Burn Injuries and Fires

Burns

Since Biblical times, serious burns have been recognized as the most physically painful of all human injuries. Serious burns are so critical that patients need the specialized care of burn centers. Anyone who has ever been in a burn ward while burn patients were having burns debrided, undergoing whirlpool therapy, or participating in physical therapy to maintain joint mobility and prevent or minimize contractures never forgets the screams and tears from the burn victims' pain. Ken Lewis, Don Bush, and Jack Smith have been with burn victim clients while they battled through this critical fight for survival and rehabilitation and understand what is necessary for these patients to both survive and recover through the very long rehabilitation process. Equally as important, our lawyers understand the heroic role of both patient and the specialized health care team in the burn unit in this battle.

Bush Lewis lawyers understand the magnitude of both the individual patient's battle and the immense scope of burn injuries in America. There are approximately 2.4 million burn injuries each year in the U.S., 650,000 of which receive medical treatment and 75,000 of which are hospitalized. Burn injuries cause an average of 10,000 deaths a year, from a combination of residential, commercial, and on-job fires, motor vehicle and aircraft crashes, contact with electricity, chemicals, hot liquids and substances, and other sources of burn injury. The Centers for Disease Control report the total yearly cost of fire and burn injuries to be $7.5 billion. While improving quality of medical care for burn injuries has increased the survivability rate to 94% in America, almost 1 million burn victims each year still suffer substantial or permanent disabilities.

Burn Victims

The young and the old are at greatest risk for serious burn injuries, and, in general, the younger or the older, the greater the risk. Children between the ages of 1 and 5 are the most frequent burn victims (with a greater frequency for those under two), followed by members of the 17 to 25 age group. The frequency of burn injuries decreases with age after 25 until age 60 is reached, when the risk of burn injury becomes greater than at any time since childhood and increases with each passing year. Burns to small children occur from home fires, from bathing, from hot items on stoves, and flammable bedding, furniture, or clothing (especially cotton-polyester blends) without adequate flame retardants. Surprisingly, the profile for injury causation in the elderly is very similar to that for young children. The younger the burn victim, the more expensive the treatment and rehabilitation, with twenty years sometimes needed to complete the necessary surgeries for a child burn victim. For the elderly, serious burns are often fatal and rehabilitation is many times less successful than with younger victims.

Sources of Burns

The four basic sources of burns are thermal, chemical, electrical and radiation (or irradiation). Radiation burns are caused by x-rays, ultraviolet, atomic radiation, and other rays. Electrical includes any electrical current, whether generated by humans or by lightening strikes. Chemicals include acids, some alkalis, phosphorus, caustic soda, and sodium. Thermal sources come from heat such as fire, hot liquids, or hot objects. Human exposure to these sources is often due to the carelessness of others or from dangerous or defective products or work.

Burn Injury Medical Care

There are two major phases in treatment of major burn injuries. The first is the acute care by a specialized medical team necessary to save the victim's life and assure patient survival. The second phase is the rehabilitation and training by a skilled and knowledgeable rehabilitation team needed to allow the surviving burn victim to live life as fully as possible with the continuing impairments from their injuries.

Early Management and Assessment of Burns

Modern burn units are battlegrounds to save the lives of burn victims and manage the burn injuries to minimize future disabilities, improving future quality of life for the survivors. Initial burn care will depend on the percentage of the body surface burned, the depth of the burns, and the environment where the burns occurred. The skin is the body's largest organ (over two square yards in adults) and a key system, just as are the circulatory, nervous, digestive, and pulmonary systems. Vital functions of the skin include protecting the body from invasion by bacteria and virus and regulation of the body's temperature and excretion of some bodily wastes through the sweat glands. The larger the percentage of the body's skin burned, the greater the risk of death. The deeper the burn into the body, the more permanent the injury. The environment of the injury is important because hot, smoky, low oxygen, chemical filled or otherwise altered air may cause internal injuries to the endotracheal, the brain or the pulmonary or circulatory systems. Previously, burn injuries were called first, second and third degree but now are classified as superficial, partial thickness, or full thickness burns. Superficial burns heal in one week, partial thickness burns usually heal in two to three weeks unless infections have caused damage to enough additional tissue to create a full thickness injury. Full thickness burns go through the epidermis (outer skin layer) and dermis (internal skin layer) and varying depths into the subcutaneous tissues beneath the skin.

