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Interviewer: What should you do if you get a burn injury? Annette Matherly from the Burn Center at University of Utah Health, what should I do?

Annette: We go to our four C's and those are cool it, clean it, cover it, and call for help. Cool it. Place it under cool, not cold, water for about 10 minutes to take the heat out of the tissues. Clean it with soap and water. Get the debris out of the tissues. Cover it because we want to stop the pain from those nerve endings. And then, we want to call for help.

Now, this could mean a couple of different things. If it's a large burn, then 911 may need to be alerted. If it's a smaller burn, that doesn't not necessarily mean that you don't need to call for assistance. It may be that you need to call a local burn center, because even a small burn injury can result in a lifetime of impairment if it's not treated correctly.

updated: April 12, 2021
originally published: July 25, 2017

Interviewer: Are you a new parent? Well, here are three burn dangers you need to watch out for. We'll examine that next on The Scope.

Woman: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: When you bring a brand new baby home, there are a lot of things that you've got to make sure that your house is safe for them. One of the things you have to start thinking about is potential burn dangers, and we're going to talk about three things you should do . . . three burn dangers you should watch out for when you bring that new child home or you have a new child in the house. Annette Matherly is with the University of Utah Burn Center. Let's cover these three things: number one . . .

Annette: Number one would absolutely be that beautiful glass fronted gas fireplace, which is quite a mouthful for me to say, but that fire is really attractive to young children and that glass stays hot for at least an hour after it's turned off. So it's not just when the fire is on that it's hot. It's when it's off and it looks safe that it remains hot enough to burn a child in about a second.

Interviewer: And I think that's really surprising when people find that out because they think that that glass is like the glass in your oven, right? The oven could be at 450 degrees. You could touch that glass. You're fine. The glass fronted fireplace, not that kind of glass.

Annette: Absolutely not, which is strange because it's about 1,300 degrees when it's hot, which is crazy to think about. And so, now, there's legislation moving forward to ensure that everybody puts a guard around that glass fronted fireplace, but that doesn't protect you if you go to a vacation spot or a hotel or a restaurant that doesn't have that guard around or it doesn't protect you if you've had your glass fronted gas fireplace in for a while and you're not aware of the danger surrounding that.

Interviewer: All right. So, remember, that glass front fireplace, it's pretty, it's like a magnet that kids' hands would love to go up there and it stays hot for a long time. So be aware of that. That's number one. If you're a new parent, you've got three burn dangers to watch out for: number two . . .

Annette: Number two would be hot liquids burn like fire, which seems counterintuitive because we think fire burns like fire. We don't think of something in a cup burning like fire, but to know that hot water right from your water heater is set at about 146 if you haven't turned it down. And so a suggestion to new parents, especially because that child has much thinner skin than an adult, would be to turn that water heater down to 120. You can measure that by putting a candy thermometer in the first water that comes out of your tap and then it's usually a low, medium setting.

Interviewer: So the default settings for hot water heaters is 146.

Annette: 146.

Interviewer: And how long does that take to burn a child?

Annette: Two seconds for a significant injury to occur.

Interviewer: And 120 is a little safer or a lot safer?

Annette: Absolutely. So it doesn't mean that you won't get burn injured, but what it means is that there's some more time. There's minutes as opposed to seconds.

Interviewer: And what about hot liquids like in your cup there that was hot, cups of coffee and stuff?

Annette: If you think about your Starbucks, or whatever it is, your beverage of choice, when a barista pours it, it's around 180, which is crazy if you think 146 is water that comes from your tap and burns you in two seconds. So 180 is outrageously high and much faster than that two second incident. So never carry your young child whilst carrying a hot beverage and ensure that your beverage stays away from countertops and tables, that tablecloths aren't used so young children can't pull on that tablecloth and pull that beverage down onto themselves.

Interviewer: And maybe go out and buy some mugs like your fancy one three with that airtight seal on it.

Annette: Absolutely. My beautiful silver one, so, you know, if you've got a young child then we usually say, "got a kid, get a lid."

Interviewer: Okay. Very good. All right. So glass front fireplaces, hot liquids burn like fire, what's the third thing that new parents should watch out for as far as burn dangers are concerned?

Annette: So we talk about a three-foot safety zone around a lot of things. So around a campfire would be another thing, but also around your cooking area. So, if you have a small child, I know it's not always possible to put a physical three-foot marker with duct tape on the floor. Most people don't want that in their beautiful kitchens.

Interviewer: You could.

Annette: You absolutely could, but to think visually where that marker would be, especially when you have little children roaming around or a brand new infant because that also includes cooking with a child in your arms. So to be aware of what you are holding in that precious bundle and is it worth the risk.

Interviewer: And other than the stove, a lot of people don't really realize the microwave, stuff that comes out of there can be dangerous, ramen noodles, boiling water.

Annette: Absolutely. So ramen noodles are the number one for teens because teens come home from school. They go and they put something hot in the microwave, and oftentimes, again, like you said, it's above head level, and so they're reaching to pull something down and they'll pull it right down on their face.

Interviewer: Yeah. And if you have a child in your arm and you reach up with one hand, you fumble that item. It doesn't take long.

Annette: Absolutely.

Interviewer: All right. So those are the three really good things to watch out for if you're a new parent because a lot of burn prevention is just awareness and implementing some of these changes in your household. Do you have any other final advice for that new parent coming home with that new child to keep them more burn safe?

Annette: So the last thing would be burn prevention is a team sport. We work as a team to ensure that each other is kept safe so when you bring home your new child then to talk to others that are maybe not familiar with the dangers that you've just heard about. So maybe grandparents, maybe babysitters would be another really important one as you go out on a date with your partner and leave your child in the care of another. And so, to ensure that they're aware of the things that could really cause lifelong injury to a small child would be really important to mention before you leave.

Interviewer: And having these conversations really can make a difference.

Annette: Absolutely. Most burns are preventable. It is very, very infrequently that we see somebody come through our unit that it could not have been prevented. So, to know and to educate yourself about the dangers of fire and then to educate those around you would be really important.

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Interviewer: What should do if your child gets burned? That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: I think it could be one of the scariest things a parent could witness or see or think about their child getting burned, whether it's fire or a hot liquid. But if it does happen, what should you do? There's actually a set of steps you should follow. Annette Matherly is with the University of Utah Burn Center. Let's talk about if a child gets burned, what you should do.

Annette: Well, first of all, it would depend on if there was flame involved. If there's flame involved, then the first thing anyone should do is go back to kindergarten, go back to stop, drop, and roll. Get on the ground. Roll around. Put that fire out and extinguish it. But we forget to do that because it's . . . I don't know about you but it's been a while since I went to kindergarten, so it's not muscle memory. And so, I want to run because I'm on fire and that just makes the fire worse. So remember to go back all the way to kindergarten and stop, drop, and roll.

Interviewer: All right. So you extinguish the fire, now you've got the burn injury. How do you help your child with that? What do you do? What's the first thing you do?

Annette: That comes down to the four C's which is super easy to remember: cool it, clean it, cover it, and then if you need to call for help.

Interviewer: Okay. Cool it, clean it, cover it, call for help. Let's circle back around, that cool it, what's that mean?

Annette: So cool it means that you want to take the heat out of the tissues because now your tissues have been burned. And so they have this additional heat. So, when you take the heat out of the tissues as quickly as you can, it decreases that depth of injury which is absolutely what you want. You want to make sure that you can prevent that injury from going deeper.

Interviewer: So further depth, like when you take your steak off the barbecue and it continues to cook for 10 minutes afterwards.

Annette: Absolutely.

Interviewer: Except for your skin, you don't want that.

Annette: No, that's a bad thing.

Interviewer: Yes. So what are we talking about cooling? Are we talking about pouring cold water on it or a washcloth, what?

Annette: We want to use cool, not cold water or ice, so cool water and you want to cool it for at least five minutes. And it doesn't matter what it is. If it's your grandma's Gatorade or if it's a nearby pond that you're going to jump in, as long as you're taking that heat out of the tissues as soon as possible with whatever is the closest liquid that you have. Obviously, you don't want that liquid to be hot, because that would not be helpful but too.

Interviewer: Or too cold either because that can cause additional problems, so cool. All right. So top that burning from happening. Number two is clean, that's infection, right?

Annette: Right, right. We want to make sure that if there's any debris in that area of injury that we get that debris off as soon as possible.

Interviewer: And what does that look like cleaning it?

Annette: So we, you know, in the burn center, we just use a washcloth to clean it. But if you're just pouring some kind of water over an area that has been burning, you might use your hand to get rid of maybe any gravel or soil that you've rolled around in if you performed stop, drop, and roll particularly.

Interviewer: Sure, okay. So cool it, clean it, and then cover it.

Annette: Right. What's really important about a burn injury and the reason why burns are so painful is that when you take off that top layer of skin, you expose those nerve endings to air, and those nerve endings are really painful. So by covering it, not only are you diminishing the chance of infection which we talked about a little earlier, but you're also covering those exposed nerve endings so that you feel better. And the other thing by covering it, because a burn is very psychological, so when you look at your hand that's now being burn injured and now you're missing some skin, that's really scary. So when you cover it, it helps you not feel so anxious.

Interviewer: Yeah, it helps calm your child down quite a bit. I didn't even think of that aspect of it. All right. And then finally, you call for help, but how do I know? Because there are different degrees of burns, right? There's first, second, third. Is there a rule or does it get a little complicated?

Annette: Definitely. You could spend the next 24 hours with me talking non-stop which wouldn't be impossible. But this is kind of tricky but the thing that we think about the most is, is it a danger to my airway? Is it going to prevent me from breathing and will I have any circulation issues that could be attributed to wherever this burn injury is.

Interviewer: Okay. And if it's burned through the skin, is it a good idea to go see somebody? Because we're talking that first-degree burn doesn't actually penetrate the skin, second-degree does.

Annette: Absolutely. But, you know, even if a burn doesn't penetrate the skin, so just like a superficial injury, the very young and the very old are still at risk because they don't want to drink very much. And even when you have a sunburn, you want to resuscitate yourself with some-degree of fluid.

