Burn Care and Management

Legal Concerns, Health Management, Legal Care Planing.

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Burns bring a horrific toll every year – pain, death, mental suffering and finance that could be unmatched by another other types of personal injury. It is estimated that more than 2.25 million burn injuries happen annually. The cost of these burns is approximately $2 billion and 9,000 fatalities. And the 9,000 of die often are better off than the many who live on in terrible suffering and pain.

Fortunately, medical care quality for burns has risen significantly in the last decade. This has risen survivability and the costs to treat and rehab people who have the most severe burn injuries. For instance, from 1965-1979, the survival percentage vs total area burned for every age group rose from 35% to 50% where 60% of the skin on the body was burned. The survivability percentage will continue to rise. And the medical and rehabilitative costs also will continue to go up with it.

Medical statistics show that burn injuries are related to the victims’ ages. Children in the 1-5-year-old range being the most likely victims. The next most likely age group to suffer severe burns are those from 17-25. The chances of a burn injury drop after the age of 25.

The most common places for burns to happen are in the kitchen or bathroom. The most common reason for burns to children is from taking a bath or taking hot items from the stove. Flammable fabrics also can cause terrible burns, especially those polyester/cotton blends that are so popular today. Clothing fires can be just as terrible to the elderly as to children. Both have a difficult time removing burning clothing, so the burns can be especially severe.

Legal Concerns of Burn Victims

One of the most significant aspects to a trial attorney on a burn case regarding the victim’s age is that the younger he is, the costlier is treatment and rehabilitation. This is in spite of the fact that the length of a typical hospital stay has dropped. It can take two decades to complete the many surgeries needed by a severely burned child. It is challenging to estimate the staggering financial cost of all this medical care, in addition to the tremendous psychological strain on the victim.

A skilled trial lawyer must know there are two different but important aspects of victim treatment. First, survival. Next, living. The first requires the specialized knowledge and skill of an advanced medical burn team. The second requires the skill and knowledge of a burn rehabilitation team.

Assessment and Classification

To properly treat the burn victim, the assessment and classification of burn injuries is necessary. These include:

  • The percentage of body surface burned
  • Depth of burns
  • The environment where the burns happened

The larger the percentage of area burned, the lower the chance of survival. The deeper the burn, the more likely the injury will be permanent. The environment where the burn happened could cause serious internal injuries to the pulmonary, endotracheal and circulatory systems.

During treatment after the initial injury, it is critical to keep internal body temperature regulated in a narrow range to avoid worse damage. The ability of the human body to adjust to the outside temperature environment will contribute to the result of heat exposure. If the body can adjust to changes of outside temperature and maintain the normal internal temperature, major cell damage can be reduced.

The body can tolerate a temperature of up to 111 degrees F for a short period. When the body temperature rises to 124 F, this can double the rate of tissue and cell damage for each temperature degree increase, even for a short period. When temperatures rise above 158 F, the likelihood of total cell and tissue destruction is almost certain – even for short periods.

Burns have classifications as follows:

  • Superficial
  • Partial thickness
  • Full thickness

The classification of the burn depends upon the depth of the burn as it relates to the internal skin structures. The outer skin is called the epidermis, and the law inside is the dermis, and inside of that is subcutaneous tissue.

Superficial burns are what were once called first-degree burns. This means the burn is only to the outer skin layer. It causes minor pain, tingling, hyperesthesia, redness, some swelling, blanching when pressed, and some peeling from the area that was burned. This burn will take about one week to heal.

Partial thickness burns are similar to what was once called second-degree burns. They involve the epidermis layer and some depths of the dermis. Typical is a pain, sensitivity to cold air, hypesthesia with mottling and blistering, and potential draining with some scarring. It can take two or three weeks for these burns to heal. An infection in a partial thickness burn can damage the subcutaneous tissue, and cause it to become a full thickness burn.

A full thickness burn is similar to what was once called a third-degree burn. They involve the full layer of the epidermis and the dermis. Some depths of the subcutaneous tissues are also involved. Symptoms are a pain with possible shock, hematuria, and hemolysis of the blood with charring, white, pale and broken skin that includes edema. Healing depends upon the depth, involvement of the degree of surface area and severity of the burn. There will be scarring.

To assess the percentage of skin involvement, there is a formula called ‘the rule of the nines’ that is used to divide the surface of the body into areas of 9% each. It is vital to determine how much of the body surface that has been burned; a prognosis between life and death may hinge upon it. In the formula, the neck and head make up nine percent, each upper extremity is nine percent, each lower extremity is 18%. Eighteen each for the front and back of the torso and one percent for the perineum. The evaluation of percentage is often done at early stages of treatment, but it can be needed to reevaluate the extent two or three days after the injury.

What  Causes Burns

Burns are caused by four things:

  • Thermal
  • Chemical
  • Electrical
  • Irradiation

A thermal source is a heat, such as fire or a hot liquid. Chemicals may include acids, caustic soda, sodium, phosphorus, and strong alkalis. Electrical sources can vary in voltage, amperage, and how the electrical current goes through the body. Irradiation burns are due to atomic radiation, x-rays, radium, ultraviolet and other types of rays.

