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Part VII: Injuries and Damages

Burn Injuries

Approximately 2.4 million burn injuries are reported each year. About 650,000 of the injuries are treated by health care professionals. Approximately 75,000 burn victims are hospitalized each year. Of those hospitalized, 20,000 have major burns involving at least 25 percent of their total body surface. Between 8,000 and 12,000 patients with burns die, and several hundred thousand sustain substantial or permanent disabilities resulting from these injuries. Burn injuries are the second leading source of accidental death in the United States, following only the number of deaths resulting from motor vehicle accidents.

TYPES OF BURNS

There are five major of types of burns: thermal burns, friction burns, electrical burns, chemical burns, and radiation burns.

  1. Thermal Burns These are the most frequent type of burns and are caused by fire or excessive heat coming from such sources as steam, hot liquids, or contact with hot objects. In automobile collisions or motorcycle accidents, there is always the risk of a ruptured gas tank or loosened gas line igniting and catching fire, burning the people in the vicinity. Even when the person is removed from the source of the thermal burn, damage to his skin is still taking place and therefore the prompt administration of first aid is required. Depending upon their severity, thermal burns can cause anywhere from the minor discomfort of first-degree burns to life-threatening third-degree burns. In thermal burns, as well as other types of burns, the swelling and blistering of the burned skin is caused by the loss of fluid from damaged blood vessels. In severe cases, such fluid loss can cause shock. Immediate blood transfusion and/or intravenous fluids may be needed to maintain blood pressure. Due to the damage to the skin’s protective barrier, burns often lead to infection, which, if not treated promptly and appropriately, can result in life-threatening consequences, even death.
  1. Inhalation Burns Fire and heat have been associated with several types of inhalation injuries as well as burns to the flesh. (Inhalation injuries also occur with different types of burns, such as the inhalation of a caustic chemical.) When inhalation injuries are combined with external burns, the chance of death increases significantly.

The three types of inhalation injuries are:

    1. Damage from Heat Inhalation True lung burns occur only if the person directly breathes in hot air or a flame source, or high pressure forces the heat into him. In most cases, thermal injury is confined to the upper airways. However, secondary airway injury can occur if a person inhales steam, as it has a greater thermal capacity than dry air.
    2. Damage from Systemic Toxins Systemic toxins affect our ability to absorb oxygen. If someone is found unconscious or acting confused in the surroundings of an enclosed fire, the inhalation of systemic toxins could be a possible cause. More than a hundred known toxic substances have been identified in fire smoke. Toxin poisoning can cause permanent damage to internal organs, including the brain. Carbon monoxide poisoning can appear without symptoms up until the point where the victim falls into a coma.
    3. Damage from Smoke Inhalation Injuries that were caused by inhaling smoke can easily be missed because of more visible injuries, such as burns as a result of the fire. Sometimes this leads to the victim not receiving the necessary medical treatment due to the rescue teams taking care of the more severely burned victims whose injuries are more apparent. People who appear unharmed can collapse due to a major smoke inhalation. 60 to 80 percent of fatalities resulting from burn injuries are due to smoke inhalation. Signs of smoke inhalation injury usually appear within 2 to 48 hours after the burn occurred. Symptoms of smoke inhalation include: (1) fainting, (2) evidence of respiratory distress or upper airway obstruction, (3) soot around the mouth or nose, (4) singeing of nasal hairs, eyebrows, and/or eyelashes, and/or (5) burns around the face or neck. Upper airway swelling (“edema”) is the earliest consequence of inhalation injury, and it is usually seen during the first 6 to 24 hours after the injury. Early obstruction of the upper airway is managed by intubation. Initial treatment consists of removing the patient from the smoke and allowing him to breathe air or oxygen.
    4. Friction Burns This type of burn commonly occurs when a person is dragged along a surface. For instance, in a motor vehicle-motorcycle accident in which the motorcyclist is dragged a certain distance, he will likely sustain friction burns caused by the asphalt or cement unless he was wearing protective clothing. Joggers, pedestrians, and bicyclists are at high risk for friction burns when they are injured by an automobile or other motor vehicle. When a person has been dragged in an accident, he usually sustains abrasion injuries as well as a friction burn.
    5. Electrical Burns Contact between a person and an exposed live wire line or other electrical source is the cause of electrical burns. Contact with a high-voltage power source often results in limbs being severely burned as the electricity seeks a way out of the body. With some voltage sources, the person is unable to release his grasp on the power line or object, often resulting in electrocution. Besides the damage to the skin and limbs, electrical burns can severely affect the internal organs as well.
    6. Chemical Burns Chemical burns are caused by acids and other caustic substances, many of which are found in household cleaning products.
    7. Radiation Burns Radiation burns are caused by exposure to the sun, tanning booths, sunlamps, X-rays, radiation treatment for cancer, and nuclear medicine.