But a second-degree injury which is where that top layer of skin has gone, now that coat of armor of your skin has an opening in it, and so there's an opportunity for infection to set in. And a second-degree burn doesn't heal for about 10 to 12 days. So you've got that open area which is an opportunity again for infection and then it, again, is very painful. So to use the correct topicals and to get that seen is really important.

Interviewer: Yeah, so not a bad idea at that point, second and third-degree burns, go get it seen. Plus also, it can hamper your mobility for the rest of your life, in a lot of cases burns can, which surprised me to find out.

Annette: Right. If you have an injury, even if it's just to the palmar surface of your hand, so maybe over a couple of joints, if you think about your position of comfort, you're going to keep your hand as comfortable as possible, which doesn't mean moving it to most people. But then that can lead to mobility issues long-term.

Interviewer: Yeah. So, another good reason to maybe get it seen and seen by professionals that handle burn stuff.

Annette: Yes, yes.

Interviewer: All right. Any final thoughts on that? I think you've given us some good steps. You cool it, you clean it. Well first, you put the fire out, you cool it, you clean it, you cover it, and then you call for help.

Annette: You know, the other thing is, what if you're forever away from a burn center. It's not just convenience. So to go to your local provider is fine. But we can use telemedicine or digital images, and those can be sent to a professional that does take care of burns full-time. And then they can talk to your primary care provider in regards to whether this is something that you may need to be seen eventually at a burn center for, or whether this is something that could be managed via distance in collaboration, in partnership with the burn center.

Interviewer: Any final thoughts for a parent when it comes to burns in their children?

Annette: So I think in closure, to remember the best burn is the one that never happened, to remember you're a mentor to your children, to practice burn and fire safety yourself, to remember the simple things around your home can cause lifelong injury and detriment to especially a small child, but to a teenager also. And then to remember that burn prevention is a team sport, to pull in all your family and to educate them to the consequences and the severity of burn injury.

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Interviewer: If you have a glass-fronted gas fireplace and a toddler or young child, what you're about to hear could save them a lifetime of pain and disability. That's coming up next on The Scope.

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: Glass-fronted gas fireplaces are responsible for a lot of preventable burn injuries to toddlers and young children each year. And these burn injuries often require painful wound care and rehabilitation. The end result can be scarring that interferes with normal function, as well as psychological after effects that will be with them for the rest of their life.

Jordan Green's son was badly burned by a glass-front gas fireplace a few years ago, and he wanted to tell his story in hopes that it prevents another child from going through the same thing and, hopefully, you as a parent as well. So several years ago, your child was burned by a glass-front gas fireplace. What happened?

Jordan: We just moved back to Utah. We built a home and it was finished right before Thanksgiving. I was actually at work. My wife woke up one morning. It was cold outside. It might have been snowing. And she had the fireplace on, and the kid was playing on the floor with his toys, our son. And she just heard a loud, loud scream and ran to him. And he was . . . obviously, he had touched the glass on the fireplace.

I got a phone call. My wife was in a complete panic and she said Maddox had burned his hand and was going on and on and freaking out. And I said, "Get him to an urgent care." So she rushed him to urgent care as fast as possible and we kind of went from there.

Interviewer: Yeah, and ended up in the burn center because those fireplaces burn at 1,500 degrees Fahrenheit.

Jordan: We just weren't aware. We just weren't aware.

Interviewer: Yeah. Do you have any idea how long his hand was in contact? Because what makes these burns worse is not only the temperature but these glass-fronted gas fireplaces, sometimes, they're so hot, it starts to melt the skin. And the child, not only doesn't realize that they're getting burned, but they can't get their hand off there.

Jordan: We don't know. My wife was, I think, doing dishes or something, but it was only maybe a couple of seconds. I mean, it was so fast. You look, it only takes one second. Your hand in there for one second . . .

Interviewer: That's all it takes, one second.

Jordan: Yeah, for it to burn like that.

Interviewer: And you have a picture and that was right after he got his hand burnt. And if you've ever burnt yourself before, you know how you get that white blister.

Jordan: Yeah.

Interviewer: His whole hand is practically like that.

Jordan: Well, and what you don't see, yeah, his whole hand is like that. But what you don't see is it's deep. It was burned so deep into his skin. I mean, well, what really hurt and was tough was all the treatments. You know, peeling back the skin, cleaning it, all the different treatments we had to do. I mean, it lasted almost two years, the process. It was crazy.

Interviewer: Two years?

Jordan: Yeah.

Interviewer: You had mentioned that coming up here for this interview that, you said, yeah, you know your way around pretty well because of all the times you had to come back. What did that process look like after the burn and then over that two-year period?

Jordan: It's crazy because your kid's so little and they're so precious and, I mean, he was not even a year old when it happened but it's like never-ending. I mean, it's two years of coming here. At first, we had to peel the dead skin away, clean it, and he would freak out. It was like the accident was happening over and over again every time we came. And that's how it was for the first several months, several treatments, is they're cleaning it out, painful for him. It's painful for his parents. We have to hold him down while they're cleaning it out. Yeah, it's an experience that you do not wish on your worst enemy, let alone your child.

Interviewer: So not only is it really painful when it happens, not only is the treatment excruciatingly painful, but the damage could last a lifetime. Yeah, I mean, to the extent that you will lose full mobility or usefulness of your hand.

Jordan: One of the scary things is . . . it may sound naÔve but you don't want your kid to grow up that has a dysfunctional hand or anything. You want him to grow up and be able to play baseball and throw a baseball and do all those normal things that we all grew up doing. And that was . . . another thing is we didn't know when we were out of the clear. Well, it could get infected. Well, we might have to go back in and they talked about if the scarring was severe enough that they would have to re-cut open the scars and relieve some of that intention.

And so for two years of all these check-ups, we never knew we're out in the clear. We still have to look and make sure that his function in his hand is properly working and things like that. And luckily, it's been great. We came up to the burn clinic and they did an amazing job.

Interviewer: But in your son's case, he's got full mobility of it, from what you've told me.

Jordan: He's got full mobility. He's got little scarring. And I know you saw the picture, it's hard to believe that that entire white deep-scarred palm, you know, you can see it now at 22 months, is barely recognized. I mean, you can barely see that anything happened to it. It looks really, really good. I mean, they . . .

Interviewer: Yeah. So what have you learned about preventing this type of injury since you've went to this experience? You said that you had no idea going in. The people you know have no idea. What have you learned since then?

Jordan: Well, I think it's awareness. I mean, if there's something as simple as a sticker on our glass of our fireplace just to say, "Hey, this gets to this temperature." We were just naÔve and unaware about it. And we're not the only ones because you were just saying every year, these little kids go to the University of Utah Burn Clinic for the same thing. I mean, it goes . . . it's a cycle.

Interviewer: Do you still use that fireplace?

Jordan: We still do use it.

Interviewer: How do you use it safely now?

Jordan: We put an iron guard around it that we fastened onto it. It's very sturdy and durable. Things are changing, obviously. The industry noticed that there was a problem and started making the adjustments, but you still see them. There are still all these homes built. And so we talked about it, but I just think awareness, specifically for that, would have saved us two years of heartache, but just drawing awareness and talking to people about it. Yeah.

Interviewer: Jordan, thank you very much for telling your story. I hope that maybe it prevents a few of these from happening because, unfortunately, sometimes people have to experience these things for other people to go, "Ha, this is a real threat. This is a real deal."

Jordan: Yeah, absolutely. And that's the thing is it was a lot of heartache for us, but, hopefully, we can prevent people from going through what we've been through.

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updated: January 15, 2019
originally published: December 14, 2016

Interviewer: Did you know that fireworks injuries are actually worse on the 24th of July here in Utah than the 4th of July? We'll explore why and give you some safety tips coming up next on The Scope.

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Interviewer: Brad Wiggins is a nurse manager at University of Utah Healthcare Brun Center. And Brad was telling me that the 24th of July is your worst day of the year for fireworks burns. I find that interesting. Why do you think the 24th?

Brad: I just think here in Utah, the population of people that we have, they celebrate the 24th a lot more readily than they do the 4th of July. The celebrations around both of those, I think people are celebrating the fact that they live in Utah and that they're a part of the history of Utah being in the United States. So I think they take it a little bit more to the extreme sometimes.

Interviewer: Yeah. And what kind of injuries do you see in the Burn Center? Would that surprise people?

Brad: The types of injuries we see and the type of problems we see, number one, in small children, is related to sparklers. Sparklers are very, very dangerous. And probably the most common thing people don't know is that a sparkler burns close to 2,000 degrees. That's as hot as a blown torch. Would you give your two or three or four or five-year-old a blow torch and have them run around with the blow torch?

Interviewer: Like one of those ones you do a copper pipe repair on, would you light that thing up and let them run around waving it in the air?

Brad: And the answer is no. Nobody does that.

Interviewer: No, of course, you wouldn't. But a sparkler is the same thing essentially.

Brad: Yeah, and I think that's the extreme of people thinking about, "Oh, this is just fireworks fun," and it is fireworks fun. And if you ask me if I held this sparkler when I was a kid, absolutely. But now in my profession, I'm a burn professional and I understand the dangers and the risk and I think they really get associated with some very life-changing types of injuries that people just don't take the time to recognize when it comes to sparkler injuries.

Interviewer: When a child comes in with the sparkler injury, what kinds of injuries do you see and how does that affect the rest of their life?

Brad: Sure. A very simple type of injury we see from a sparkler is the fact that they held this sparkler, not on the handle part, that they actually held it where the chemical is that's burning. And the child doesn't know that. They haven't been educated and taught where to hold the sparklers. And it burns down into their tissue of their hand. When it's burning to 2000 degrees, it gives you a third-degree burn in less than a second.

Interviewer: So it's a guaranteed third-degree burn.

Brad: It's a third-degree burn and the only option for third-degree burn is surgical intervention. And the problem is this when a third-degree burn hits the finger or joint, which is where you're holding it because it's your fingers. So wherever you hit on a joint like that, it can actually lend itself to the possibility of amputation of fingers, partial amputation of fingers, skin grafting procedures on those areas and a lifetime of disability of movement of the joints in that area.

Interviewer: So you see sparklers and what are some of the other usual suspects when people come in like, "Oh yup, now there's another one of those."

