Hot oil in the canteen: a burn and a fall, one first aider
12:30 in a busy staff canteen. A caterer pulls a pan of frying oil off the hob and it tips, pouring hot oil over her right forearm, wrist and the back of her hand. The skin is angry red and she is crying with pain, holding the arm away from her body. Her apron is soaked with oil. On the same wet floor a colleague has slipped and put out a hand to break the fall; his left wrist is visibly deformed and swelling, he cannot move it, but there is no wound and his fingers are warm and pink. Someone has dumped the hot pan into the sink to get it out of the way, and the sink is now blocked. Twelve staff are queuing for lunch and the floor is slick. You are the only first aider present. The first aid kit is in the office next door.
1. Two casualties, one first aider. Set out your order of action and the timings you are working to.
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The burn is time-critical; the wrist is not. Hot oil keeps cooking tissue while it sits on skin, so the clock starts at the moment of injury.
0–2 minutes:
- Shout for a second person to call 999 and to bring the first aid kit.
- Remove the oil-soaked apron and any clothing soaked in oil - but not anything stuck to the skin. Oil holds heat against the body.
- Get the arm under cool running water. The sink is blocked by the pan, so either lift the pan out with a cloth (it is hot - use tongs or a towel, not bare hands) or use another source: a cleaning hose, a shower, or bottled water poured continuously. Start cooling within 20 minutes of the injury and keep going for 20 minutes.
- Send another person to cordon the oil slick and stop staff walking through it.
Then, in parallel:
- Check the wrist casualty's circulation and support the arm in a sling or on a pillow. He can wait a few minutes while cooling starts.
- Keep the burn casualty warm elsewhere - 20 minutes of water on a limb can drop core temperature; the rest of her should be covered.
Crowd control and floor safety come after cooling has actually begun.
2. Describe the burn care in detail: what you use, what you avoid, and what determines whether she must go to hospital.
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Use: cool running water at about 15 °C for 20 minutes, started as soon as possible; remove rings, watch and any tight items from the hand before swelling begins; keep the rest of her warm; cover the burn loosely, lengthways, with cling film laid on rather than wrapped around, or a clean non-fluffy dressing; simple analgesia such as paracetamol if she can swallow and has no allergy, and record what and when.
Avoid: ice or iced water (vasoconstriction deepens the injury and can cause hypothermia); butter, toothpaste, oil, flour or any home remedy; cotton wool or adhesive dressings; popping blisters; wrapping cling film circumferentially around a limb, which can act as a tourniquet as the limb swells.
Hospital assessment is required because of the site alone. Any burn to the hand, wrist or across a joint, any circumferential burn, any full-thickness (white, brown or charred, painless) area of any size, and any partial-thickness burn larger than roughly the casualty's palm warrant medical review. She has a hand and forearm involved and is in severe pain, so she goes. Also ask whether the burn was from a splash to the face or whether she inhaled any vapour - a hoarse voice, singed nasal hair or soot around the mouth changes this to an airway emergency and an immediate 999 call.
Update her tetanus status at handover.
3. What may and may not be done for the wrist, how do you check it, and what will you hand over?
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May: support the arm in the position found, using a triangular bandage as an elevated sling or resting it on a pillow; apply a cold pack wrapped in cloth for 10–15 minutes to reduce swelling; remove his watch and any ring before swelling makes it impossible; keep him still, warm and reassured; offer analgesia if trained and appropriate.
May not: pull, straighten, rotate or "reduce" the deformity - that risks converting a closed fracture into an open one or damaging nerves and vessels; test by asking him to move the wrist; wrap tape directly onto the skin; give him food or drink, since he may need reduction under sedation or anaesthetic.
Check distal circulation and sensation before and after any splinting: colour, warmth, capillary refill at the fingertip, radial pulse, and whether he can feel light touch in each finger. Compare with the uninjured side. A wrist that becomes cold, pale or numb after splinting means the splint is too tight.
Hand over: the mechanism and time of injury, the deformity seen, the distal neurovascular findings before and after splinting, what analgesia was given and when, when he last ate or drank, and whether tetanus status is known. For the burn casualty, hand over the burn surface area, the time cooling started and finished, and any airway concerns.