DEGREES OF BURNS

The severity of burns has traditionally been described in terms of degree. First-degree burns are the most shallow (superficial), and they affect only the top layer of the skin, the epidermis. First-degree burns are red, moist, swollen, and painful, and such burns may result in peeling and in severe cases, shock. Second-degree burns extend into the middle layer of the skin, the dermis, and often affect the sweat glands and hair follicles. Second-degree burns are red, swollen, and painful, and they develop blisters that may ooze a clear fluid. The skin may be white or charred, and the person may go into shock. If a deep second-degree burn is not properly treated, swelling and decreased blood flow in the tissue can result in the burn receiving a third-degree burn classification as the body’s condition worsens.

Third-degree burns involve all three layers of the skin—the epidermis, the dermis, and the fat layer—and usually destroy the nerve endings as well. In third-degree burns, the skin becomes leathery and may be white, black, or bright red, with coagulated blood vessels visible just below the skin surface. There is usually little pain with third-degree burns, as the nerves have been destroyed, but the victim may complain of pain. This pain is usually due to second-degree burns. Healing from third-degree burns is very slow due to the skin tissue and structures having been destroyed. Burns of this severity usually result in extensive scarring. There are also fourth-degree burns, which involve damage to muscle, tendon, and ligament tissue.

The categorization of burns in terms of degrees is being phased out in favor of one reflecting the need for surgical intervention. The new language refers to burns as superficial, superficial partial-thickness, deep partial-thickness, and full-thickness.

Twenty-five years ago, people who suffered burns over 25 percent or more of their bodies were likely to die of their injuries. Today, advances in medicine make it possible to save many victims who have been burned over 90 percent of their bodies. Of course, these survivors will have long-term impairment, disability, scarring, and disfigurement, and they may never get back to leading a normal life.

When burn damage is due to another person’s negligence, that person must compensate the victim for all of her injuries: financial, physical, and emotional. Over half of serious burn victims are now treated in the approximately 200 hospitals or clinics specializing in burn treatment. Many hospitals now have trauma teams that are specially educated in the treatment and management of burns.

TYPES OF SCARS

As burns heal, scars develop. There are three major types of burn-related scars: (1) keloid (2) hypertrophic, and (3) contracture. Keloid scars are an overgrowth of scar tissue that grows beyond the site of the burn. Generally red or pink at first, they become a dark tan over time. They occur when the body continues to produce collagen, a tough fibrous protein, after the wound has healed. Keloid scars are thick, nodular, ridged, and itchy during formation and growth. Extensive keloids may become binding and limit the person’s mobility. Additionally, clothing rubbing or other types of friction may irritate this type of scar. Dark-skinned people are more likely to develop keloid scars than those with fair skin, and the possible occurrence of keloid scars reduces with age. Keloid scars may be reduced in size by freezing (cryotherapy), external pressure, cortisone injections, steroid injections, radiation therapy, or surgical removal.

Hypertrophic scars are red, thick, and raised, but unlike keloid scars these do not develop beyond the site of injury or incision. Additionally, hypertrophic scars will improve over time. This time can be reduced with the use of steroid application or injections.

