Classification of Burn Injuries
Burn injuries to the skin and flesh can be caused by several things, including chemicals, heat, friction, electricity, and radiation. There are different classification systems that describe the severity of a burn, with the most familiar one describing the “degree” of the burn. This includes:
- A “first-degree” burn that only injuries the superficial layers of the skin;
- A “second-degree” burn that penetrates into the underlying layers of the skin;
- A “third-degree” burn that extends all the way through the layers of the skin; and
- A “fourth-degree” burn that produces injury to the underlying tissues such as muscle and bone.
Treatment needed for a burn injury is primarily dependent upon how severe the burn is. Superficial, first-degree burns may require no treatment at all, while more significant burns may require cooling with tap water or ice to reduce pain and minimize damage, while severe burns may require hospitalization for immediate care and wound management, and full-thickness burns may need surgical intervention, such as skin grafting. Infection is a common complication of burn injuries that penetrate beyond the outermost layer of skin, so careful wound management including cleaning and dressing the injury is important in these circumstances.
Severe burn injuries include both those that produce a high “degree” burn in a small area of the body and those that burn large portions of the body with even lower “degree” burns. Severe burns can certainly be fatal, however modern medical care has substantially reduced the mortality rate. Only about 1 patient out of 20 who are admitted to burn centers in the United States dies from their burns. However, in less developed countries that have less available or less modern medical care, this rate may be significantly higher. The “degree” of the burns and the amount of body surface affected are the main determining factors in the injured person’s long-term outcome.
The most common causes of burn injuries in the United States are fires and scalding, which together account for approximately three-quarters of these injuries, with injuries from chemicals, electricity, and hot objects accounting for most of the remainder. The home is far and away the most common place where burn injuries occur, with the workplace being the second most common location. In the United States, about half a million burn injuries per year receive medical care and cause somewhat more than 3,000 deaths annually.
Specific risk factors for burn injuries including smoking (and burns from this source have declined over time in the United States along with the decline in smoking) and climate – burns are much more common in colder climates due to sources of indoor heating. Smoking is the cause of approximately one-quarter of fatal house fires in the United States, with about the same number of fatal fires being caused by indoor heating devices. Scalding is most commonly seen in young children, with about two-thirds of all scald injuries in the United States being in children under five years of age. Scalds are most commonly first or second-degree, but can still be very dangerous when they affect a large portion of the body. In the United States, young males are also commonly seen with burns from fireworks.
Chemical burn injuries represent a relatively small percentage of burn injuries overall, but produce nearly a third of all deaths from burns. In the United States, chemical burns are most commonly from ingestion of chemicals by young children or from workplace exposures to strong acids or bases.
Electrical burns are most commonly seen in children who are injured by electrical cords and outlets, by workers who are directly working with sources of high-voltage electricity, and by people who are struck by lightning while working our recreating outdoors. About 50 people per year die in the United States from lightning strikes and the severe external and internal burns that they can produce, along with cardiac arrest.
The most common burn injury produced by radiation is sunburn, while much rarer causes involve exposure to other sources of ultraviolet radiation (e.g., tanning beds), microwave radiation, X-rays, and radioactive substances.
The most immediate forms of medical care for those with widespread burn injuries address the injured person’s breathing and blood circulation. In cases of burns produced by fire, it is common to see damage to the airway and lungs caused by the fire and/or associated smoke inhalation, and severe skin damage can result in extensive fluid loss, shock, and circulatory collapse. As these wounds begin to heal, a primary concern become prevention and control of infection – the skin is the body’s primary defense against infection, and loss of skin tissue makes burn victims much more susceptible to infectious organisms. Medium-term care must address complications such as respiratory failure and pneumonia (particularly where airway or lung damage has occurred), cellulitis, and systemic infections. Long-term care often must address keloid formation, scars, scar revision surgery and mental health care for the psychological impacts of burns.
Various studies have concluded that about half of all historical burn injuries could have been prevented. Modern forms of burn prevention that have significantly decreased the number of burn injuries include home smoke alarms, improved construction materials and methods that reduce the rate of fire spread, and devices to control the temperature of water in hot water heaters. These forms of prevention also include public awareness programs such as “stop, drop and roll” to teach children an effective way to put out clothing fires and reminding adults to check smoke detector batteries twice a year to ensure detectors are working effectively (checking along with the twice annual daylight savings time changes).
But for all the prevention efforts, serious burn injuries still occur at a significant rate and result in trauma, disability, and death. Far too often, they occur because adequate prevention efforts have not taken place – missing or malfunctioning smoke detectors or hot water heater thermostats, improperly labeled or secured cleaning products and chemicals, workplace safety guidelines that are inadequate or not properly being followed.
I’m Ed Smith, a Sacramento Burn Injury Attorney with the primary personal injury information site on the web, www.AutoAccident.com. If you or someone you love has sustained a serious burn injury, call me now at 916-921-6400. If you are outside the Sacramento area, you can call at 800-404-5400 for free, friendly advice. You can find out more about our office by looking at either Yelp or on Avvo, the attorney rating site.