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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: 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

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.

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