Working as a registered nurse, I have seen my fair share of burns in the emergency department and intensive care settings. I have seen sunburns galore from long days outside, arms scalded by hot coffee, charred feet from drunken jumps over campfires, and singed eyebrows when smoking near an oxygen source seemed like a good idea. Yet, I have also seen severe burns that result in life-changing outcomes for patients, families, and communities. The type of burns that stem from a greater tragedy, like a workplace explosion or motor vehicle accident, and require more care than a single emergency visit can provide.
In July 2019, a man from Aberdeen, Washington, made national news when he saved his young niece from a house fire and sustained severe burns. Attracted to his heroism, the media focused on the man’s ability to save his eight-year-old niece and quoted the man as saying, “Even though I got burnt, I really didn’t care. I’d do it again” (1) Though this story is touching, the information can also be misleading in describing how severe burns commonly occur and what the health consequences are of severe burns.
Types of Burns
To determine the severity of a burn, healthcare professionals developed a classification system to place burns in one of three categories: First-degree, second-degree, and third-degree. Impacting only the top layer skin, first-degree burns are the mildest type of burn and typically present as red, painful skin. Second-degree burns are slightly more acute, as injury affects the top and bottom layers of the skin. A second-degree burn will appear similar to a first-degree burn, but tends to be more swollen and will blister. A third-degree burn is the most severe type of burn and causes injury to the skin and deeper tissues below. A third-degree burn may harm fat, muscle, tendons, ligaments, and bone. The tell-tale sign of a third-degree burn is a painless white or black wound. (2)
Additionally, the severity of a burn may be determined in the hospital by calculating the total body surface area affected. Generally, a second or third-degree burn that presents on over twenty percent of the body is considered severe or major. (3)
Burn Demographics
Severe burns result most commonly from exposure to flames, but may also arise from electrical sources, scalds, and chemicals. (4) Nine percent of all severe burns cause injury to the lungs, and there is no specific time of year where the risk for a severe burn is heightened. (3) In dealing with flames, men have the highest risk of being burned, but children under the age of 15 experience almost one-quarter of all reported burns (4). Overall, severe burns are only a small number of all burns reported annually. (4)
Treatment of Severe Burns
As a whole, death related to burns have been decreasing since the 1990s and survival after a severe burn is more likely now than ever. (3, 4) Still, the 30-day mortality rate for a severe burn is approximately 19%, with the highest likelihood being in the first 24 hours after admission. Researchers attribute the improvement in survival from severe burns to the teamwork of healthcare professionals and regionalization of burn programs. (3)
Priorities for doctors and nurses caring for burns include preventing infection, keeping the burn clean, maintaining fluids status, reducing tightening in the area of the burn, and managing pain. Expect ample amounts of intravenous fluids and antibiotics on the first day after the burn to replace fluids lost and protect the body from infection. In some cases, a skin graft or synthetic skin will be considered to improve healing. (5) Most patients with a severe burn are discharged to either a rehabilitation program, long term care facility, or home with nursing care. (3)
Finally, burns can harm the mental health of patients and those around them. Addressing the trauma of the event that resulted in the burn or changes in physical appearance may require psychological treatment, extended social support, and environmental alterations. (5) Recovery from a severe burn is a long road and the effects may be felt throughout the lives of all those impacted.