Brad: Sure, someone trying to hold a firework like a firecracker, that's obviously going to have big ramifications. You can lose fingers from that, things blown right off.

Interviewer: And you've seen this stuff?

Brad: Absolutely, we see that every Summer. Yeah, absolutely.

Interviewer: It must be heartbreaking.

Brad: It is heartbreaking because it's such an easy thing to prevent. I think that in the burn world, we'd like to say about 75% of all the injuries we see in the burn center are preventable injuries. We're starting to see a lot of aerial types of injuries where someone will point in aerial firework at someone goofing around, having fun, maybe they've had some alcoholic beverage and they're enjoying themselves. Or maybe they have one and they're just being goofy and having fun with their friends. But they point them at each other, they're shooting them at each other and they don't know the ramifications. Most clothing catches on fire incredibly easily. You're pointing fireworks at people, you're sitting too close. Sparks can get you, embers can get you and the same goes back to the sparkler thing. Most catastrophic type of injuries we see from sparklers are that you have a child who's holding one and it catches their clothes in fire and no one is with the child when that happened and extinguish them close enough.

Interviewer: Some of these things that you are saying seemed incredible. People's clothes, catching on fire, that sort of thing, but that happens. You see that.

Brad: We see that every week. It's a common occurrence for us. Yeah, flame injury from clothes catching on fire is a huge deal and those are the types of injuries that are catastrophic on a much larger scale. And that's where people forget that your skin is the largest organ of your body. You damage the largest organ of your body significantly with flame and it's dead, the skin is dead, it impacts every other body system. It's the kind of thing that puts you in intensive care unit. It puts you on a breathing machine. It puts you having most likely to have that have some type of skin grafting and surgical intervention. There's a really huge cascade here from the simple concept of buying a sparkler pack at the booth and letting your child run around and play with it.

Interviewer: You're kind of bombing me out. This festive time now all of a sudden sounds like this is a very dangerous time. So let's talk about safety. It sounds like your number one suggestion is to leave it up to the professionals. But people are going to want to do this sort of thing. So what are your big safety tips other than what we've discussed?

Brad: Actually having a conversation about the safety risk. Promote the idea of letting an adult light the firework or have a supervised teaching moment with your child of, "This is how you do it and these are the risks." Not a scare tactic, but really direct communication about, "This is how you light a firework. This is what you want to do. You never want to hold it in your hand. You never want to try to keep it on some part of your body part. You don't want to throw it at someone because it can cause a life-changing injury for them." Let's just watch it and have some fun. We're going to do it the safe way.

Interviewer: Thank you very much. Hopefully, this conversation will reduce your workload on the 24th.

Brad: Yeah, I certainly hope so. And just as another reminder, if you do need our attention and you do need our care here at the Burn Center, we are available for that. And burns is incredibly unique and there are a lot of specialties to be able to do that. We recommend not using a lot of home remedies out there. There are a lot of myths. There are a lot of things you can find out there on the worldwide web that guide you with different directions. So why not. You have an incredible resource here in the State of Utah. We will take care of you. Let us do it for you.

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Interviewer: What would you do if you get burned and help isn't coming soon? We'll explore that next on The Scope.

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Interviewer: Annette Matherly is the outreach and disaster coordinator for the Utah Burn Center. What should you do if get burned and help isn't coming soon, say you're out maybe hunting or backcountry camping, or something like that? Is there anything a regular person can do or are they out of luck?

Dr. Matherly: No, absolutely. There are so many simple things that can be done when you get burned and help isn't coming. So I like to keep it simple. I think of the four Cs. The four Cs are cool it, clean it, cover it, and call for help.

Number one, cool it. If you get burned with some kind of hot fluid, and to cool it and take that heat out of your tissues would be incredibly important and that's because the longer that heat stays in those tissues, the deeper your injury will become. So to take that heat out over a five or 10-minute period would be really important.

Number two would be to clean it because who knows what you've been rolling around in, or what you've got on your fingers or your toes, or wherever it is that you've been injured. So you want to keep that clean. And so just having some regular soap and some water, preferably nonperfumed because the perfume will make it sting a little more, but just your common soap and cleaning that wound to get all those bacteria off of that open area. Because if you have that top layer of your skin missing, now you can have bacteria in the environment. Bacteria that's crawling around on our bodies, by the way, those gram positives that are all over us, now they can get into that opening into our bodies and can make us sick.

Interviewer: So for number one and number two, cool and clean it, what about stream water? Should I avoid that?

Dr. Matherly: If that's all you have, then you use stream water. You've got to take out that burn. And is it optimal? No, but there's not many of us, you know. Or maybe we have bottled water hanging around and we can get our soap out and open that bottled water or we're trying to save the universe, we can get out our little reusable bottle and pour it over. So another good reason to carry those around with you.

Interviewer: Yes, so that's optimal. Stream water, though. If you have to, you've got to do these things.

Dr. Matherly: Absolutely.

Interviewer: All right. So we've got cool it and clean it. Number three?

Dr. Matherly: So number three is cover it because now we have this opening into our body. The skin is kind of a coat of armor. And what we want to do when we lose that piece of the armor is we want to still cover that area that has the opening. So now we want to cover it and we want to use something that won't stick because if you don't have any skin in that area, then it's nice, and oozy, and weepy. And you don't want to put something on it will stick, but sometimes you may not have that option.

So hopefully, in your backpack because you've been thinking this through before you went on your trip, you've got some Bacitracin, or some Polisporin or some Neosporin or something that will have some kind of bacterial coverage. You pop that on that opening and you'll cover it hopefully with something non-stick, but if all you've got is a t-shirt of a friend, then you put a clean t-shirt of a friend over that opening and you make sure that nothing else can get into that opening.

Interviewer: What if you don't have such a clean t-shirt? Still covering it with that is better than not covering it?

Dr. Matherly: Yes.

Interviewer: You have to cover it?

Dr. Matherly: Covering it is better than leaving it open because if you think about as you're walking through the forest or the amount of times that your hand comes into contact with something, then again, it's picking potentially picking up bacteria on mold, or spores or something from the environment. So you want to keep that area as covered as possible.

Then number four would be your call for help if you need help. Now, obviously, that might not be very timely, depending on how deep on the woods you are, but as soon as you're able to make a call and to seek assistance, especially if it's something larger, then that has to be done because even a small injury can cause an infectious process that can make somebody very sick.

Interviewer: When does that infectious process start? How long after the burn?

Dr. Matherly: Well, the burn is pretty clean, right? Let's think about the ideology of burn injury. It involves something hot touching the skin and what that means is it's just burned off all the existing bacteria, so you've got a little while before that bacteria starts to multiply again. We usually say that about 24 hours is a safe bet. So after 24 hours if a patient has a temperature, then now they're growing some kind of bacteria that can be associated with the burn injury. So before that, it was probably something that the patient came in with.

Interviewer: So if I'm not in the middle of nowhere and I get that burn, as long as I do some of these steps, I've got 24 hours before I need to really start worrying about something setting in if it's going to set in?

Dr. Matherly: Absolutely.

Interviewer: It's not going to set in after eight hours necessarily?

Dr. Matherly: Well, they can start, right? I mean, bacteria are so small and we're crawling with it. With that it's all over us so can it start? Absolutely. Is it likely to make us sick right away? No, it won't. So we'll be maintaining enough that we can do what we need to do to get us somewhere safe, hopefully, and then we can have somebody else take care of business for us.

Interviewer: Physical activity okay? Getting that hurt rate up, that's not going to affect the burn in any way?

Dr. Matherly: No. Obviously your heart rate's going to increase because this burn is going to be painful. So if you have some over the counter medication that you take with you, that might be great because that will help decrease the pain so that you can hike out or you can walk out. But, other than that, we encourage activity in all patients that have been burn injured. You don't want to splint something, you want to keep using the body parts so that it kind of won't contract in place. That's the worst thing possible so you want to keep moving that area that's been burned, which will decrease the inflammation and will help it to be useable.

Interviewer: What about the skin? The skin gets tight, that's going to hurt, isn't it?

Dr. Matherly: Absolutely.

Interviewer: But still keep moving it?. That's more important? Okay. Any final thoughts if you get burned and help is not coming soon?

Dr. Matherly: I think that what's most important is to remember how resilient we are as human beings. We can do anything. That fight/flight response is absolutely amazing. We have seen people coming with some really large burn injuries that have driven themselves down from the getting burned, walked into the emergency department, and they have still been okay. So remember, your catecholamine response to injury is huge and you can do it and you can get out if you're stuck somewhere, even if you may have a pretty significant injury.

An exception to that would be your airway, so hopefully your airway will not occlude That's really important. But on other body parts you usually have some time.

Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Interviewer: What to do if your child gets scalded. We'll talk about that next on The Scope.

Annette Matherly is with the University of Utah Burn Center. Scald injuries, of course prevention is always the best thing you can do, is you want to prevent a scald injury because they are devastating, they're painful, and they can last a lifetime. But if you can't prevent it, if something happens, what do you do? We're going to find out right now. First of all, scald injuries, they're pretty common right? Is that the burn injury?

Annette: It is. In fact it's the top burn injury for those under the age of five. But scalds are on the gamut of age, so there's no one safe from hot liquids.

Interviewer: Under five, really important you pay attention. But just kids in general, they're all getting them.

Annette: Absolutely.

Interviewer: So why are scald injuries so terrible? What makes them so bad?

Annette: Well, I think it's because you don't realize that things are so hot. In fact, we teach our children that hot liquids burn like fire. But when you have a hot frappuccino or your beverage of choice in your hand, you don't think that it's 160 Fahrenheit, and that can cause a burn injury in just one second in a child. If you think about the water that comes from your tap, if you haven't turned your hot water heater down, then that water is about 146 which would cause injury in a couple of seconds. So it's these things that we use every day that we don't think are dangerous that absolutely can cause devastating injury.

Interviewer: Yeah, I think that's because most of the time when you think scald injury you go back to school and they taught the pot of boiling water that's the thing that you got to watch out most for, but that's not even the case really, is it? I mean, it's dangerous but, some of these other things are more dangerous.