As part of the medical evaluation, it is key to understand the environment in which the burn occurred. Inhaling heat, smoke, carbon dioxide or chemicals can have serious effects upon the circulatory, pulmonary and endotracheal systems. The environment where the injury happened also can provide important information as to the severity and extent of the burn injuries.

Early Burn Management

Effective early management of the burns affects the chances between life and death, and also the quality of life for the survivor.

The first treatment priority is for the systems of the body that have suffered damage. The areas of the body that had direct exposure to the burn might appear to be the top priority, but the systemic effects that are secondary to the actual burn could create a grave risk to life in the first stages of treatment.

The first order of business with a serious burn case is to replace lost bodily fluids. Burns cause dilation of small vessels and capillaries in the affected areas. This dilation leads to elevated capillary permeability, allowing seepage of plasma into the surrounding tissue. Edema and blisters may result. If you do not replace this vital systemic fluid, there can be reduced, thickened blood with lessened efficiency in the circulatory system.

The next order of business is to prevent infection. Burn wounds expose tissue areas that get infected quickly. The areas of exposure will rise as the burned skin falls off. There can be increases in fever, tachycardia, lymphangitis, and tenderness to the damaged area.

Burn patients need diets high in protein and calories, and regular blood transfusions may be needed often.

It is often needed to close the wounds so infection is prevented. Skin grafts may be needed; they are classified as autografts (skin taken from other parts of the patient), heterografts or xenografts. allografts (skin taken from another patient, either alive or dead).

Each grafting technique has limits and problems. In the end, the grafted skin must be replaced by the actual patient’s skin. In any graft, the granulation tissue that the graft is placed on should be free from any necrotic tissue upon which the graft would not work. Also, puss, serum exudation, eschar, bleeding or other infection under the skin graft will prevent the graft from adhering.

Dead tissue does not have any blood circulating through it, so there can be serious problems when bacterial infections arise. The circulatory system will block antibiotics from getting to the wound, thus making it necessary to administer them through other ways. These ways include topical chemotherapy, open method, occlusive dressings, and excision.

In exposure, the burn is exposed to light in a cooler environment to reduce and control bacteria present. This is most often used for burns to the face, neck, perineum, and trunk. The treatment leads to drying and formation of hard crust over the burn would give it protection after a few days.

The open method is using treatment with topical chemotherapy is common. Advantages are the ease of assessing wound progress, being able to start physical therapy sooner, and superior temperature control. Disadvantages are needing frequent bacterial cultures to monitor the topical agents that are being used. And the burn victim needs to be chilled.

Complications

During early treatment of burns, there are serious dangers of complications. These include problems with the circulatory and pulmonary systems, hypertrophic scarring, pruritus, and psychological issues.

Circulatory Problems

To deal with circulatory problems in the first treatment stages of burns, there needs to be regular fluid and plasma replacement and blood and urinary specimens, and output must be monitored. Within two days of a serious burn, several problems can develop related to changes in the levels of water and electrolytes and various fluid imbalances. Some of these problems are general dehydration, reduced blood volume, decreased output of urine, an excess of potassium, lack of sodium, hemoconcentration, sepsis, and cerebral vascular problems.

Pulmonary Problems

Pulmonary problems can show up right away or even months later. These may include hemoptysis, pneumonia, and hemostasis. These are typically caused by smoke inhalation, heat, steam, carbon dioxide exposure, flames and foreign matter in the lungs. Generally, the more confined area where the exposure happened, the more severe the injury can be. Early medical management involves setting up an appropriate airway and the administration of oxygen. Other treatments may be bronchial suctioning, humidified air, antibiotics, and induced coughing

Contractures

It is often necessary to keep a joint immobilized over a long period of time. This leads to shortening of muscles, tendons and various related structures that can cause the joint to contract. This leads to a loss of range of motion of the joint. Any motion loss in a major joint is a serious complication. This can cause serious consequences from a psychological and financial point of view. The best treatment here is to engage in physical therapy as soon as possible.

Hypertropic Scarring

This can also lead to contractures and can lead to serious psychological complications. This scarring can be seen in burn victims and is caused mostly by a large increase of collagen fibers. They appear abnormally on the skin surface and attract undesirable attention from others. A burn suit may be used to reduce contractures and hypertropic scarring. Burn suits are measured very carefully and applied to the person to provide help in reducing formation of contractures and scars. These suits can be referred to by the manufacturer’s name or by the part of the body covered, such as jobst stocking, or jobsts globs. Plastic surgery is the major way these scars are taken off and should be considered by the attorney when he calculates future damages.

Pruritis or Itching

Pruritis is a serious problem in a burn case because of the intense discomfort, but also because it cause infections from scratching the new skin that is growing. There are oral and topical drugs that can control this problem, but it can be permanent.

