From sizzling hot glue guns in art class to unexpected chemical reactions in the science lab and even seemingly innocent playground equipment baking under the summer sun, the potential for burn injuries lurks in surprising corners of every school environment. Burns, while not the most common injury school nurses encounter, can be particularly challenging due to their potential severity and the need for quick, appropriate action. 

Assessment and Initial Management

The first step of any initial burn assessment is to simultaneously assess the student's airway, breathing, and circulation while determining if the burning process is still occurring. Removing the student from the burn source and stopping the burning process is the priority. Room temperature water should be applied for up to 20 minutes, using caution to not over-cool. Treatment with ice is not recommended to avoid additional damage to tissues. If possible, jewelry and constrictive clothing around the burn area should be removed unless the clothing has adhered to the burn wound. 

Burn Classification and Treatment

After cooling, assess the burn's severity by evaluating the size, depth, and location of the burn. Burns are categorized based on the depth of skin penetration, and understanding the different degrees of burns is crucial for effective treatment.

1. Superficial burns, also called first-degree burns, affect only the epidermis. They appear red, dry, and painful and may result in tiny blisters but generally heal within a few days. After cooling, a superficial burn should be washed with water (avoid soap unless the burn is dirty) and loosely covered with a clean dressing that will not stick to the burn. Any blisters should be left intact. Students with superficial burns may remain in school, but their parents/guardians should be notified, and a tetanus booster may be needed.

1. Superficial partial-thickness burns, commonly called second-degree burns, involve the epidermis and extend partially into the dermal layer. They are characterized by painful, red, and blistered skin that may also be swollen. A partial-thickness burn that involves 10% or more of the total body surface area (TBSA) is considered emergent, and EMS should be activated. If the burn involves greater than 2% of TBSA, a blister larger than 1 to 2 inches in diameter is present, or the burn completely circles an arm, an urgent referral to a healthcare provider is necessary. Appropriate instructions for referral, follow-up, and tetanus booster considerations should be provided to parents/guardians.

1. Full-thickness burns, also known as third-degree burns, penetrate the dermis and possibly beyond, reaching subcutaneous tissues. The affected area may appear blackened, charred, or white and feel leathery or firm without blanching. Any full-thickness burn in the school setting warrants activation of EMS.

Any electrical burn or burn located on the face, hands, feet, eyes, ears, or genitalia is generally considered a higher risk and requires further medical evaluation. 

Pain Management and Emotional Support

Burns can be extremely painful…and distressing. If, after cooling a minor burn in the school setting, the student is still experiencing pain, over-the-counter analgesics like acetaminophen or ibuprofen can provide relief if orders are in place and medication administration protocols allow. Even when there is little to no pain or it's appropriately managed, minor burn injuries can also have significant emotional effects on students. Scarring, in particular, can be a common concern for both students and parents following a burn injury. School nurses need to address these concerns with empathy and accurate information. The likelihood of scarring from a burn depends on how deep the injury goes:

• Mild burns that don't blister usually heal without leaving a scar.
• Burns that cause blisters might leave a scar or change the skin color in that area.
• Deeper burns are more likely to scar.

To help reduce scarring:

1. Keep the burn covered until new skin has formed and no longer oozing.
2. After it's healed, it can be left uncovered.
3. Protect the healed burn from sunlight for a year to prevent skin discoloration.

Burns may not be daily occurrences in school health offices, but when they happen, they demand the school nurse's full attention and expertise. The ability to rapidly assess, provide appropriate initial care, and make critical decisions about referral when appropriate can significantly impact both short-term recovery and long-term prognosis for students with burn injuries. After all, in the world of school nursing, you're not just putting out fires – you're healing them, too.