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October 2013

The nature of burns

By Ellis Brasch

Most of us know the feeling of a superficial burn, especially after spending a sunny day on the beach without sunscreen. But severe burns are another matter. Recovery from a severe burn may take years, leaving the victim with a loss of physical abilities, disfigurement, and scarring.

Burns happen when an energy source damages living tissue. The energy takes one of four forms: thermal, electrical, chemical, or radiation. A burn's first contact point is typically the human body's largest organ – the skin. The skin is also is a sensory organ that regulates body temperature, stores water and fat, and prevents entry of bacteria. A superficial burn can upset the skin's delicate functions. A severe burn can overwhelm them, damaging underlying bones, muscles, tendons, and nerves.

Classification of burns

You're probably familiar with the three-level classification of burns. Do you know what each level means?

A victim's age and the percentage of body surface area affected are critical factors affecting the outcome of a burn. Clinicians evaluate these factors to determine if people with severe burns need treatment at specialized burn centers.

Types of burns

Thermal burns

The most common source of thermal burns is heat: fire or flame, scalding liquids, and contact with hot objects account for 86 percent of burn cases in the U.S.

Although heat is the source of most thermal burns, contact with extremely cold substances (such as dry ice and liquid nitrogen) will also damage living tissue and is classified as a burn in the current edition of the Bureau of Labor Statistics' Occupational and Injury Classification Manual.

Electrical burns

Electrical burns can cause surface damage to skin as well as damage to underlying tissues and other organs. Severe electrical burns penetrate deep into the skin, causing muscle or tissue damage that may affect every system of the body.

Voltage, current, resistance, and contact time are key factors that determine the severity of an electrical burn. Severity also depends on the path the current takes through the body as it seeks an exit point. Blood vessels and nerves offer the least resistance – but muscle, skin, tendon, fat, and bone are also suitable exit paths.

Chemical burns

Chemical burns are caused by the corrosive action of chemicals. The word corrosive, which means "to eat away or consume" gives a stark description of the nature of chemical burns. Most chemical burns occur immediately on contact with skin but some chemicals (such as hydrofluoric acid) can be absorbed through the skin and will damage underlying tissue without apparent damage to the skin's surface.

Household products that may cause chemical burns include bleach, concrete mix, drain cleaners, and metal cleaners.

Because there are thousands of products that can cause chemical burns, the best way to avoid one is to read the label on the product's container and follow the safety instructions for using it. Make sure that safety data sheets are available for such products and keep them readily available for emergencies.

Radiation burns

Overexposure to the sun's ultraviolet light is the most common radiation burn and the most common cause of first-degree burns. Ultraviolet radiation from a welding arc will also burn unprotected skin. Radiation therapy, X-rays, and radioactive fallout are also sources radiation that will also burn unprotected skin. The light from some lasers can burn the eyes and skin as well.

Accounting for burns: on the job

In Oregon, burns account for a small percentage (about 1 percent) of the claims that insurers accept for disabling work-related injuries. Thermal burns – especially those caused by contact with hot objects – accounted for 73 percent of work-related burn injuries in 2011. Cooks and food preparers, especially those younger than age 25, have the largest proportion of such injuries.

In 2012, the average cost of a burn-related disabling injury claim was $8,670.

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