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Severe burns can be an overwhelming experience. An estimated 2 million burn injuries occur each year in the United States, resulting in 200,000 hospitalizations and 8,000-12,000 deaths. Burns occur in every age group and across all socioeconomic levels, both at home and in the workplace, and in urban, suburban and rural settings.

It has been estimated that 65-75 percent of all burn injuries occur in the home, with house fires responsible for the majority of fire deaths. Careless use of smoking materials, heating equipment malfunctions and cooking accidents are the leading cause of house fires. Within the homes, kitchens and bathrooms are the highest risk areas for burn injury, since potential victims have access to hot liquids and foods, electrical appliances, stoves and space heaters. Scalds from hot liquids are a major cause of non-lethal burnsMost burn victims are injured as a result of their own actions - children playing with matches or adults using gasoline improperly. Other victims are innocent bystanders or rescue workers burned in the line of duty.

Prior medical conditions such as stroke, epilepsy, decreased sensation due to diabetes or nerve damage may predispose a person to accidental burns. An estimated 4 percent of victims are burned intentionally, as in cases of child abuse or arson. Alcohol use has been identified as a contributing factor in burn injuries because it affects victim's judgment and reaction time.

The highest risk age groups for burn injuries are children younger than 2 years and adults over age 60. Both groups may have a limited ability to recognize and escape from a fire or burn incident. Their relatively thinner skin predisposes them to more serious injuries. Burns are the third leading cause of accidental death in children, and those who are 5 or younger are the most frequent victims of scalds.

Death and complication rates increase dramatically for burn victims older than 50 due to the likelihood of preexisting health problems and their immune system's decreased ability to fight infection.

Skin death and injury occur as the applied heat exceeds the body's ability to handle it. This starts at about 113 degrees Fahrenheit. The amount of depth of skin damage depends on the heat's intensity, duration of contact and skin thickness.

Causes of burns

Burn injuries may be classified as: thermal, chemical or electrical.

- Thermal burns. Not all thermal burns are caused by flames. Contact with hot objects, flammable vapor that ignites and causes a flash or explosion and steam or hot-liquid scalds are other common causes of burns. Just two seconds of exposure to water at 150 degrees can cause a full-thickness (third-degree) burn in an adult.

- Chemical burns. A wide range of chemical agents are capable of causing tissue damage and death upon contacting the skin. As with thermal burns, the amount of tissue damage depends on duration of contact, skin thickness in the area of exposure and the strength of the chemical agent. Chemicals will continue to cause tissue destruction until the chemical agent is removed. Two types of chemicals - acids and alkalis - are responsible for most chemical burns. Alkalis produce a deeper, more extensive burn.

- Electrical burns. The injury severity from exposure to electrical current depends on the type of current (direct or alternating), voltage, the area of the body exposed, and the duration of contact.

Alternating current, used in lights and household appliances, may be significantly more dangerous than direct current at low voltages. It can induce ventricular fibrillation; cause respiratory arrest; or "freeze" the victim to the electrical contact point with powerful muscle spasms that increase the amount of exposure.

Victims of low voltage electrical injury may have no skin burns at all, yet suffer cardiac arrest or respiratory arrest. Once the victim has completed the "circuit," current may penetrate the skin, distribute throughout the body and then collect at exit sites. Burns are seen at entrance and exit sites. Additionally, heat is generated along the pathway of current flow. It may be helpful to think of an electrical injury as an iceberg, since a very extensive injury may be present below the surface, despite relatively small entrance- and exit-site burns.

First aid

The first step in emergency care of the burn victim is to stop the burning process. How you do this depends on the cause of injury.

- Thermal burns. Remove the victim as quickly as possible from the heat source. If clothing has ignited, extinguish flames by having victims roll on the ground, smothering them with a blanket or dousing them with water. If possible, remove smoldering clothing, as it may hold heat near the skin and extend the burn. Cool scald or contact burns by briefly rinsing them with cool - not cold - water.

- Chemical burns. Since chemicals continue to "burn" as long as they are in contact with the skin, you must rapidly try to remove all of the chemical from the victim. Dilution with large amounts of water decreases the chemical concentration and helps to wash it away. If the chemical is in a dry form, carefully brush it off before irrigating the area. Clothing may hold chemicals, so remove all of the chemical from the victim. Dilution with large amounts of water decreases the chemical concentration and helps to wash it away. If the chemical is in a dry form, carefully brush it off before irrigating the area. Clothing may hold chemicals, so remove clothing. Initial water irrigation is recommended for at least 30 minutes. If no water supply is available at the accident scene, seek immediate medical attention.

Do not try to neutralize the chemical, even if you know which chemical is involved. The neutralization reaction always generates heat, potentially causing more skin damage. Chemicals in the eye are especially serious. Continue eye irrigation until the victim is seen by a physician.

- Electrical burns. Be very careful when trying to help a victim of an electrical burn. It may be necessary to wait for authorities to shut off power before trying to rescue anyone. Burn wounds can be cooled as described earlier.