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Interviewer: Electrocution injuries from the perspective of a power lineman and a burn center doctor. That's next on The Scope.

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

Interviewer: Dr. Stephen Morris is with the University of Utah Burn Center and we have three Rocky Mountain Power linemen with us today. Justin Holleran, Rick Wroby, and Mark Maomao. First off, before we get to the safety message, I think it's really important that people know what incredible work guys like you do. Being a lineman, I did a little research, is in the top ten most dangerous jobs and the fatality rate is twice that of police officers and firefighters.

I think it's kind of an unsung hero type job because when the power goes off we just wait for it to come back on, and usually are grouchy about it. But it's men and women like the ones you're going to hear from today that make it happen, and often times in the worst conditions like storms and darkness, long hours. They are really, truly the unsung heroes. Hopefully we are going to use some of your experience and expertise to save some lives today or at least save some pain. First of all, I want to talk to Justin Holleran. He's one of the linemen. Tell me what happens when someone comes into contact with electricity.

Justin: When someone gets in contact with electricity, especially high voltage, hopefully they're still alive at such a high voltage, but a lot of burn and could be amputation.

Interviewer: How so? How does that happen?

Justin: At such a high voltage if there's a lot of amperage going through it, if your arm is bent or leg is bent, a lot of times it won't even make the bend, it will just disconnect.

Interviewer: So have you seen instances where a high voltage power line is down and somebody comes into contact with it?

Justin: A lot of times when we get on scene, they have been taken off, medical personnel has taken them of and we're just there to repair. A lot of them are backyard accidents, people tree trimming on the weekend, new construction. A lot of times they're building structures too close to the power line and they've been there a week or two and they've forgot about it, and they lift either lattice of some sort, or just a piece of metal up in the air to come in contact. We get a lot of those calls.

Interviewer: Let's get Rick up here. Rick, when you go through your training, what are some of the things you're told to watch out for when it comes to high voltage electricity?

Rick: Well it's definitely important when you're dealing with electricity to insulate or isolate, and by that, a few of the terms that we use in our trade is whether you use insulation to protect yourself, or you isolate the danger. You isolate the hazard. Now if we do work at hot, which we often do, we use PPEs and protective equipment to keep us insulated.

Interviewer: But the average person doesn't have this type of equipment. So if I've got a ladder up against my house next to that thing where the power comes into my house, what should I be doing then?

Rick: You should make sure to stay away ten feet from the power line at all times.

Interviewer: But it has that insulation on it so it should be fine, right?

Rick: Well not always. It doesn't always have the insulation on it.

Interviewer: Got you. Well especially at a point of entry like that.

Rick: Some of the older applications are not even insulated at all, and so the ones that Justin was talking about where the home tree trimmer gets into the power line, is there's an old power line built in the '60s running through the backyard, then those lines will most likely not be insulated at all.

Interviewer: Dr. Morris, what do you see from your perspective when someone comes in who has been electrocuted?

Dr. Morris: It depends upon the voltage. It depends upon the type of contact. Sometimes patients will come in who literally have not had any conduction of electricity through them, but because of a short there can be a real flash of a material around the electricity, and so they can have face burns, hand burns. We see that a lot with electricians.

Sometimes it's a low enough voltage, for example, a child who is fascinated by electrical outlets, or who puts a cord in their mouth. They can have a very small localized wound. But the worst are probably the high voltage electrical, where they have contact. They will literally have kilowatts going through their bodies. It takes a lot of energy to get through the skin which is high resistance, so lots of heat right there at the skin. Where there's resistance in the body, along bone, for example, you can have a lot of heating there, and so it is what we call an "iceberg" type of thing, you see only the tip.

Those patients can have total destruction of muscle, and nerve and blood vessels, and those are the patients that we were talking about a few minutes ago who could end up having amputations because there is no living tissue anymore.

Interviewer: Because the way electricity works is it generates heat when it meets resistance, and that's how people end up getting burned, is that correct?

