advice that we can share on burns awareness. Joel, I really appreciate your assistance today in answering a lot of these burning questions
Joel Levy from Burnshield on Awareness and Partnering with Arrive Alive
A lot of these questions are quite simple questions. They really are not new questions. These are the same questions people ask us time and time again. I think the importance of partnering with Arrive Alive is to answer these questions and to give people some peace of mind that the management of the burn, whether it's in a factory situation, or at home, is very simple and by using Burnshield as an effective means of the first phase for burns, you can minimise the extent of damage when it occurs.
Burnshield and the Type of Burn:
We have some questions that came in online and the first one is from Adeline. She basically wants to know: Can I use Burnshield on any type of burn? And how long should I leave Burnshield on? And how long does the burn wound actually take to heal?
Answer: Okay, so quite a few questions. First, is how long do you keep Burnshield on for? Burnshield is prescribed for the first 24 hours. The first cooling aspect is within the first hour, thereafter you keep the burn area moist and covered and you control the infection.
That is the basis of what Burnshield does. Again, if you find after that period of time that the wound looks like it's still infected and getting worse, you should seek medical attention. You can use Burnshield for the first 24 to 36 hours.
How long does it take for the actual wound to heal?
Answer: How long it takes for the wound to heal depends on the severity of the burn. Everyone reacts very differently. That's why I think if you ask any professional they would rather treat someone who has a finger that maybe has been badly damaged than treat a burn wound.
The burn can change within half an hour to three hours. It is important to understand the progression of a burn. If you leave it untreated it can very quickly progress from a first degree into a second-degree burn and that brings about with itself other complications. Our advice is always to use Burnshield first.
The first hour is the cooling aspect. Thereafter you keep the burn area moist and you control the infection.
Burnshield and the Area of the Burn:
A question from Kyle: Can you break down which dressings are best suited to where the burn is situated?
Answer: The Burnshield range construction has always been very simple. We try to keep the number of products that we have to a minimum to make sure they're very effective. We can produce 500 different dressing sizes.
What we decided to do is to make sure we only produce a range that is suitable for each body part. So it depends on the size of the burn, We have the basic burn dressings which are 10 by 10, 20 by 20 and 60 by 40 centimetres.
A lot of people categorize those as small, medium and large. To give an example, if you have a 10 by 10 size dressing, it's more for small area burns. The 20 by 20 for medium-sized burns, hands and face, and the 60 by 40 dressing is for large area burns. The total head and neck area, back and chest and small children can be wrapped in the large dressing.
A good point to remember is how we classify burns from the public's point of view. Not too much in-depth but in area, how big is the burn? This is called body surface area.
There is a good rule if mommy's at home and she's not sure. A good indication, if she is phoning the doctor or an emergency call centre, is that if you take the patient's palm it represents one per cent of the body surface area of that particular patient. Please understand it is the size of the patient's palm, not your palm.
So, if mom takes the palm of the child or the person who has been injured, she can get a rough estimate of how big that particular burn is when she's calling for medical advice and medical assistance.
She can herewith give the operators some idea as to how big that burn is which will escalate the severity of that particular call.
Second and Third Degree Burns:
We have a question here from Brandon: What's the difference between a second and a third-degree burn?
Answer: I think I explained early on with Johan that the second-degree burn is what you call a deep partial-thickness burn. This will redden.
This will blister immediately. It is extremely painful. And it is the one burn that if not treated correctly, can easily progress into a full-thickness burn [Third-degree burn]. The reason why it is so painful is that all the nerve endings are still exposed. It is almost like if you have a filling in your mouth or a hole in your tooth, when any hot water or cold water goes over that particular area it's hardly painful because all the nerve endings are exposed. This is similar to the burn injury.
So, it is a bit ironic, that if you can still feel the pain, the burn is not so deep. When you come to a full-thickness burn it's normally charred and blackened and scarred and all the nerve endings have been destroyed plus the underlying tissue and fat layers have been destroyed. The biggest indicator is that there's no pain. So that is always a good indicator of whether you really need to get that person to hospital as quickly as possible.