Psychological Complications

Starting with he unusual environment of dealing with sterile people in a burn unit and the sterile environment in the hospital that is necessary to treat a burn victim, burn victims are usually under great stress. This is definitely true for children. The longer the burn victim is confined, the more likely there will be psychological trauma. After the patient is discharged, the patient is often stared at, and people may have difficulty in not acting revolted at hypertropic scars, and the inability for the person to move around normally. Psychological counseling should start in the medical facility and continue as long as required. This could be for life. Counseling should also be available for the family of the victim so they can better cope with the problems of the victim, as well as the personal problems they will be dealing with.

More Complications

Pressure ulceration can be one of the more painful complications when in the hospital. It is mostly caused by having to stay in bed. The new skin also is probably tender and can be easy to damage. In the long term, there is the possibility of skin cancer developing, and high sensitivity of the new skin to heat, cold, cloth and sunlight.

In the long term, there can be problems with the development of skin cancer. The new skin also can be highly sensitive to sunlight, heat, cold and cloth.

Damage Assessment

The areas below must be addressed to assess financial damages legal that may be due to a burn victim:

  • Medical costs – past and future
  • Psychological counseling for the burn victim and family – both past and future
  • Loss of earning capacity, past and future
  • Pain and suffering, physical and mental – past and future
  • Physical impairment
  • Scarring and disfigurement
  • Amputation
  • Loss of consortium – ability to have intimate relations with partner
  • Loss of services
  • Recovery of bystanders

Medical Expenses

The past expenses for a burn victim can easily be in the hundreds of thousands of dollars. Early treatment usually necessitates intensive care by highly trained medical personnel using advanced medical equipment and supplies. This is usually followed by physical therapy and many surgeries. During the initial treatment and rehabilitation, there usually will be a long list of costly and advanced medical equipment and supplies used.

These can include oxygen experience, electrically powered beds, suction devices for gastric and endotracheal suction, ventilators, Hubbard tanks, emergency cutdown and tracheostomy trays, whirlpool tubs, burn suits, splinting devices, physical therapy equipment and specialized braces for stretching.

Many of the complications in burn cases may not show up for months after the injury, such as pulmonary problems and contractures, you should never be in a rush to make a final determination of your financial damages. Future medical damages could include considerations for plastic surgery, and the need for medical appliances to help you to develop independence and the ability to get from place to place.

Psychological Counseling

In many cases, psychological counseling should start in the hospital and go on for as long as needed for the burn victim. Also of great importance is the psychological counseling for the family to learn how to deal with the many problems that the burn victim will face. The cost of that counseling should be recoverable in any legal action in most jurisdictions even without establishing cause of action for bystanders. According to the right of bystander recovery, family members should be able to get money for any counseling that they may need to help them to learn to deal with their own challenges that are caused by the injuries of the victim.

Loss of Income and Earning Capacity

There is a good chance that the ability of the victim to earn an income will be affected by major burn injuries. This impairment can be caused by multiple physical limitations caused by amputations, contractures, from injuries to the pulmonary, circulatory or endotracheal systems, or even from the psychological complications that were caused from the stress reaction of the injuries and treatments. These types of losses must be assessed by an experienced professional, vocational rehabilitation counselor.

Pain and Mental Anguish – Past and Future

Burns are the among the most painful injuries to the body. Consider the fact that many Christian churches and other religions teach that God is fair and just and rewards believers with Heaven and eternal life. But God is said not to punish the unbelievers with death. They are punished with a life forever of pain in Hell, where they burn forever. This mythology through the centuries shows that the pain that one feels from burning is seen as one of the most painful by much of the population. In addition to the physical pain, what about the anguish that you feel when you are singled out as a freak and are stared at in public on a regular basis? This type of reaction can cause the victim to want to stay out of the public eye and to even avoid family. This type of pain and anguish should be considered when trying to come to a settlement amount for a burn injury lawsuit case.

Physical Impairment, Scarring, Disfigurement and Amputation

These four types of damages should be considered separately by the jury. In a case where at least two of these four exist, the jury should find damages for each but should not be awarding overlapping damages. Pain and mental anguish should be separate as well.

The physical nature of such injuries is obvious, but implications on the life of the victim may not be so clear. They can overlap with other elements of damages and need to be explained to the jury. For instance, limitations of motions that support a claim for physical impairment are very painful, and so can an amputation. Scarring and disfigurement also can lead to mental anguish. The implications of such injuries are more than just a reduction in earnings or in one’s capacity to earn. They can prevent a person who is otherwise physically capable from being able to get a job or even keep one. A victim may be required to wear compressive garments for long periods that interfere with getting employment for up to two years after discharge from the medical facility. The longer you are not working, the harder it will be to get employment, which will reinforce the victim’s feelings of being rejected. About 20% of major burn victims cannot return to the labor market because of physical and psychological issues. Many who do return will experience a reduced earning capacity and enjoyment of their life.

Loss of Consortium – Loss of Services – Bystander’s Recovery

These three types of damages all can be involved in a major burn case. Each is a separate claim for damages, but as with the factors mentioned above, the jury must be instructed to think about each one separately and not give overlapping damages.

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