Dr. Morris: That is correct. And so it is a thermal injury, a heat-injury or sorts, but a very specialized kind that really can unpredictably course through the body and usually you don't have direct injury to vital organs, brain, heart, and things like that. But because of the massive extent, every body system is involved.

Interviewer: So it sounds like the burn part isn't the worst part in electrocution injuries. It sounds like you can destroy muscle tissue, you can destroy bone.

Dr. Morris: Well that is burn, but it is deep and it is hidden.

Interviewer: Oh I see, so we're used to the superficial skin burn, but this is burn.

Dr. Morris: Correct.

Interviewer: You're cooking somebody, in a way.

Dr. Morris: That's right. From the inside out.

Interviewer: Wow. Mark Maomao is one of the linemen. What safety tips to you have?

Mark: I would say probably the biggest safety tip as a lineman and for the most part, even in our trade, what I see is people aren't using common sense out there. If you're in a dangerous situation call the Rocky Mountain Power Company, ask those questions to professionals that deal with it day in and day out. I also want to add that yes we do see a lot of injuries, we talked a lot about high voltage a bit, but it only takes point five milliamps to kill you. Point five.

Interviewer: Give me a perspective of where I would find point five milliamps. Like sticking a fork in an outlet? That would give me point five milliamps. That could kill me.

Mark: That could kill you. Correct. If the electricity, as the doctor alluded to earlier, it's unpredictable.

Interviewer: We've talked a lot about high voltage, and I think now we're starting to even understand that even the outlet in your house could be dangerous. Do you see burns from inside the house electricity? Like, I'm installing a new light fixture, I went down to the Home Depot and I got a new light fixture. I didn't turn off the right breaker, bam, could that burn me?

Mark: Yes of course. I think we need to get better as a society, educating folks on how to be careful, even in your home.

Interviewer: Rick, what did you want to say?

Rick: I've got one point to add to that. Education. Educate your neighbors, educate your family, and especially educate your kids, because your home is your safe place, but often times that's where the accidents happen.

Interviewer: Justin?

Justin: I just wanted to add that not all power lines are in the air. Anything new, they're underground. So anybody on the weekend, even putting a fence in your backyard, we see that almost daily now. People hitting their power line serving their house and there is a lot of other ones, high voltage, running across the back of the property line. A lot of people rent an excavator for the weekend or just out there with a shovel and a digging bar.

Interviewer: So I think that those are a good couple takeaway messages. Dr. Morris, do you have a takeaway message?

Dr. Morris: The most common reason people get injured by electricity is they're not aware that there is an electrical hazard. So whenever you do anything, you said it best, look up, because there's a lot of overhead.

Interviewer: And remember to look down, check down.

Dr. Morris: And be sure to be safe before you start digging, it's not just the inconvenience of not having cable or internet. You could kill yourself with electrical gas, with electricity. That's one, just being aware of what's around you when you're doing something you don't do every day.

Interviewer: And there other takeaway is from our lineman.

Mark: Could I just say something about our partnership with University of Utah Burn Center? We really appreciate the opportunity that we've had as lineman to work together with Rocky Mountain Power local 57. We are a big fan of what you folks do here. You said earlier it takes a special person to be a lineman. I think it takes an even more special individual to do the kinds of things you do here for people. I just wanted to say on behalf of everybody that I work with it is a big deal for us and we wanted to personally say thank you.

Dr. Morris: Well and likewise I wanted to say that in the midst of tragedy we've seen such great, noble people from you as linemen literally picking up the pieces and going on and making a difference in the world. A lot of it is education and a lot of it is community help and community service. We really appreciate that and the financial support that you give us so we can do things like this, so we can educate people that, take care. Be careful.

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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.

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: At a family barbeque, everybody's laughing and having a good time. You lose track of the three year old for a couple seconds. They lean into the barbeque grill and they get burnt. How bad is really bad, and what should you do if that happens? Dr. Stephen Morris, medical director for the University of Utah Burn Center is going to help us answer some of those questions. First of all, when it comes to burns, what's bad, what's really bad and how do I know as a normal person?