Annette: Absolutely. I'm not knocking the scalding water on the stove, because of course we should keep our pan handles in and cook on the back burner, and we have lots of children that come in that way too. And so, that's really important, that whole circle of safety around the stove. So to make sure there's about three feet that your child doesn't enter when you're cooking anything. So that's a cause of injury too but the bathtub scalds, the "I'm drinking a hot drink" scalds. In fact, the other thing that we say is, have a kid get a lid. So we want you to use lids on your travel mugs so that we can keep those injuries from occurring to small children.

Interviewer: Because those liquids we can handle drinking gets on young skin and it's just terrible.

Annette: Absolutely. They're so curious. They just want to reach up and they want to pull that cup down.

Interviewer: Prevention again, the most important thing you can do as far as you know, you just don't even want it to happen. But what should a parent do at that point?

Annette: Probably the easiest thing to remember is, the four C's. And those stand for cool it, so you want after the injury has occurred, you want to quickly take your child or take whoever's been injured and cool that injury under cool but not cold water for about 5 to 10 minutes. Take that heat out of the tissue, remember to remove any diapers or any clothing that the child has on because those can also retain heat.

The second thing that you want to do is clean it, and that includes the sticky noodles, the pieces of carrot or potato that are on the child, or inside the diaper. So you want to cool it, you want to clean it. And then, you want to keep your child warm.

So one of the most important things to do after you've cooled and cleaned it, is to cover your child in something that will cause them not to be cold, because we want to get heat to that area and open up those blood vessels, and allow perfusion to occur that's happened to an area of injury. So wrap a blanket or wrap a towel around the person that's injured, and then call for help. And that's much simpler I think than people imagine, because you can call from the community directly to the burn center and have your needs addressed right over the phone.

So if you have a child that's been injured you can call 801-581-2700, talk to one of our charge nurses that's on call 24 hours a day. Be linked in with a physician who can get you immediate assistance, whether that be being admitted to the burn center or an outpatient appointment, or hopefully just being able to take care of it at home with some simple instructions on what to do. And we've received many calls from the community and helped them.

So good rule of thumb to remember is, if its life threatening, then call 911 and get the help that you need. If it is a minor injury, even if you don't think it perhaps needs to be seen, then it's a good idea to call the burn center. We're on call 24 hours a day and at least run it by us, and we can help figure out if it should be seen or not. Because sometimes it doesn't look significant, but it can cause injury that maybe you wouldn't have thought of.

updated: February 6, 2023
originally published: February 4, 2015

Interviewer: Burn injuries are painful and can affect the person for the rest of their life. There's nothing more devastating than seeing your child with that kind of injury. Today we're going to find out what a parent whose child sustained a burn injury, we're going to find out their story and what he learned from the experience. That's coming up next on The Scope.

You know the pot of boiling water is kind of the quintessential burn hazard. That's one that everybody knows. But what about a hot drink or the hot water in the bath tub, or even chicken noodle soup which, believe it or not, can be really bad? And for the most part, burn injuries don't happen due to out and out negligence. It's just a matter of the right set of circumstances all coming together, kind of the perfect storm.

Hopefully the result of this conversation is you will think about things differently and be able to recognize those circumstances when they arise in your house. We're with Taylor Vowles, and Taylor's son sustained a burn injury not too long ago. First of all, I think a lot of people think this will never happen to us.

Taylor: Yeah, of course. Scot, I think you nailed it. I volunteered for the Boy Scouts of America for 20 years and you go over these first aid merit badge and other things and you think, "Wow, I've never had to face that situation." And you really don't think of it as a parent at all. It's not at the top of your mind.

Interviewer: Yeah. So tell me the story of your son. What kind of burn did he get?

Taylor: He got a second degree burn over 8% of his body, mainly on his leg. Initially, we didn't think it looked like a second degree burn but it we found out later how incredible painful it was.

Interviewer: Yeah. I think a lot of people kind of make that mistake. I think they take a look at that burn, this is what I've heard anyway from the burn center here, and they think, "Oh, it's not that bad. I don't need to contact anybody." They always recommend if you have a burn injury give them a call. So what did you do at that point? Well, let's back up. How did it happen?

Taylor: He was on roller blades. It was his birthday a few weeks before it happened and he got roller blades and it being cold outside he didn't have time to roller blade much outside. So he's wearing his roller blades in the house despite, we kind of have a family rule for him not to do it. He was rollerblading around in the house and he just learned, a 7-year old, this is like the first cooking thing they learn but he just learned to make a hot water ramen in the microwave. So he started making ramen in the microwave and he got it out and he was on his roller blades and all the water just came right down in his leg and the back of his rear, essentially.

Interviewer: I've heard that that's a burn danger not a lot of people are aware of, those ramen noodles, because the severity of burn are two things. It's temperature and time, and those noodles stick to your skin and increase the amount of time. Is that what happened with him?

Taylor: Yeah, I think so. And what also contributed to it is he had his roller blades on, so when the water came, the water rolled down his leg and it kind of settled at the top where the roller blade boot met his calf.

Interviewer: Oh, so it stayed there longer.

Taylor: So it even put a more severe line where that happened, but it got all over his leg. I mean, it was horrible.

Interviewer: Yeah. So then that happened, what happened after that point?

Taylor: Yeah. We didn't think it was that big of a deal. In fact, when we initially saw it he wasn't in too much pain. But I thought it best to take him to the instant care just to get it checked out anyway, and right when we got there they didn't even admit us. They just took one look at it and said, "You've got to get up to the burn center up the University of Utah. This is bad."

Interviewer: Yeah. They say that if that happens you can actually call the burn center directly which is something I'm sure you've learned since your experience. So you go to the burn center, what happened at that point?

Taylor: So they cleaned off the wound eventually of dead skin, skin that had seared off. And then they dressed it with clean dressings. And that was probably, of the whole process that's the least painful of the process because I think, at least my son, he was still in shock, he was handling it all very well. But later down the road when you have to go do the re-dressings, that's when it got really sketchy. I mean, the hardest part about the whole experience, really, is that redressing.

I mean, you have a kid who goes up there to get his burns redressed and he's a tough kid, right? He hasn't cried up to this point with the injury but then after, when he goes to get his burns redressed he literally has tears starting to come out of his eyes and then he's starting to shake with pain. The severity of pain is so bad he starts to shake for hours.

And then hours after than all your pain receptors are exposed, the new skin and because your pain receptors are exposed to air that's coming around you, the pain is just excruciating. That whole day, my wife said it was the worst day of her life. She cried for him. He cried and she said it just didn't stop for hours, and he's a tough little kid. The pain is really excruciating.

Interviewer: And this is all from a burn that at first glance didn't look like it was that big of a deal.

Taylor: Yeah, exactly.

Interviewer: Which I think is a good testimony that you should take all burns . . .

Taylor: Very seriously. And it's like the whole sunburn adage. You get a sunburn, it doesn't really hurt after, but the day after, within 24 hours you're singing a different tune.

Interviewer: Is there going to be any sort of long-term?

Taylor: The nice thing is the second degree burn on him, at least we've been told, you can still see it heavily now but there shouldn't be any long-term consequences.

Interviewer: But you just don't know.

Taylor: You don't know.

Interviewer: Some children, they get their hands burned, for example. They don't quite have full functionality for the rest of their life.

Taylor: It's a concern. I wonder, too. He tans up really easy. That's a part of his leg, too, where you go out swimming. I just wonder how it's going to affect him. I mean, he's 7 years old. He's got the next 50 years of his skin which is the largest living organism in your body.

Interviewer: Yeah. What did you learn from this experience? What's your takeaway?

Taylor: For me it's just being vigilant with your kids, common sense type stuff. As parents you don't think it matters. Maybe your kids think you're too strict and I don't know if every parent's experience it but a lot of parents hear their kids say, "I hate you," or "That's a dumb rule," or "You're so dumb."

Interviewer: Yeah, like wearing roller blades in the house.

Taylor: Yeah, like wearing roller blades in the house.

Interviewer: That's stupid.

Taylor: I'm being pro-active. I mean, we probably should have said, "Can we help you with that? Can we help you get that hot dish out of that microwave?" Just being more aware of your surroundings because it happens in a second and you really can't prepare for it that well unless you're being vigilant.

Interviewer: Yeah. So it sounds like you see things a little differently now. When you go around the house do you see potential burn dangers?

Taylor: Yeah, burn dangers, sharp corners, everything. I've thought about burns before and I turned down our water heater a long time ago because I never wanted that to happen. I didn't want the hot water burns but I never thought of it with cooking.

Interviewer: Yeah. And especially microwaves. I don't think people think of that. There again, it come back to the quintessential burn dangers, that pot of boiling water. You're supposed to turn the handle in but there's a lot of other things as well. What one message would you communicate to a parent listening right now based on your experience?

Taylor: Well, watching the excruciating pain that my son had to go through and my wife who took him up when they had to redress the burn, it's not worth it. If you can do all you can to safeguard your kids and just watching them and helping them, it's kind of a tragedy, it happened so fast. It could have been a lot worst.

Interviewer: Yeah. I mean, you hate to kind of say that but the leg is probably one of the better places it could have landed.

Taylor: Yeah, exactly. And it landed on the outside of his leg. If it were to have landed on the inside of his leg it would have even been worse.

Interviewer: Yeah. Well, Taylor, thank you very much for sharing your experience. I'm sure it's difficult for you but hopefully if we could prevent one burn injury because somebody maybe notices now the set of circumstances arising or realizes how fast it happened, hopefully it was all worthwhile.

Taylor: Thanks, Scot.

updated: February 3, 2023
originally published: February 4, 2015

Interviewer: Part of being prepared for disaster at work is what to do if there's a fire at work. We'll examine that next on The Scope.

Announcer: Medical News and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Annette Matherly is the outreach and disaster coordinator for the Utah Burn Center. If you find yourself at work and there's a fire, what should you do? Well hopefully you've had some sort of training on that. But we're going to find out from Annette what you should do.