The stages of a full thickness burn are pain with possible shock, hematuria (blood in the urine), and hemolysis of the blood (breakdown of the membranes of red blood cells so that red cell components are released into surrounding tissue), with charring and pale, white, dry, broken skin with edema (swelling from trapped fluids). Scarring in certain, with the extent of healing dependent on the depth, surface area, and severity of the burn--as well as the speed and quality of care.

Body Fluids and Circulatory Complications

Burn victims who survive the initial burn incident are more likely to die from systemic effects secondary to the burns than from the burns themselves. This puts the highest priority on medical response to damaged body systems rather than the directly burned area. Burns cause dilation of blood vessels in the burned area, increasing capillary permeability. The increased capillary permeability causes seepage of plasma into surrounding tissue, resulting in blisters and edema (fluid-retaining swollen tissue). Along with the plasma, other body fluids are lost through the seepage. The plasma loss removes it from the circulatory system, requiring rapid replacement of plasma and other lost body fluids. Failure to adequately replace fluids results in a reduced and thickened blood supply, reducing circulatory efficiency. Blood specimens and urinary output must be meticulously monitored. Changes in water, electrolyte levels, and fluid imbalances during the first 48 chorus after a serious burn can lead to generalized dehydration, reduced blood volume, decreased urinary outputs, excess potassium, metabolic acidosis, cerebral vascular accidents (including stroke), hemoconcentration, sodium deficiency, and sepsis. These complications, individually or in any combination, are potentially fatal to burn victims.

Infections

The second most deadly complication of serious burns is infection. Burned skin loses its ability to protect against infections and viruses and actually becomes a breeding ground for bacteria. Highly elevated risks of infection exist in part because burn wounds expose areas of unprotected tissue that easily become infected and in part because of the severely weakened victim's body systems (including the immune system). Any infections slow healing and increase scarring. Burned skin sloughs off (similar to a snake's shedding of its skin). This additional loss of skin leaves more tissue unprotected, elevating yet more the risk of infection. Symptoms of infections include increased fever, tachycardia (inappropriately quickened heartbeat), lymphanagitis (a quickly spreading infection of the lymph system caused by bacterial infection), and localized tenderness, all of which require immediate emergency medical intervention. Special diets high in calories and protein are necessary to battle infection and provide the burn victim's systems the necessary energy and building blocks to survive. Blood transfusions are often necessary.

Serious problems are involved in treating bacterial infection because dead tissue has no blood circulation. This means that the circulatory system cannot carry systemically administered (whether oral or intravenous) antibiotics to the wounds. Antibiotics must be applied to severe burn wounds through various alternative methods, such as exposure, open, topical chemotherapy, occlusive dressings, and excision of infected areas.

Burn Wound Care

Closing burn wounds and getting rid of dead burned tissue are essential but complicated steps in the burn treatment process and are required to both help fight infection and begin the long process of minimizing the impact of serious burns. When a serious burn injury victim goes into shock, swelling occurs. Badly burned skin becomes stiff and resists swelling, leading to increased pressure inside limbs, fingers or toes that potentially chokes off blood flow. When elevating limbs is insufficient to relieve pressure, surgical cuts called escharaectomies in the burned skin allow the burned area to expand and decrease the pressure. Bandages can protect against infection, reduce heat and water vapor loss from burned skin, prevent discomfort from air current sensitivity in the injured area, keep limbs, fingers and toes in proper post ion fro healing, and collect drainage from wounds. Unfortunately, bandages do not provide permanent closure of burn wounds. Skin grafts provide the solution to this problem. Before skin grafts can be successful, the dead skin and other tissue must be removed. This is done by surgical excision or debridement. Debridement is physical removal of the dead skin without surgery and is typically done during whirlpool baths with sterile brushes.

Skin grafts can be with skin taken from other places on the patient (autograft), or taken from other persons, either dead or alive (homograft, allograft or allogenic graft, or taken from pigs (heterografts or xenografts). All skin grafts have their own limitations and problems. All grafts must be placed over areas free from any dead or seriously injury tissue and development of any pus, serum leakage, bleeding, peeling or infection under the graft must be absolutely prevented to avoid the graft failing to take. Rejection of the graft is a problem that must be addressed with anti-rejection drugs when anything but autografts from other areas of the patient are used. The use of autografts are obviously limited by the extent of remaining available healthy skin on the patient. No skin graft will ever closely resemble unburned skin and graft donor sites will often remain discolored. Full depth burns that are allowed to heal without grafts are very disfiguring.