Dr. Stephen Morris: We look at burns maybe a little differently than you might in the community. We know they all hurt, but in fact, the worse they are sometimes the less they hurt. If it is your fingertip it's going to hurt a lot or your palm or if you step on some hot pavement and have a small area on the bottom of your foot, even though that hurts a lot, it's probably going to heal because it's partial thickness or second degree burn. That is, it doesn't go all of the way through the skin, so there's enough there to heal back. However, if a little kid falls into a fire, into a barbeque pit, and has very deep burns that are basically numb because not only is the skin burned, but the nerves are burned too, those can be some of the worst.

Host: So if you're touching it and it's numb that's a sure sign that you probably should go to an E.R. or call 9-1-1?

Dr. Stephen Morris: That's right.

Host: Okay. First degree is least dangerous and third degree is most dangerous.

Dr. Stephen Morris: Correct.

Host: If it's just a second degree burn what do I do to treat that?

Dr. Stephen Morris: Cleanliness is an important thing because if it gets dirty, if it's not well cared for infection will get started. You can get infection that spreads beginning at the burn out to areas that are not burned.

Host: It's a painful thing. Do you use just soap and water? What do you use to clean it?

Dr. Stephen Morris: Soap and water is a great thing. Just wash it off with a washcloth, soap and water, and put a little burn ointment or a band-aid on it if it's small. If it takes more than that you ought to get in to see a doctor.

Host: Okay. I'm going to draw an analogy here. For your ears an airplane would produce so many decibels of sound which they would say that's very dangerous to your hearing. Are there things around the house you could look at like that boiling pot of water and go, "That's going to generate probably only a second degree burn if it contacts the skin for a second." Is there any way that you can judge the dangers in your house?

Dr. Stephen Morris: Yes, we normally don't check the temperature of the bath or of water on the stove. If it's bubbling at this elevation you know it's going to be close to 190 or 195 degrees. That in a matter of a second or less is going to cause a very serious burn. We recommend that you check your water temperature. You can use a candy thermometer early in the morning, turn the water on long enough for it to heat up and check the temperature. Make sure that it's less than 130 degrees.

Host: A lot of times it's kids that are getting burned, and a lot of times those burns are happening in the house. Let's talk prevention for a second.

Dr. Stephen Morris: Sure, we would much rather see safe and healthy children than have to take care of them here. For that reason it's important that you remember the kitchen and the bathroom are two of the most dangerous and perhaps even deadly places in the home for a number of reasons. Burns are really near the top of that list. When there's a small child they should not be left unaccompanied in the kitchen particularly while cooking is going on or in the bathroom particularly when there is a tub full of hot water and the potential for tap water which could cause serious burns.

Host: Or curling irons.

Dr. Stephen Morris: Curling irons are all over the place. Treadmills are another danger in the home that people don't think about. Friction burns can happen basically instantaneously and you have to make sure that little children won't be sticking their hands under that whirring belt. We think about treadmills making us healthy, but they can also hurt us.

Host: You don't think of burns coming from a friction burn. That's a great point. What are some sources of friction burns that you might want to watch out for?

Dr. Stephen Morris: Well, I think that certainly treadmills are something that we see a lot of, bicycles, motorcycles, any place where there is a very rapidly moving object near a not so rapidly moving kid, that's danger.

Host: What other causes of burns have you seen here that might surprise a regular person?

Dr. Stephen Morris: I think most people think about fireworks, barbeques and fire pits. Despite the fact that everybody knows about it we still see little kids that are injured. I suspect probably a good rule of thumb is when you're around dangerous environments like that a kid under the age of two ought to be attached to an adult.

Host: What's the one take home that you would offer to our listeners at this point?

Dr. Stephen Morris: Many things in our lives we take for granted, such as a boiling pot of water or the radiator of a car, but a second or two tipping that pot of water or popping the radiator cap off can change your life unalterably forever, so always be aware.

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