Annette: So, a lot of these concepts go back to elementary school, you know, get out fast. Don't stop and call a friend, don't stop and pick up your favorite plant. If there is a fire at work, take it seriously. And I know many of us are guilty about, "The fire alarm again, it's just another drill." But when we hear a fire alarm go off, we instantly should take flight. We should think about what our exit routes are, and we should already know them, because one of the things about life is that we should pre-plan for things that are bad, and if we get into that habit we'll never be disappointed, and we'll always be prepared. So we should know our exit routes out, and we should get out as quickly as possible.
Now if your exit routes are obstructed and you're unable to go downstairs, or you're unable to get out of your room, then one of the things that you need to do collectively, or if you're by yourself, find whatever you can to stuff under that door to make sure that no smoke comes into that room and obviously put the back of your hand against that door. See if it was hot before you opened it. If you close your door at work, feel the knob, make sure that there's no heat on that knob. And if there is, then you will not open your door, because that will cause a draft to come into the room and then you'll get all those hot gasses and that fire that will then come in. So you want to make sure that the gap underneath the door is completely filled with something so the smoke doesn't come in.
Then, if you have a window, then you want to go over and you want to signal for help at that window. Obviously, if you're first or perhaps second floor with a window with a ledge that you can jump down on, then you want to get out your window if possible. But you definitely don't want to jump. If you're too high and you could get injured, then one of the things that you want to do is just stay there, and breathe slowly and be really calm. There have been a lot of studies that have shown if your heart rate is up, then you don't have the ability to think clearly. So to be able to keep your heart rate as low as possible, to function adequately, to think clearly, and to know that there are some great fire fighters out there that would love to get you out of that building in a timely manner and keep you safe.

Interviewer: If I'm in some sort of office where they can't see me, what should I do? Should I be yelling in there? I mean, you told me to stay calm and yelling kind of goes counter to that, should I get out my cell phone? I mean, what do I do?

Annette: Absolutely, every time I ask for a 'hands up' in class, whenever I teach, about who does not have a cell phone, I think there's one person in about the last ten years. But obviously call. Now, calling is not going to be the first thing you do, you're going to try and get out, but if you cant get out, then to call 911 to tell people where you are. So knowing where you are in your building and being aware of your surroundings prior to the event is really important. There's no point in saying "Well I'm the fourth floor down on the right, in that weird T." So to know exactly where you're located would be super helpful for the fire fighters, and one day may save your life.

Interviewer: So, 911 will then take that information and they'll help coordinate behind the scenes and get that information to the firefighters. "We know for sure we have somebody in office 210 on the third floor"

Annette: Absolutely. Absolutely.

Interviewer: Very cool. If you're trapped in your office, is there any place in your office that's better than the others?

Annette: No, the only place that's really safe is underneath the smoke that will maybe come through that door, even if you've packed it. So, to be low to the ground, and to keep under that smoke, because that smoke contains toxins and that's what will kill you, and that's what kills many people. So to keep low, to crawl on the ground, and then to not breathe in any of that smoke. If you have something wet, if you put it over your nose, then, and breathe through that moisture, then that can help so some of those particles don't get into your airway. But, other than that, keeping obviously as far away from that smoke as possible, and keeping low to the ground is the only options that you might have.

Interviewer: All right. Have you ever seen the results of a burning office building, in the burn center?

Annette: You know, I have, unfortunately. And hotels are another one, and manufactured homes, and apartment complexes, and senior centers, and all of those things that break your heart, unfortunately.

Interviewer: What's getting them hurt? What's a common kind of thing that they're doing wrong, that people are doing wrong in these situations?

Annette: You know, sometimes I think we just have that 'deer in the headlights look. So that stop, and take in your surroundings and to grab your bag and think about what books you might want to take. That is not helpful; going back in to a burning building to get something that's been forgotten is something else that we see. Never ever go back into a burning building because you will get injured.
The other thing that we see is that people just aren't prepared. They have never done it before, and so the most important thing is to think about exiting any way you're at. If you're at a hotel, ask for a room on the lowest level close to a fire exit. Although, if we all ask for that, there's not going to be many rooms available for the rest of us. But to think about your surroundings, to be aware, to know that fire can start anywhere, and that fire is powerful, fast and dark, unlike the movies that show this bright exotic flame. Fire is dark, and we can't see, and so to know by feel how to get out of somewhere would be really important.

Announcer: The ScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: What should you do if you're trapped in a burning building? We'll examine that next on The Scope.

Announcer: Medical news and research from the University of Utah. Physicians and Specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: So if you remember back when you were a little kid stop, drop and roll. You touch the door to see if it's hot. What should you do if you're trapped in a burning building? Are those still the same steps or is there something else we should know? Annette Matherly is the Outreach and Disaster Coordinator for the Utah Burn Center.

I'm caught in a burning building, whether it's at home or at work. What do I do? Are those basics I learned in school still good or what?

Annette: Absolutely some things never change; you just try and make them right? So let's just say I'm in my bed, I'm snoozing away and the smoke alarm goes off. I wake up but I'm kind of still sleeping. It's dark, right? But is it dark because there's smoke in my room or is it dark because my eyes aren't open yet or is it dark just because it's night?

Well, I don't know the answer to that and so I roll out of bed and I drop to the floor. My door is closed because remember we're supposed to keep our doors closed when we sleep at night and that's because if there's a fire outside our room, if our door is open and we open the windows so we can escape out the window then it will cause this draft which will pull the heat and smoke into our room.

So that's why we leave our door closed. So I'm crawling across the floor, I'm heading to the door. I use the back of my hand to feel the door. Is it hot? No, I can't feel it. I put my hand up and I feel the knob and the knob is hot so that means there's some fire, something hot outside my room. So now, man, I can't get out of my door. I know that I've got to stay in my room.

So what I want to do is I want to make my way to the window. I'm safe to open it if the doors closed but what if I'm on the 5th floor? What if I'm on the 25th floor? I can't jump out of my window now.

Interviewer: I don't like this scenario you're painting at all. What am I going to do? Tell me.

Annette: Well, so now I know I can't jump so I'm kind of stuck in my room for a while. So what I want to do is pull the sheets off my bed and I want to stuff them right underneath that crack in the door and around the door so I stop that smoke from coming in as quickly as I can. Obviously my first thought is for my safety so I want to get somebody's attention so they can get me out of this burning building as quickly as possible.

It is safe to open the window because your door is closed, it's not going to cause that draft and pull the heat into the room. So I want to get somebody's attention by being at that window. Now obviously if I'm smart I'll also have a flashlight by the bed but I can use the lights if the electricity works to get peoples attention. If not, then to have a flashlight and signal for help and yell and scream out the window so those firefighters who know how to do this, who are experts, can get up to me.

The other thing I might want to think about if I'm maybe on the 3rd or the 4th floor is they have some handy-dandy great ladders that can be used as a fire escape in an emergency situation. If I have one of those I can get out of the house but it's not very helpful if I'm on the 25th floor. I'm pretty sure they don't make ladders that long.

Interviewer: So I'm in my room, my door is closed because I've listened to you. I've checked, it's hot. I would imagine a lot of parents at this point would go, "What about the kids? I need to get out and help the kids." What's the answer to that?

Annette: This is a heart-wrencher, because as a parent of course you want to get your kids out. But we have also many people in saving the children and in saving the hamsters and in saving their dogs, they get severely burn injured. So the key thing is, and this is the kicker, is many people don't want to deal with this because it's kind of an iffy topic and people kind of shy away from things the things that scare us.

But if people practiced their fire escape plans, their home escape plans with their family and they practiced it in the day and they practiced it at night, and they practiced it with their kids and their kids could demonstrate competency in getting out of the house. That muscle memory, that second nature that kicks in when you have fight flight, if you have practiced that then your children are likely to get out of the house.

You may only have two minutes. What's really important is to think about it before. We should just talk about freely in our homes and in our families. Kids love to take responsibility. The kids can be the Fire Marshall and they can prepare the drills and they can have unexpected drills at 2:00 A.M. on a weekend so that parents and everyone can practice crawling out in the dark, going to a safe meeting place and rejoicing with everyone because everyone's got out safe.

Interviewer: You know the worse part about it is that I hear you say all these things and I'm like, "It's never going to happen to me. It sounds like a lot of work." I get totally what you're saying that it has to happen before. You're not going to save lives during, you're going to save lives before. How do you get over that "it's not going to happen to me" barrier?

Annette: Well you know as an ICU Nurse we hear that all the time. Unfortunately because nobody ever thinks it's going to happen to them. It's human nature to think... We don't want to think about bad things. But we need to be motivated enough to engage in preparation and prevention so that we can keep not only ourselves but our loved ones safe and secure. We can know if it happens, and tragedy does, that we did our absolute best that we can to change an awful situation.

Interviewer: I like your idea of turning it into a game to prep for the kids. I bet you the kids would absolutely love that. That's a good idea. What about having a plan where all right you've got the baby, part of the plan is everybody feels their door. If somebody doesn't feel the heat, they are the ones. Like before you plan, they are the ones to go examine to see if the baby's safe. Is that something you can do or is that a bad idea?

Annette: Sure, absolutely. Let's just take there are four people and three of them feel the heat and they're going to get out the window or they're going to stay and they're going to signal for safety. One person doesn't feel the heat. Now not feeling the heat doesn't mean not necessarily hot or dangerous behind the door, so you want to open your door very carefully and slowly because if there is something out there you want to close it really fast.

But if you don't see anything in the hallway and you have a baby next door to you, then you can obviously open up that door, run and grab the baby. Check those corridors because remember if you can see smoke then you need to get underneath it. The toxins that the smoke contains will get into your lungs. Many people don't die from the burn injury; they die from the toxins in the smoke itself. Because the unfortunate thing is it clouds your mind so you can't make very good decisions, so maybe you're not clear.

So you need to get underneath that smoke. You need to crawl either out of the house through your escape route with your child or if you can't escape, you've seen it, there is smoke at the bottom of your stairs and fire down through that exit way, you need to go back into your room and then you need to signal for help from your room. Do all those things under your door. Stuff your blankets underneath so that you and your child can stay safe as long as possible.

Interviewer: Keep your child's, keep your baby's door closed as well.

Annette: Absolutely.

Interviewer: Because then there might be a chance that you get out. The Fire Department shows up, they're still able to save the child.

Annette: Absolutely.

Interviewer: Wow, all right. So get out and practice those drills. Any final thoughts when it comes to what to do if you're trapped in a burning building?