The third type of scar, a contracture scar, is a permanent tightening of skin that may affect the underlying muscles and tendons; this can limit mobility, and there can be possible damage or degeneration of the nerves. Contractures develop when normal elastic connective tissues are replaced with inelastic, fibrous tissue. This makes the tissues resistant to stretching and prevents normal movement of the affected area. Physical therapy, pressure, and exercise can help in controlling contracture burn scars in many cases. If these treatments do not control the effects of contracture scars, surgery may be required. A skin graft or a flap procedure may be performed. The doctor may recommend a newer procedure, such as Z-Plasty or tissue expansion.

SURGICAL PROCEDURES TO IMPROVE SCARS

There are two major types of surgical procedures that can help to conceal scarring and replace lost tissue for severe burn victims: (1) dermabrasion and (2) skin grafts.

Dermabrasion is a surgical procedure to improve, smooth, or minimize the appearance of scars, restore function, and correct disfigurement resulting from a burn injury. Even with dermabrasion, scars are permanent but their appearance will improve over time. Dermabrasion may be performed in a dermatologic surgeon’s office or in an outpatient surgical facility.

A skin graft is a surgical procedure in which a piece of skin from one area of the person’s body is transplanted to another area of the body. Skin from another person or animal may be used as a temporary cover for large burn areas to decrease fluid loss. The skin is taken from a donor site, which has healthy skin, and it is then implanted at the damaged recipient site. Skin grafts and flaps are more serious than other scar revision surgeries, such as dermabrasion. They are usually performed in a hospital under general anesthesia. Depending on the size of the area and severity of the injury, the treated area may need six weeks to several months to heal. Within 36 hours of the surgery, new blood vessels will begin to grow from the recipient area into the transplanted skin. Most grafts are successful, but some may require additional surgery if they do not heal properly.

The success of a skin graft can usually be determined within 72 hours of the surgery. If a graft survives the first 72 hours without an infection or trauma, the body in most cases will not reject the graft.

Before surgery, the recipient and donor sites must be free of infection and have a stable blood supply. Following the procedure, moving and stretching the recipient site must be avoided. Dressings need to be sterile and antibiotics may be prescribed to avoid infection.

For many severely burned persons, skin grafts using their own healthy skin are not possible. These patients tend to have very little healthy skin or they may not be strong enough for the surgery. When other sources of skin must be used, options can be cadaver skin or animal skin. The body will usually reject both of these procedures within a few days and the surgery will need to be performed again. A synthetic product called Dermagraft-TC is made from living human cells and it is being used now instead of cadaver skin. The FDA has approved Dermagraft-TC and two artificial “interactive” burn dressings for use in treating third-degree burns. Unlike traditional bandages, some new dressings promote wound healing by interacting directly with body tissues.

Other substitute skin products may become available soon. Already, in addition to artificial skin, there is cultured skin. Doctors are able to take a postage-stamp-sized piece of skin from the patient and grow the skin under special tissue culture conditions. From this small piece of skin, technicians can grow enough skin to cover nearly the entire body in just three weeks.

COST OF TREATMENT/GETTING LEGAL HELP

Serious burns are one of the most expensive catastrophic injuries to treat, and they can lead to lasting physical disability and emotional damages. For instance, a burn of 30 percent of total body area can cost several hundred thousand dollars in initial hospitalization costs and physician fees. For more extensive burns, there are additional significant costs, such as the cost of multiple hospital admissions for reconstruction and rehabilitation. Scars may heal physically but they remain visible and last emotionally. Hence, it is of utmost importance if you have been severely burned due to another person’s carelessness, that you retain an experienced personal injury lawyer who understands serious burn injuries. This type of lawyer can help you get full compensation for the physical and emotional trauma associated with the burns. You are entitled to recover all of your medical expenses—past and future—lost wages, pain and suffering, loss of enjoyment of life, and other damages.