Last year, according to the American Burn Association, nearly 500,000 people in the United States had burns so serious they required medical treatment. Nearly three-quarters of serious burns happen in the places most people think are their safest refuge: their homes.
So physicians such as Linwood R. Haith Jr., co-medical director of the Crozer Burn Center in Upland, are constantly working to devise new treatments for these painful injuries and ways to prevent people from getting burned in the first place.
The center — formally, the Nathan Speare Regional Burn Treatment Center at Crozer-Chester Medical Center — admits almost 500 burn patients a year and sees 3,000 people in its outpatient offices. It recently received national recognition from the ABA as the “Burn Program of the Year” for 2017. And Haith, also clinical professor of surgery at Drexel University College of Medicine, was named president of the association. He spoke to us recently about his work, and what’s new in burn treatment and prevention.
What are the most common causes of burns? Are there new risks people should be aware of?
It depends on the age of the patient. For children less than 8 years old, it’s typically scalding. It happens either in the kitchen, from pulling over a container of hot liquid, or in the bathroom, because people may not have the water temperature regulated properly. Another common cause of burns is single-serving containers of prepared soups. You microwave it and then someone opens it and it spills. In the last few years, as the use of glass-fronted fireplace doors has become more common, we have seen a lot of toddlers walking up to the glass and burning their hands.
For older kids, the risk is associated with playing with matches or flammable liquids. You even see some kids with fire-setting behavior who will have flame burns.
For adults, the most common type of burn would be flame burns, either from flammable liquids or structural fires. Next would be scalding and heat contact. We get a lot of patients with hot grease burns. They are frying chicken and the cooking oil spills on them. Or they go out of the room and the oil catches on fire, and they pick up the pan to throw it outdoors so the whole kitchen doesn’t burn. Grease can go up to 350 or 400 degrees Fahrenheit before it ignites. If the skin approaches a temperature of 160 degrees, a third-degree burn can ensue within a second. At 140 degrees, it would take about five seconds. And at 120 degrees, it would take several minutes.
One burn injury we are seeing more of in adults comes from people smoking while they’re on oxygen lines. Because of advances in medical care, there are many more people who are alive now even though they have serious lung problems. They are at home on oxygen therapy. People understand the risk, of course, and they usually have the good common sense to turn the oxygen off when they smoke. But sometimes, they just have a momentary lapse. We see it at least twice a month.
It’s interesting that, today, the average serious burn size is 10 to 20 percent of the body. One injury, resulting in burns of 30 to 90 percent of the body, that was almost eradicated by strong public service announcements, was from smoking in bed. It is a beautiful display of how grassroots and public support can work. You still see it, although rarely. Another cause of larger burns that is not common anymore is house fires. Now, with everyone having smoke detectors, we don’t see many people with 50, 60, 70 percent burns and smoke inhalation injuries.
Tell us about some of the latest research.
We’re on a continual quest for a permanent substitute for skin. We have some good materials, including a synthetic skin, that replicates some components of whole human skin. In another development, if you take just a small piece of skin, you can clone that 10,000-fold in about three weeks. But it’s not the whole skin. It’s just the outer later, the epidermis. Plus, it’s quite expensive, difficult to use, and very fragile. What we want is something that replicates both the epidermis and the underlying dermis, and it is the subject of fervent research efforts. Another product, now in the last phase of research, involves taking a small sample of a patient’s skin, mincing it up and putting it in a solution, and then spraying it over the affected area. The cells will replicate in place.
The other thing we are looking at are better tools for determining the depth of a burn injury. In people with deeper burns — about 30 percent of patients — we end up operating or doing skin grafting. That will provide a quicker cure rather than letting the burn heal over weeks to months. And the patient will end up with a better scar outcome. We have some tools on the market, but they’re cumbersome. We’re always looking for a better tool.
We also are looking for better tools to help eradicate dead tissue. Some research efforts are focusing on enzymatic debridement techniques that help eradicate dead or necrotic tissue more rapidly and maybe – maybe – less painfully.
What about pain management and burns?
Many of the people who come in to burn centers have some of the most severe pain from any trauma that you would imagine. So the staff — the nurses, the techs, all the people involved in hands-on management of the patients — are very special. They don’t hear it enough. I’d like to applaud them.
There has been a tremendous amount of discussion about the opioid epidemic, and we in the medical field are caught squarely in the middle. In the burn world, we’ve always been acutely aware of the issue. One of our missions is to provide not only the best possible wound care, but also pain control. I think we do it very well. Unfortunately, even in this day and time, there is no better drug to use for severe pain than potent narcotics, including morphine and fentanyl. I will also say that we have a stellar record in our burn center. Less than one half of one percent of our patients could be identified as having an abuse or addictive problem after they are discharged. You can almost tell the ones that are going to have a problem, because they had a problem when they got burned.
Are there promising new burn treatments?
In the old days, they would put the patient in a big tub and put a specific cream on the burns every day, and then they would wash it off. But they had trouble keeping these tanks clean. Crozer pioneered a kind of trolley you could put the patient on, and then use a spray to wash the cream off. But now, even better than that, there is a whole group of products that are called long-acting topical dressings. Silver is the main active ingredient. They are applied to the wound, and they last up to about 10 days. Let’s say you have a scald on a child. As opposed to changing the bandage every day, the child can go home, you bring them back in a week, and by that time, the wound is almost healed.
What are some simple environmental and behavioral changes people can make to prevent serious burns?
Everyone should double-check the temperature of their water heater, especially if they have young children, and lower it to less than 140 degrees. If you have children, be especially careful in the kitchen. It’s an ever-present threat. And with glass-fronted fireplaces, be aware that burns from it are something that actually occurs.
In general, be careful when you open a microwave. The liquid is almost at boil, and then it sort of explodes.
For people who are on oxygen, I’d like to stress the importance of education, and how often it has to be restated that there’s a potential great danger with oxygen, especially for those who smoke.
Always, always, please check your smoke detectors. We do see people who are in structural fires still. It’s predominantly because the batteries are dead, or people don’t have the devices in the first place. And those are going to result in severe burns, as well as smoke inhalation injury.