Annette: The other thing that I would say is there's some amazing websites out there. The NFPA website, the Burn Prevention Network, the Safe Kids, they have some great tool kits, some great games for your kids. They have things for adults too but they have really basic important concepts that you can adapt into your homes and make a part of your every day life to make prevention just the same as can I have an egg and some toast in the morning. That's how prevention should be.

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Interviewer: Do you have a body ache or pain? What do you do? A lot of people go and grab the heating pad, even if they're cold they just go grab a heating pad, but there's actually a burn danger, which surprises me. We're talking with Brad Wiggens, nurse manager of community outreach at the University of Utah Health Care Burn Center. I can't believe that a heating pad could actually burn you. Really?

Brad Wiggens: Absolutely, heating pads actually pose a big risk to the elderly population, the geriatric population. They can burn anybody, never should be used with a small infant, but again, our number one population that we see the most that is an elderly, geriatric type of patient.

Interviewer: How hot do they get?

Brad Wiggens: Well actually a heating pad will only get to about 120 degrees, at the most, when it's kind of in a confined space, but I think the danger of that is that people don't realize that leaving it in the same place, falling asleep on it, putting it on a patient who may be, or a loved one that has some neuropathies, maybe as you get older you don't feel as much in certain areas of your body, they leave it in the same place, they get left alone, maybe they don't have as much movement or ability to get away from it when it does get hot, and people don't realize it'll actually cause a second degree burn over just a few hours of time of exposure.

So they really should be used for short durations of time and really pose a lot of risk to breaking the skin and having a significant burn injury, and even nationally, this is a surprising stat that most people don't realize, is that there is a risk of actual death. So there are reported deaths nationally from heating pad burn injuries.

Interviewer: So it's not the intensity of heat, it's the heat plus the time, it sounds like. So what's the difference between like if I put a heating pad on my back and fall asleep versus an elderly person, is their skin like thinner or something or?

Brad Wiggens: Sure, so there skin is a little bit thinner or more frail, but they don't have nearly the best circulation that you and I have at a younger age. So definitely there're at a higher risk because their skin doesn't heal as well. So you're heating up an area, damaging it, you're causing inflammation and then you're trying to heal that injury, so it is a little bit more complicated because of their age, you're just, your skin is more frail and you don't have good circulation.

Interviewer: So is a burn from a heating pad a third degree, is a third degree burn a third degree burn, whether it's from a flame or a heating pad?

Brad Wiggens: Sure, yeah, I mean a third degree burn is a third degree burn. So a first degree burn would be a sunburn, a second degree burn would be when you get significant blistering from touching something hot, not blisters that you get from a sunburn, and a third degree burn would be burning all the way through all the layers of your skin, down past your dermal layers and down into subcutaneous tissues.

So a third degree burn is a third degree burn no matter which way you got it. Whether it was from the glass front fireplace, whether it was from a heating pad, it's pretty difficult to get to that point with a heating pad because of the heat they do put out, however, because it's on an elderly person we see of danger with that, where you actually have such significant amount of damage, you have a deeper injury, they don't have the good circulation that they need to heal that injury, so it actually ends up being a deeper second to a third degree burn and lends itself to needing to have a skin graft, which lends itself to a hospital stay within our intensive care unit, and really longer outcomes.

Interviewer: So it's the kind of complications more than the burn itself, for an elderly person, like breaking their hip for example?

Brad Wiggens: Yes, it's the complications, it's the same type of thing. You're taking someone who has a lot of problems and a lot of comorbidities typically, a lot of elders, as we all get older you have more ailments, I mean things get harder to do. It's harder to recover from the flu, it's harder to recover from falling and breaking your hip, those are the dangers and it's exactly the same type of situation when you're using a heating pad.

Now, a lot of people chose to use those with infants as well. The danger risk of all those types of things, heating pads should never be used with infants, they shouldn't be used with people who are paralyzed, either I think that that's a big focus. So you have someone that's paralyzed and has no feeling and maybe they're going to put it on something to make themselves try to feel better in that area, for some reason, or they'll have a loved one that does it, and they won't even know they got burned because they can't feel it, so those risks really are there.

Another huge risk is that people actually fold them and wrap them, and it's a heating element that sits inside a piece of fabric and when it gets a little bit used, it starts to get a little bit more rigid, so you fold it up, you wrap it, you stuff it in your, you know, in your towel closet and you know, you pull it out when you need it, but there's some electrical safety risks there too. I think at the end of the day really think about what you're doing. You're placing something hot against the biggest organ of your body, your skin. And you're putting your skin at risk. Really focus on that safety, that personal safety piece of what am I doing and why am I doing it and for how long should I do it.

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updated: November 23, 2018
originally published: March 3, 2014

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Interviewer: Probably just about every house has one. Talking about a portable heater, and you would think that they would be fairly safe, I mean, there is so much stuff in between you and those heating elements, how could you possible burn yourself? Well, you can burn yourself.
Annette Matherly is the Outreach Education and Burn Disaster Coordinator at the Burn Center at University of Utah Health Care. I wouldn't think that a portable heater would be a serious burn hazard, but it is.

Annette Matherly: Absolutely. Especially if it's in a kid's room. Kids are naturally curious about hot things. You know, when they're a year old, we give them a candle with a cake and they blow it out and they think they can control fire, and then we reward them with gifts and cake so why are we surprised when they want to prod and play and light fires and touch fires?
So obviously children are very curious about fire, and so they will touch it. They will touch the bars. They will put things in it. Kids, again, love to play and they'll build tents, and they'll put the heater in the tent because the tent is cold, and they'll put things around the fire, and they'll throw clothes in a pile, and those clothes are too close to those fires. There should be a three foot radius around any portable heater, and when those things are closer than that, they will ignite and they will ignite very quickly.

Interviewer: So the real danger of portable heaters more so is of a fire starting, not so much, I'm touching it I'm going to get burned.

Annette Matherly: Absolutely.

Interviewer: Even with the modern-day heaters with all of these safety things? I mean, my heater, sometimes it just shuts off when I get too close to it because I don't know why.

Annette Matherly: Well, you know the heaters that blow hot air are a little bit different. Oftentimes the heaters that cause the fires are propane heaters . . .

Interviewer: Oh, okay.

Annette Matherly: . . . and are the electric heaters with the coils. And so, those get extremely hot and oftentimes they have open bars. And so those are usually what catches, ignites curtains and then the curtains catch on fire.
The other thing with propane heaters, or actually with any heater is that if you are working in a garage, so let's say you have your heater in the garage and maybe you are working with an accelerant and those fumes that come off those accelerants are pretty dense and they travel really fast and when they hit the heater, they can ignite.

Interviewer: Let's talk about some preventative things as kind of our final thought here. What are some things you can do with portable heaters to prevent these things from happening?

Annette Matherly: You know, always, always have a three foot radius around any heater no matter what kind of heater it is. You know, make sure that your bedding isn't close, make sure that the curtains aren't close. Sometimes we have long curtains that drape down against a heater that's on the wall.
Talk to our children and to our families about the importance of staying away, you know, knowing that children are naturally curious and love that warm glow, to talk to our children and to say, you know, this is hot and let's talk about what hot is.
The other thing would be to always have a home escape plan, to make sure that in the worst possible scenario if something were to happen, that our families and ourselves have a plan that we can talk to our kids about stop, dropping, and rolling in case they, you know, they catch on fire from backing too close whether it be at our home or it be a neighbor's home.

Also, to talk to them about the basics going back to kindergarten, and to make sure that we have a place to meet outside of the home, a safe meeting place. A place where everyone can gather so that firefighters, when they're fighting a blaze in that house aren't going back in for a child that's maybe in the backyard or a parent that's in the backyard when people think that they're still in the house.

Interviewer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. There's nothing better in the wintertime than gathering around a warm fireplace with the family, but it can be dangerous, and maybe in ways you haven't considered. We're talking with Brad Wiggins, Nurse Manager of Community Outreach of the University of Utah Healthcare Burn Center. So fireplaces and glass fireplaces is what you said you wanted to talk about. What's the difference between a regular, old school and a glass fireplace, and what's the concern?

Brad Wiggins: Sure. Well, they both have significant dangers for risk of burn injury. But particularly, this time of year here in Utah and throughout the Intermountain West, we really see a very high percentage of children, particularly toddlers, that do not understand the safety risks of how hot the glass gets. Parents leave a small child in a room where the fire's going, and I don't think, really, there's been a lot of emphasis on education to help people to understand the dangers of those risks and how detrimental it can be.

Interviewer: I'd imagine a lot of parents say, 'That's fire. That's bad.' But they never say, 'That's glass. That's hot.'

Brad Wiggins: Absolutely. I think that those are the risks of parenthood; the safety moments where you think everything's fine, and you find yourself trapped in one of those moments where, all of a sudden, it comes back to get you. I think that, really, the emphasis here is about education, teaching people, and getting the word out about those safety risks. Right now, particularly in an environment here where we have this incredibly difficult inversion, people do use a lot more natural gas fireplaces. They have a lot more glass, and the glass is getting bigger. People are choosing larger, more beautiful types of fireplaces. And they are beautiful, but they come with a very inherent risk.

Interviewer: How hot does that glass get?

Brad Wiggins: Greater than 350 degrees, actually.

Interviewer: You're kidding.

Brad Wiggins: No. It will actually give you a third degree burn in less than one second. And one of the biggest complications we see if it's toddlers who are pushing around the room and pushing off the furniture, they get to the glass, and they put both hands on, and they lean in with their weight. It's so hot that they actually end up sticking to the glass and they can't pull themselves off. It gives you a third degree burn to the entire palm or surface of your hand. So not only are you dealing with a burn, but you're dealing with a third degree burn that must be skin grafted, and it will impact the movement and the functionality of that hand for the rest of that child's life.

Interviewer: Is a child's skin more easily burned than an adult's? I mean, at 350 degrees, I don't know if it's really . . .

Brad Wiggins: Absolutely. But if you think about an adult's hand, they have callous all over it. They have a little bit more reaction time where they know they're touching something hot, and they pull off. So a toddler doesn't understand the instinct that once they touch something hot they should pull off. The reaction is different. They feel something hot. They feel the pain. They start screaming. They're looking around for someone to help them, and they don't remove their hands from the glass. They actually stay attached for a longer period of time, and it sounds absolutely horrible, it's incredibly difficult to recover from, and it really leads itself to a lot of long-term complications throughout life.