Less pain shows the depth of the burn is far more severe.
Hydrogel and Burn Dressing
For a third-degree burn, do you use the hydrogel or the dressing?
Answer: It is not so much the classification of the burn. It's more the situation of the burn. Where is the burn located?
If you can apply the dressing to the affected area, the dressing is the number one product of choice.
The hydrogel is best used for the difficult to get to areas or to rehydrate the dressing.
Bleeding after a Burn:
Simphiwe asked: "My sound got burnt by a hot plate, so I used Burnshield. I removed the Burnshield and saw bleeding. I don't know what to do?"
Answer: It depends how long they kept the dressing on initially, bearing in mind that Burnshield is a hydrogel, wet water-based dressing.
Keep in mind that it will dry out. In summer the dressing will last for a shorter period of time than it would in winter due to the temperature outside.
So maybe she kept the dressing on for too long. Therefore, when she looked to remove the dressing, the dressing had adhered to the wound and therefore when she took the dressing off it could have pulled some of the skin away from that particular wound which then caused the bleeding. I do not think that the dressing caused the bleeding. She probably left it on for too long and should have replaced the dressing within the first 24 hour period.
Burns and Scarring after Cosmetic Treatment
We have another question from Adrie: "I have a beauty salon and offer “plasma pen” which causes burn wounds. What should I use to treat, heal, and prevent scarring?"
Answer: Burnshield in its current form is not a scar management product. But what it will do, it will minimize the extent of the damage.
Naturally, you should have less damage and therefore you should have less scarring, but everybody scars differently. Burnshield should be used to minimise the damage and currently there are scar management products available which are well documented which should then be used to treat the scar. Normally you treat the scar after about two to three weeks post-burn.
Perspiration and Burns:
A few more questions that just come in: Is sweat bad for a burn?
Answer: I didn't know the answer to that particular question so I did a little bit of research. What I did find, is that any burn heals better in a moist environment and by activating the body's natural response, the sweat glands are activated to produce moisture. It is the activation of the sweat gland which is important because that keeps the burn area moist rather than the sweat itself.
So, if you have any excess fluid on top of the wound it shouldn't be a problem. It is in fact the body's natural reaction for the sweat gland to be active and is actually a good thing.
Burnshield and Blisters:
Can Burnshield be applied on top of a blister?
Answer: Burnshield can be applied on top of the blister, bearing in mind that everything under the blister is sterile.
It is the body's natural protection. So as soon as you touch something hot, the body in some instances will form a blister as protection. Everything underneath the blister is sterile and therefore from a home, domestic point of view you should leave the blister intact.
Let the paramedics or the trauma nurses in the emergency departments decide when to break the blister and how to treat it thereafter.
The initial response to anyone is to leave the blister intact, put the Burnshield dressing or spray over the blister and take the patient to the hospital if needed or continue treating it from home.
Burnshield and Cold Storage in a Fridge:
The last and final question is actually quite a good one. We are actually getting asked this quite often: Should Burnshield be stored in a fridge?
Answer: Burnshield is not required or specified to be stored in your fridge. The optimum temperature in which to apply cool water to a burn is between 15 and 19 degrees and therefore Burnshield’s gel formulation, the thickness of the gel, the manner in which we produce it and the manner in which it should be stored, doesn't require that it should be kept in the fridge.
If you do put it in the fridge, it will probably be cold when you apply it onto an open wound. Burnshield should be stored at normal room temperature. Opened and applied as indicated.
Thank you. For all our listeners and viewers out there, where can we find Burnshield?
Burnshield is available in most key major retail outlets from a consumer point of view. Most of the pharmacies and retail stores will have it available either in individual dressing, gel, or kit form as you alluded to. And from the professional side, it's available at all state and private hospitals.