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Burn Victims — Dealing with Burns Resulting from Explosions and Fires

Burn Injury Lawyer Serving Clients Nationwide and Throughout Texas, including Beaumont, Orange, Port Arthur, and Surrounding Areas

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

Burns: Injury Facts and Statistics

Bush Lewis personal injury attorneys understand the magnitude of both the individual patient’s battle and the immense scope of burn injuries in America, which includes:
  • Approximately 2.4 million burn injuries each year
  • 650,000 burn victims receiving medical treatment annually
  • Hospitalization every year of 75,000 burn victims
An average of 10,000 burn injury deaths a year, from a combination of the following:
  • Residential, commercial, and on-job fires
  • Motor vehicle and aircraft crashes
  • Contact with electricity, chemicals, hot liquids and substances, and other sources
  • The $7.5 billion reported by The Centers for Disease Control as the yearly cost of fire and burn injuries
  • One million burn victims with substantial or permanent disabilities despite the 94% increased survivability rate due to improved quality medical care

Burn Victims Most at Risk

The young and the old are at greatest risk for serious burn injuries, and, in general, the younger or the older, the greater the risk. Children between the ages of 1 and 5 are the most frequent burn victims (with a greater frequency for those under two), followed by members of the 17 to 25 age group. The frequency of burn injuries decreases with age after 25 until age 60 is reached, when the risk of burn injury becomes greater than at any time since childhood and increases with each passing year.

Burns to small children occur from home fires, from bathing, from hot items on stoves, and flammable bedding, furniture, or clothing (especially cotton-polyester blends) without adequate flame retardants. Surprisingly, the profile for injury causation in the elderly is very similar to that for young children. The younger the burn victim, the more expensive the treatment and rehabilitation, with twenty years sometimes needed to complete the necessary surgeries for a child burn victim. For the elderly, serious burns are often fatal and rehabilitation is many times less successful than with younger victims.

Sources of Burns

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

Burn Injury Medical Care

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

Early Management and Assessment of Burns

Modern burn units are battlegrounds to save the lives of burn victims and manage the burn injuries to minimize future disabilities, improving future quality of life for survivors. Initial burn care depends on the percentage of the body surface burned, the depth of the burns, and the environment where the burns occurred. The skin is the body’s largest organ (over two square yards in adults) and a key system, just as the circulatory, nervous, digestive and pulmonary systems are. Vital skin functions include protecting the body from bacterial and viral invasion and regulation of the body’s temperature and excretion of some bodily wastes through the sweat glands.

The larger the percentage of the body’s skin burned, the greater the risk of death. The deeper the burn enters into the body, the more permanent the injury. The environment of the injury is important because hot, smoky, low oxygen, chemical filled or otherwise altered air may cause internal injuries to the endotracheal, the brain or the pulmonary or circulatory systems. Previously, burn injuries were called first, second and third degree but now are classified as superficial, partial thickness, or full thickness burns. Superficial burns heal in one week, partial thickness burns usually heal in two to three weeks unless infections have caused damage to enough additional tissue to create a full thickness injury. Full thickness burns go through the epidermis (outer skin layer) and dermis (internal skin layer) and varying depths into the subcutaneous tissues beneath the skin.

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

Body Fluids and Circulatory Complications

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

Infections

The second most deadly complication of serious burns is infection. Burned skin loses its ability to protect against infections and viruses and actually becomes a breeding ground for bacteria. Highly elevated risks of infection exist in part because burn wounds expose areas of unprotected tissue that easily become infected and in part because of the severely weakened victim’s body systems (including the immune system). Any infections slow healing and increase scarring. Burned skin sloughs off (similar to a snake’s shedding of its skin). This additional loss of skin leaves more tissue unprotected, further elevating the risk of infection. Symptoms of infections include increased fever, tachycardia (inappropriately quickened heartbeat), lymphanagitis (a quickly spreading infection of the lymph system caused by bacterial infection), and localized tenderness, all of which require immediate emergency medical intervention. Special diets high in calories and protein are necessary to battle infection and provide the burn victim’s systems with the necessary energy and building blocks to survive. Blood transfusions are often necessary. Treating bacterial infection involves serious problems because dead tissue has no blood circulation. This means that the circulatory system cannot carry systemically administered (whether oral or intravenous) antibiotics to the wounds. Antibiotics must be applied to severe burn wounds through various alternative methods, such as exposure, open, topical chemotherapy, occlusive dressings and excision of infected areas.

Burn Wound Care

Closing burn wounds and getting rid of dead burned tissue are essential but complicated steps in the burn treatment process and are required to both help fight infection and begin the long process of minimizing the impact of serious burns. When a serious burn injury victim goes into shock, swelling occurs. Badly burned skin becomes stiff and resists swelling, leading to increased pressure inside limbs, fingers or toes that potentially chokes off blood flow. When elevating limbs is insufficient to relieve pressure, surgical cuts called escharaectomies in the burned skin allow the burned area to expand and decrease the pressure. Bandages can—
  • Protect against infection
  • Reduce heat and water vapor loss from burned skin
  • Prevent discomfort from air current sensitivity in the injured area
  • Keep limbs, fingers and toes in proper post ion for healing
  • Collect drainage from wounds
Unfortunately, bandages do not provide permanent closure of burn wounds. Skin grafts provide the solution to this problem.

Before skin grafts can be successful, the dead skin and other tissue must be removed. This is done by surgical excision or debridement. Debridement is physical removal of the dead skin without surgery and is typically done during whirlpool baths with sterile brushes.

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

Pulmonary Injuries

Inhalation of smoke, carbon dioxide, heat, steam, chemicals, flames or other foreign matter can cause pulmonary complications. Potential injuries include:
  • Pneumonia
  • Scarring of the lungs
  • Hemoptysis (damage to the lungs that causes bleeding that is spit up)
  • Hemostasis (interruption of the flow of blood to or in the lungs)
  • Hypoxic injury to the brain through decreased oxygenation from lung injury or impairment
Initial medical management of pulmonary injuries requires establishing an appropriate airway and delivery of oxygen. The more confined the area of exposure, the more severe the pulmonary injuries.

Other Burn Injury Complications

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

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

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

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

Permanent Impact of Burns

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

Child Burn Victims

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

The Burn Injury Lawyer in Fire and Burn Cases

Burn injury attorneys have two main roles. The first is find out what caused the fire or burn injuries and determine if something or someone is legally responsible for the injuries. This may include visiting the fire or burn site. In one case, Bush Lewis lawyers reconstructed an apartment from dumpster materials in a Galveston parking lot to determine how the fire started, spread and severely burned a young child. We inspected numerous work site explosion areas with our experts. We have been there when our experts have disassembled burned up motor vehicles to determine why the vehicle caught fire and how the fire spread to the burn victim.

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

If you or a family member has suffered burn injuries or suffered losses from a fire, protect you rights by hiring an experienced Texas burn injury lawyer to investigate your claim. Bush Lewis lawyers are experienced in all areas of burn and fire injury litigation. Call Ken Lewis, Don Bush, Dale Hanks, or Stephen Townsend today at 409-835-3521, or email us. We serve burn injury victims nationwide and throughout Texas from our Beaumont, Texas offices.

Know This Before An Accident

No one plans to have an accident and no one expects to sustain a serious injury or lose a loved one to death from someone else's actions or mistake. It helps to at least have heard what experienced lawyers say you can do to ease the situation. At Bush Lewis, we think there are some helpful guidelines that we recommend to you. Our lawyers suggest: Learn more.