Burning Issues

   Electrical burns account for 3%-7% of admissions to burn centers in the U.S. each year. Many of these are occupational injuries. In an electrocution, the injury pattern differs from other types of burns. While exterior injury to the skin may occur and be readily visible, internal injuries may not be as obvious but can be severe.^2,3,7-10

   Electrical injuries can occur from direct contact with a source or from a source's arc. In contrast to other burn types, electrocutions may involve entrance and exit wounds. When a person comes in contact with an electrical charge, the charge seeks a path out of the body. As the electricity passes through the victim, resistance to the flow of the current generates heat and damages tissue between the electricity's points of entry and exit. In most cases, the flow of electricity is from low to high resistance. Resistance is lowest in nerves and increases in blood vessels, muscle, skin, tendon and fat; the most is offered by bone. When the current flows through the body, massive electrical charges with extensive contact can leave tissue blackened and scarred.^2,3,7-10

   Various types of injuries can occur with an electrocution. For example, an arc injury can occur up to 10 feet away from an electrical source. A flame injury may occur if the patient's clothes ignite. Musculoskeletal injury can occur if muscle spasms develop. The patient may also develop traumatic injuries during or after the initial electrocution if they fall or are thrown from the source.^2,3,7-10

   Flash burns may also occur with electrocutions or lightning strikes. In flash burns, clothing can be protective. However, if the clothing ignites, thermal burns may result. Flash burns tend to be seen on areas of exposed skin where contact was made with the source. The most severe occur on skin that was facing the ignition source.^2,3,7-10

   With these cases, providers need to maintain a heightened awareness of the potential for internal damage. Thorough assessments and close monitoring should be part of prehospital treatment.

CHEMICAL BURNS

   Exposure to chemicals results in about 60,000 injuries and 3,000 deaths a year. Chemicals can have various effects, ranging from minor skin irritations to acute respiratory compromise. Because the signs and symptoms associated with chemical burns may take time to develop, injuries can appear benign early, but become considerably more severe.^2,3,7-10,12

   A number of factors can influence chemical burns, including the strength and concentration of the chemical, quantity involved, duration of contact, mechanism of action, extent of penetration and mode of entry into the body. Modes of entry include absorption through skin or mucous membranes, inhalation through the respiratory system, or the agent being swallowed, eaten or injected by needle or through an opening on the skin.^2,3,7-10,12

ASSESSMENT

   The assessment of any burn patient must be deferred until the scene is secured and deemed safe. In the opening presentation, the ambulance was staged in a secure location. Firefighters then moved the patient out of the danger area to the ambulance. This type of approach is key in ensuring the safety of responders and protecting the patient from additional injury.

   Assessment of the patient should begin before physical contact is made. As you approach the patient, be aware of their surroundings. What is the patient's overall appearance? Are there any clues or signs to what happened on scene? Factors such as medicine bottles and medical supplies may provide insight to the patient's medical history. Evidence of substance abuse should also be noted.^2,3,5,6

   When assessing a burn victim, consider some specific questions: What was the source of the burn? How long was the exposure? Was there direct contact with the burn source? Was the patient in an enclosed room when the incident occurred? Were any chemicals involved? Is specialized decontamination required? If an electrical burn is involved, what was the source, and is it possible to determine the voltage? High voltage is generally considered 1,000 volts or more, although some authors have argued that the risk of significant injury increases with exposures exceeding 600. Typical household circuits in the United States are 110 volts, with bigger appliances operating on 220-volt circuits. Power lines in residential areas can carry more than 7,000 volts.