Interviewer: And I'd imagine also not just the physical pain, but there's some mental thing. I bet you'd never forget that.

Brad Wiggins: I'm sure that you won't. From a parent perspective, I think you deal with a lot of people who are not forgiving themselves for allowing that to happen in their home. Again, it's an accident just, like, if you get in a car accident. Things happen.

Interviewer: What about prevention other than trying to tell the child, 'Be careful,' which might be lost on the child? So what else do you recommend?

Brad Wiggins: The number one thing that you can do if you have a small child is don't use your glass fireplace. If you're going to be sitting in the room with your small child toddling around, don't turn the fireplace on. The second thing would be definitely get a screen in place. There's lots of different types of opportunities and different manufactures out there for you to find that actually have types of coverings that keep your child from actually getting to the glass fireplace.

Interviewer: Any final thoughts?

Brad Wiggins: If you walk into the room, the fireplace is on and you go to turn it off, it doesn't immediately cool the glass. It's actually been recorded that it takes almost 25 minutes for that glass to actually cool in that room to a safe, touchable thing. The other issue is that most of them are actually hot right now. Your pilot light's in there running. Whether you're at work or home or wherever you are, it might not be on, but it still actually has quite a bit of heat. You'll be surprised. So feel it and get an idea of what exactly what you're dealing with. Protect yourself. Put those screens around it. Turn them off. Teach your kids not to teach that area if possible. But still, at a toddler age, they just don't know. Again, don't use it. Put a screen around it if you have to use it for some reason and that's your main heating source for your home in the wintertime. Protect your young ones. Protect your families. Really pay attention to those safety needs of each of those children.

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Host: Did you know that you could get hypothermia when it's 40 degrees outside? I'm with Dr. Troy Madsen, emergency room physician at the University of Utah Hospital. Let's talk about hypothermia. Is there a comparison to be drawn between heat exhaustion and heat stroke here?

Dr. Troy Madsen: Absolutely. Heat stroke is when the body temperature gets really high. Hypothermia is when it gets really low.

Host: Okay.

Dr. Troy Madsen: Neither of those is good. So think about it this way. Probably the easiest way to compare this is to your car. If your car's really hot, it doesn't run well. But then think about these cold mornings we're having now, going out there, trying to start your car up. You're just trying to get that engine going. It just starts to turn over a little bit, and once it gets going, it doesn't work well.

Host: Yeah. And then even you try to shift it into gear, the transmissions sloggy.

Dr. Troy Madsen: Exactly. It just does not work well. That's exactly what the body does. You know, your heart's kind of the engine of your body. If it's cold, it does not work well. You know, at high temperatures, same thing with your heart. Absolutely. There's definitely a comparison there.

Host: So 40 degrees, it could start happening. Is it normal at 40?

Dr. Troy Madsen: Not normal at 40. The big thing in the 40's is if you're in damp weather, if it's raining on you, you've got cold clothing, you can get hypothermia. So people who are outside maybe. You know, it's a little late in the year for people to be hunting, but maybe for outdoor activities, you may think, "Hey, its 40 degrees outside. I should be fine." But you could or your children could be experiencing hypothermia if you start to get cold or you just don't have the right clothing on.

Host: What temperature does it normally happen? When do you really need to start worrying about it?

Dr. Troy Madsen: This last winter, I saw several cases of it in the ER because we had some really cold days. But usually, once you get these temperatures down in the teens and the single digits at night, we see it a lot in people who are homeless, who are out on the streets, who don't have any place to go or may have not gotten into the place, into some of the resources that we have available. Or people who may be intoxicated, who may not be aware exactly what's going on, that their body temperature's dropping. That's where we really start to see some serious cases in the ER.

Host: So generally, it's not somebody that's doing some outdoor activities such as snow shoeing, skiing, that sort of thing?

Dr. Troy Madsen: Typically not. You know, I think most of us, we know when we're getting cold. It's not, like, you're walking out to your car in the morning and you get overcome suddenly by the cold. It's usually people who are in some other situation. They may be out skiing. They may be out in the back country where they just can't get to where it's warm soon enough. But for most of us, in our day-to-day activities, it's not a big issue.

Host: So frostbite's probably a little bit more predominant though? Because I can be out doing an activity and not have gloves on.

Dr. Troy Madsen: Right.

Host: I could be warm enough, but my extremities are not?

Dr. Troy Madsen: Exactly.

Host: Okay.

Dr. Troy Madsen: And that's one, too. You know, the big thing with skiing is usually these temperatures are in the single digits, and those can be some pretty cold days. When you're snow shoeing or hiking or whatever, when it kicks up, you've got part of your face exposed. You can get some frostbite on your face or on your nose. Certainly on your hands if you don't have the right equipment on. And when it gets cold like that, your body's going to pull blood from your hands, from your feet to your core to keep it warm. That's when you get some issues in your hands, some frostbite in your hands and fingers.

Host: So if my face gets frostbitten. What does that mean?

Dr. Troy Madsen: Basically, what it means is you got dead tissue there. You got tissue where there's just not enough blood supply there because the blood has been pulled away from it, and the temperatures have gotten so cold in that part of the body that the tissue actually dies. So, real cases of frostbite, that's dead tissue. Oftentimes, if it's severe enough, you know, we'll have cases of people who come in with frostbitten toes. I've seen cases, interestingly, of just people who are just out working, just out shoveling their snow. I've had a couple cases of that. They had some other medical problems that I think made things worse, but they've had amputations of some of their toes because of that, because the frostbite was so bad.

Host: So frostbite can cause things to have to be amputated?

Dr. Troy Madsen: It can. It can. You know, usually, it may cause some cosmetic issues. Certainly if it's on your face, that can be a problem. But in some cases, you actually have to have an amputation.

Host: What are the symptoms of either one of these that I need to watch out for? You know, because I've been really cold before.

Dr. Troy Madsen: Yeah.

Host: So cold that I think, "My toes are going to fall off."

Dr. Troy Madsen: Right.

Host: But was I really in danger?

Dr. Troy Madsen: I think the first one with hypothermia, you know, if you're shivering, that's a good sign. So you think the normal body temperature's 98.6. Once it starts to drop down around 97 or 96, you're going to start shivering. And that's just your body's way of trying to produce heat. You shiver. It produces heat. It tries to warm up the core. But the really concerning thing is if you stop shivering. That's when your body temperature gets less than 90 degrees, and that's where it becomes life threatening. Your heart just starts to do weird rhythms. It gets really slow. And certainly, if you're with someone and they just are not shivering and you're really cold, and they're just not shivering at all, and they are not really responding to you, those are signs of severe hypothermia.

Host: Is there anything that you could do for them at that point if you can't get them to help?

Dr. Troy Madsen: It's not everyone's ideal scenario or consideration, but if you have to, the best way to get someone warm is number one, make sure they're dry. Number two, if you've got a sleeping bag or something to insulate you, strip them down. Strip yourself down. Get your body heat next to them. That's the best way to warm them up.

Host: And that's about all you can do at that point?

Dr. Troy Madsen: That's about all you can do besides trying to get help. You know, obviously, if you can make a fire or whatever resources you have there, but that's going to be the quickest way to warm someone up.

Host: Any other thoughts?

Dr. Troy Madsen: Yeah. I think the number one thing is just preparation. Make sure you know where you're going. Know what the temperatures are. Make sure you're prepared for that, so that doesn't happen to you.

Host: And bundle up when you're shoveling your driveway.

Dr. Troy Madsen: Exactly. Stay bundled up.

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Interviewer: My name is Vivian Lee. I'm the senior vice president for health sciences at the University of Utah, and today we're going to talk about the cold. This can mean dangerous medical problems for people that are exposed to the cold for long periods of time and even short periods of time. Joining me today is Dr. Amalia Cochran, assistant professor of medicine at the University of Utah's department of surgery. She's also an attending surgeon in the university hospital's burn unit and a leading expert on frostbite. Welcome to the show.

Dr. Amalia Cochran: Thank you very much.

Interviewer: We had an experience that made me have to go online and look up frostbite and I realized there wasn't as much information as I would hope. My daughter came back. She was fine after a whole day of skiing, and then she got into the bathtub and she started screaming because she said her feet were really painful and then the tips of her toes were dark red, almost bluish. At that point in time you can imagine I just panicked and tried to look online. I thought, here you are, the expert, let me ask you, what was happening with her? How could I have prevented that?

Dr. Amalia Cochran: It honestly sounds to me like she probably had a case of frost nip. When you're out skiing you've got a prolonged exposure, as does anyone who's outdoors during this weather. The fact that prior to that exposure to the warm water bath she hadn't really had any significant complaints and you hadn't really noticed anything different . . .

Interviewer: No, and is that because you have numbness so you don't even realize what's happening?

Dr. Amalia Cochran: Precisely. There is numbness with frost nip and you see very few changes in the skin if someone has a case of frost nip.

Interviewer: Frost nip is different from frost bite?

Dr. Amalia Cochran: Frost nip is the extremely mild form of frost bite. The way that we tend to differentiate between them is that frost bite involves tissue changes where the skin will actually blister up versus frost nip where there is some of that damage to the skin and the soft tissue but not to the level where it blisters.

Interviewer: Is it blistering because the tissue is actually freezing? What's actually happening there in the skin?

Dr. Amalia Cochran: There are really two different things that occur in the skin with a frost bite or a frost nip injury. One of those is the direct cold injury from the temperature. That impacts the tissues. They do freeze. Little crystals form in them. The other phenomenon that occurs in association with that is ischemia where there is poor blood flow to the cold effected areas. Initially, when the outdoor temperature drops or when we're exposed to lower temperatures somewhere in the neighborhood of 50 degrees fahrenheit, there's a cold induced phase of dilation that occurs.

Interviewer: Blood vessels expand. All of a sudden this blood rushes back in, and then what happens?

Dr. Amalia Cochran: Right. But then after that they constrict. They narrow back down and so the blood flow diminishes.

Interviewer: One of the things about this that worries me is that because of the numbness the kids don't even seem to know that it's happening, so how do we know that that damage is occurring?