Pulmonary Injuries

Pulmonary complications can be caused by inhalation of smoke, carbon dioxide, heat, steam, chemicals, flames, or other foreign matter. Potential injuries include pneumonia, scarring of the lungs, hemoptysis (damage to the lungs that causes bleeding that is spit up), hemostasis (interruption of the flow of blood to or in the lungs), and even hypoxic injury to the brain through decreased oxygenation from lung injury or impairment. Initial medical management of pulmonary injuries requires establishing an appropriate airway and delivery of oxygen. The more confined the area of exposure, the more severe the pulmonary injuries.

Other Burn Complications

During the healing process of serious burn injuries, it is usually necessary to immobilize joints to promote healing of the skin and skin grafts. Over extended periods of time, this immobility and the scarred skin combine to cause a shortening of tendons, ligaments and muscles, which causes contractures of the joints into fixed or near fixed partially flexed positions. This causes loss in range of motion in the joint that must be treated with very painful physical therapy to restore motion to the joint to allow proper flexibility and movement.

Hypertrophic scarring is seen almost exclusively in burn victims from the increase in collagen fibers during burn healing. This type scarring is the abnormal, raised, shining appearance of severely burned skin that attracts the unwanted attention of other people. Special pressurized burn suits, gloves, vests, stockings, or masks (known by the manufacturer's name of Jobst) are used to attempt to reduce both contractures and hypertrophic scarring. These are specially fitted for each individual burn patient to maximize effectiveness. Multiple plastic surgeries are often used to try to minimize hypertrophic scarring.

While the horrible psychological impact of scarring to serious burn victims should never be overlooked, there are profound problems beyond the cosmetic damage. After maximum healing, burned skin continues to profoundly itch causing continuous discomfort and anguish to the victim. Scratching the itching skin can lead to new infections. Topical and oral medications are used to minimize this complication but it still often is a permanent condition.

Burned skin cannot be exposed to direct sunlight without further damage and has lost its ability to sweat, meaning it no longer performs its temperature regulation function and no longer excretes any waste. This severely complicates life for the burn victim. Both new skin and burned skin is very tender and unusually sensitive to sunlight, heat, cold and clothing and bedclothes. The burn victim is more prone to skin cancer than other people. Severe burns on extremities often result in loss of fingers, toes or even entire limbs to amputation.

Permanent Impact of Burns

Psychological or psychiatric counseling for burn victims usually begins in the hospital and often continues for life. Self-esteem is drastically impacted and dealing with constant pain and disability is difficult. Counseling for family members is often necessary as both visual appearance and roles have dramatically altered family relationships. The emotional impact of burn injuries is great for both victim and family. Most serious burn victims recover with disabilities and altered lifestyles that prevent them from returning to their former work. Burn scars often prevent those who remain capable of employment of securing adequate job placement. Physical and vocational therapy can help but substantial economic losses almost always accompanies severe burns in the form of lost income and the huge costs of medical and other care for the victim.

Child Burn Victims

There are few visions that have greater emotional impact that a severely burned child. The burdens such children face are huge. Such children face a long future of medical care and multiple surgeries and often face thoughtless torment in their daily dealings with peers.

The Lawyer in Fire and Burn Cases

Attorneys handling a burn injury case have two main roles. The first is find out what caused the fire or burn injuries and determine if something or someone is legally responsible for the injuries. This may include visiting the site of the fire or burns. Bush Lewis lawyers had an apartment rebuilt in a Galveston parking lot from discarded materials in a dumpster to determine how the fire started and spread that severely burned a young child. We have been inside numerous work site explosion area inspections with our experts. We have been there when our experts have disassembled burned up motor vehicles to determine why the vehicle caught fire and how the fire spread to the burn victim.

The second role is to learn everything there is to know about the fire or burn victim's injuries and the total impact of those injuries on the victim and victim's family. These two roles are best filled by lawyers with experience, integrity and commitment like the lawyers at Bush Lewis.

If you or a family member have suffered burn injuries or suffered losses from a fire, protect you rights by hiring an experienced Texas burn injury lawyer to investigate your claim. Bush Lewis lawyers are experienced in all areas of burn and fire injury litigation. Call Ken Lewis, Don Bush or Chris Smith today at 409-835-3521, or Email us. Serving injury victims in Beaumont, Port Arthur, and Orange, Texas.

Serving Beaumont, Orange, Port Arthur, and surrounding areas of Texas.