Dr. Amalia Cochran: Cold checks are what are recommended in the Alpine mountaineering literature. I think they apply to those of us that are recreational outdoor in the winter as well. The concept of cold checks is that you get yourself to a relatively sheltered location, and I phrase it that way since this is from the Alpine mountaineering literature because there would be a relative shelter if you're skiing, you can say, hey, let's take a hot chocolate break after an hour and a half, and go in and check fingers, check toes.

Interviewer: We do them every half hour sometimes.

Dr. Amalia Cochran: Some days that's really appropriate. You can check everyone's fingers, check everyone's toes. If you notice that the fingertips or the toes are looking particularly pale, if they start getting a little bit woody in terms of how they feel, if they're not as soft as they normally feel, any of those sort of characteristics, that would make you concerned that you may have the early phases of a cold injury occurring.

Interviewer: How can we prevent it?

Dr. Amalia Cochran: Preventing it is a little bit tough if you have a love for winter sports. One of the things is that if you are someone who knows that you have circulatory challenges finding ways to keep your fingers and toes warm.

Interviewer: So even when it's not that cold our fingers and toes get kind of cold. We're particularly sensitive to developing it.

Dr. Amalia Cochran: Absolutely. Be mindful. I tell people I have something known as Raynaud's phenomenon, which means that when I get cold my blood vessels in my fingers and my toes clamp down. So I not only very easily get cold fingers and toes but I'm at higher risk for cold injury. So when I ski I have heaters in my boots and my mittens.

Interviewer: Those hand warmer, toe warmer type things?

Dr. Amalia Cochran: They're actually battery packs.

Interviewer: Oh, I didn't know they made that.

Dr. Amalia Cochran: Yeah, they're a little spendy but they're worth it. I whine a lot less and I have to take fewer breaks.

Interviewer: But short of that, you recommend the hand warmers and toe warmers?

Dr. Amalia Cochran: They're definitely helpful.

Interviewer: Dr. Cochran, you're not only an expert in frostbite but you're also a leader in burn injuries. I noticed we recently had an avalanche victim who had frostbite and was cared for in our burn unit. Maybe you can explain to us this relationship. Why are the frostbite patients and the burn patients all cared for by the same people?

Dr. Amalia Cochran: That surprises people and I know our avalanche victim was a little confused when I showed up and introduced myself and said I was a burn surgeon. She gave me this puzzled look. I said, "Trust me. This is going to be okay." There are a couple of reasons that frost bite victims end up in the care of the burn unit, and one of those is because the mechanism of injury, the way that the body works to generate the frostbite injury or the cold injury is actually very similar to what ends up happening if people have a burn injury. The underlying pathophysiology, to use the big fancy word for it, of what causes the tissue damage is very similar. The other part of it is that with more major cases of frostbite when people have blisters or if they don't get treatment in a timely fashion they can even have gangrene where the tissues die, we are experts in managing soft tissue loss and getting areas of soft tissue loss closed or covered because of the fact that that's what we do with burns. So it ends up making our frostbite practice a very logical extension of what we're already doing.

Interviewer: One of the things I read online when I was reading about this was that you're not supposed to rub the tissues. Why not?

Dr. Amalia Cochran: That's an old wives tale. Historically, people were advised to remove their gloves and their boots and rub the area with snow even to help with cold injury if they thought they were getting cold injury. The problem with doing that is you extend the damage in the soft tissues with the friction. So it's actually not helpful to do that

Interviewer: So the tissue is already pretty fragile and if you're rubbing it you're just making the damage worse.

Dr. Amalia Cochran: Right. So the recommendation for rewarming now is a 40 degree centigrade, which is around 100 degree fahrenheit, warm water bath.

Interviewer: Is 100 degrees about a normal temperature bath?

Dr. Amalia Cochran: It would be a warm bath.

Interviewer: A warm bath.

Dr. Amalia Cochran: Yes.

Interviewer: I was always told that you need to keep your central body really, really warm and if you kept your trunk warm your extremities would sort of take care of themselves. But you're sort of saying, no, those hand warmers are important too.

Dr. Amalia Cochran: Yes, it's both. You need to keep your core warm because of the risk of hypothermia, but when you're looking at a risk for frostbite you need to look at keeping your extremity areas, your fingers, your toes, even your nose is an area that's at risk for lower blood flow when you get really cold.

Interviewer: So those face warmers too.

Dr. Amalia Cochran: Yes.

Interviewer: Well, Dr. Amalia Cochran, thank you so much for being my guest today.

Dr. Amalia Cochran: Thank you, Dr. Lee.

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Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Host: Hot oil, barbeque grills, falling into a campfire; you know I don't think that there's much more that is more terrifying than a severe burn. We are here with Dr. Stephen Morris Medical Director of The University of Utah Burn Center to talk about severe burn cases, why they're so bad, and the recently renovated Burn Center at The University of Utah Hospital. Thank you for taking some time to talk to us today.

Dr. Stephen Morris: Thanks for having me.

Host: For me anyway there's nothing much more terrifying than a thought of a severe burn. From a medical stand point is that the case as well? I mean that's kind of the worst of the worst. How bad is it?

Dr. Stephen Morris: Yeah the pain in and of itself is very terrifying. I think all of us we've had small burns and we know how much they hurt.

Host: Yeah.

Dr. Stephen Morris: And we can imagine if a patient has fallen into hot water, or had severe flame burns, over more than half of their body how much it hurts as well as how badly it affects them.

Host: Yeah, so what are some of the things that a burn will do to the human body that you're worried about if somebody comes in?

Dr. Stephen Morris: Well what we worry about initially is just maintaining the circulation because that's one of the first things to go.

Host: Really?

Dr. Stephen Morris: And the patience will lose fluids in there burns. They will also lose fluids throughout their body and so they become very swollen, and they become severely dehydrated and go into what we call Burn Shock, and so we have to worry about that. Likewise, they can often have severe problems with breathing. They can swell enough to block off their airways, or they can have injury that goes down to their level of lungs so their lungs don't work properly and so they can die from breathing problems as well.

Host: Even if they just burn their legs it can affect the lungs?

Dr. Stephen Morris: Correct.

Host: And your circulation throughout your whole body?

Dr. Stephen Morris: Correct.

Host: What are your other concerns that you have? Are infections a concern?

Dr. Stephen Morris: And that's just what I was going to say, and the next thing...The next thing down the road of course is trying to get the areas where the skin is now destroyed get that covered because you can imagine skin is an important barrier to infection.

Host: Yeah.

Dr. Stephen Morris: And so through their lungs, through their intestinal tract, and through their open wounds of their skin we have great concerns of infection, and that ends up being one of the causes of death in burn patients.

Host: Okay, so then a burn patient comes in you take care of a couple of the first issues, you try to take care of infection, what then? I mean the skin's damaged will it ever grow back?

Dr. Stephen Morris: It depends... If the skin is only partially burned through then of course the underlying areas will regenerate. We call that a partial thickness, or second degree burn.

Host: Okay.

Dr. Stephen Morris: But frankly if it's burned all the way through, no that skin will not grow back.

Host: Yeah.

Dr. Stephen Morris: And that's where surgery is required to remove the dead tissue and to put new skin in the areas where the skin was destroyed.

Host: And where do you get the new skin? Do you have like a skin bank here on site, or...?

Dr. Stephen Morris: Well the skin bank that we use actually had its origins in this hospital, now it has gotten much larger, and is off site, but the problem with bank skin is that it is temporary.

Host: Okay.

Dr. Stephen Morris: No matter where you get the skin, unless you have an identical twin that is, you have to use your own or it will reject. We can't use anti-rejection medicines like heart transplants, and lung transplants, and kidney transplants do because of the infection problems.

Host: Okay.

Dr. Stephen Morris: And so the skin has to come from the very patient who is injured.

Host: So you have to find some good skin and then start the process of doing some transplants?

Dr. Stephen Morris: Correct, these transplants are called skin grafts, and that's exactly what we do a lot of here.

Host: And how long of a process is that for somebody that's burnt maybe on 15%, 20% of their body?

Dr. Stephen Morris: Well there's a generally accepted rule of thumb, maybe it's a little antiquated, but the rule of thumb is this, for every percent of your body surface area that's burned, and if you look at your hand, the palm surface, the fingers, and the palm together that is 1%.

Host: Okay.

Dr. Morris: And so in a full grown adult that's a pretty good sized area, in a little child it would be much smaller.

Host: Yeah.

Dr. Stephen Morris: But we figure that every percent that is burned will require about one day in the hospital.

Host: Okay, wow.

Dr. Stephen Morris: So a 15% burn would be at least a couple of weeks.

Host: Yeah, so tell me a little bit about the renovated burn center. What makes this facility so incredible?

Dr. Stephen Morris: Well it's the people that work here I think that make it incredible, but they need to have a facility where they can actually do their job.

Host: Yeah.

Dr. Stephen Morris: And we've had a burn unit here with 12 beds for the past 30 years, and we've outgrown it. Certainly we're busier than we were back then, but more importantly I think we've learned how to take care of patients even better, and we needed to update the facility so that we could do the best possible job.

Host: What's different from this facility than the old facility and how does that help you treat patients better?

Dr. Stephen Morris: I think it's the space. We were so crowded it was actually fairly cramped. We have expanded to more than twice the area to take care of about the same number of patients and so it makes it much more comfortable for the patient; it makes it much more comfortable for the families, and the friends, of the patient.

Host: Is there anything else like this Burn Center in the Intermountain West?

Dr. Stephen Morris: No we are what's called a Verified Burn Center that we are independently assessed, and reviewed, and there's nothing like this Burn Center between Denver and the coast.

Host: All right.

Dr. Stephen Morris: And from the Canadian Border down to Phoenix, and so it really is the largest area for a single Burn Center to cover in the United States.

Host: Now what does this all mean for patients and/or people that live in the five state area of University of Utah Hospital Burn Center?

Dr. Stephen Morris: Well that means that they can go to bed at night knowing that we're, you know God forbid that they're injured, but were they severely injured, or were they to have a severe problem where they would lose their skin or have bad wounds that there's a facility that is quite close to home that provides world class care.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Science's Radio.