Why Are Scalds The Focus of National Burn Awareness Week?Feb 3, 2014
When you think about scald dangers, you likely think about that boiling pot of water on the stove or hot cup of coffee. But, because the temperature needed to cause a severe scald is so surprisingly low, there are many other situations that you might not have even considered dangerous, especially for kids and the elderly.
Annette Matherly, education, outreach and burn disaster coordinator, talks about the causes of scald injuries that come into the University of Utah Burn Center and how to prevent them. She’ll also tell you why noodles are dangerous, how most scalds happen in the bathtub, and give you some things to do around the house to prevent burn injuries that take seconds to happen and last a lifetime.
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Interviewer: Burn awareness week this year is scalds. We're talking with Annette Matherly, Outreach Education and Burn Disaster Coordinator at the University of Utah Health Care. Tell me, why scalds? Of all the different types of burns, why are scalds being focused on this year?
Annette Matherly: Scalds are so important because they're so generic. We have hot water that comes out of our taps. Every day we take a shower in the morning and we don't think twice about the fact that hot water burns like fire. It seems so innocent, and yet it's so deadly and costly and painful for the small children and for the elderly who have especially thin skins and can be injured really easily by the water that comes out of our tap.
Interviewer: Anatomically, what's going on when that hot water hits the skin?
Annette Matherly: Our skin is paper thin and the cells that we see, the epidermis, which is the outer layer skin, is all dead. The water that comes out of your tap if it hasn't been turned down is about 146 which will cause significant burn injury in two seconds.
That water will penetrate through that dead cell layer through the epidermis and go down into the dermis which is the second layer which houses all the nerve endings and all the blood vessels. It's where all your cells are and your ability to regenerate your skin. When it injures that part it will take off that top layer and expose those nerve endings. This is why burn injuries are so painful to those that sustain them.
Interviewer: Scalds, that's fascinating, 146 degrees is enough?
Annette Matherly: Yes.
Interviewer: Because I think a lot of people think it's got to be boiling water before I need to watch out.
Annette Matherly: No. In fact, this morning I was just reading the Los Angeles Times and there are frigid temperatures in Minneapolis and the Midwest. There were some news reporters on the news back there that were throwing boiling pots of water into the air on the TV and showing it come down as snowflakes. People in the community saw this on the news and they copied it. When they tried to copy it there were over 50 reported burn injuries from . . .
Interviewer: Are you kidding?
Annette Matherly: . . . community members from watching that on TV. We're smart people, and there are some amazing people out there, but because it's so generic we just don't think about it. We use it every day, therefore it seems pretty benign.
Interviewer: What are some tips that you would have for people, especially people with children?
Annette Matherly: Never leave a child unattended in a bathtub. Always stay with them. If you have to leave for whatever then take the child out of the bathtub.
Kids are curious. When they're sat in the bathtub they want to touch things, so they reach for the faucet and they turn on the hot tap. Again, if you haven't set your water heater temperature to a low setting, to 120, then that water will come out very, very hot and it can injure the child.
We see this all the time in the burn center. The kids reach for the tap, or they're in the bathtub with an older sibling who also reaches for the tap. By the time the parents have finished on their cell phone call and they come back the younger child is burn injured and can't get out of the tub. That's very problematic. Always stay with your child.
If you have hot liquids, if you drink hot chocolate, hot coffee, hot chai, whatever is your beverage of choice, then when you do that around small children you should use a travel mug so that the mug has a lid on it. Then, small children, who want to be just like their mom and dad and want to be big, when they pull it down from a table--because it's really hard to remember all the time the precautions that we should use with small children--when they pull it down it won't land on them and it won't spill over a large body surface area.
The other thing for those folks that are unable to turn their water heater down, because there are many that live in multi- family dwellings, there are some really great anti-scald devices that they can put on their faucet. Those anti-scald devices, even despite not being able to turn the water heater down if you're in a large multi-family unit, they will not allow water to come out of the tap that is greater than 120, and 120 is the temperature suggested by the American Burn Association, by Safe Kids, by N.F.P.A. It's a standardized temperature.
It doesn't necessarily mean that you should bathe in water that's 120, because that will still burn you, but you will be able to move in time and not sustain a burn injury if you get out of the way really quickly with a temperature of 120.
Interviewer: Would you say there's a common type of scald you see more often than not in the burn unit?
Annette Matherly: Absolutely. Cups of hot drink. I have kids myself. I love them. I try to be a good parent, and I'm a nurse. You can't remember everything all the time. Some people are working multiple jobs, and they're tired. A lot of people are sick and not getting a lot of sleep, and their kids are sick.
You can't remember to be there 100% of the time to protect your children. It's really important to take the steps that just take a minute, that take an extra few dollars to purchase those things that might help you make your family safer when maybe you're not thinking as clearly as you could be.
Interviewer: Is it generally kids that you see for scalds, or adults, or a mix?
Annette Matherly: We see a little bit of a mix, because there are a lot of folks with disabilities also. The folks that are in wheelchairs oftentimes are trying to move hot drinks or hot food from a microwave to maybe a seating area where they can eat, and because they're in a wheelchair they'll maybe put food on their laps. We can see some lap injuries from that. One of the key points for people that have that disability would be to put a tray on their lap with a big lip.
Talk to family and get something that is safe for your loved one to make sure that they don't get injured, because it just takes seconds. It doesn't take long. Burn injuries are lifelong. They're not like a broken bone. They last forever.
Interviewer: Tell me the top three things that people get scalds from that might surprise me. Like, when you said microwave, for some reason it didn't even dawn on me, but you maybe have a lid over the top of something in the microwave, you take that lid off and that steam hits you. Could you get a scald from that?
Annette Matherly: Oh absolutely. You should always open a lid away from you. We're very bad as a population. We don't really read directions very well. If you were to read the directions you're supposed to leave your popcorn bag for a little while before you open it. You're supposed to turn it away from you. When you're pulling something out of a microwave be especially cautious. Those things are super hot.
There are a lot of people that put soups, etcetera in the microwave, or noodles is a big one, you know, like the Top Ramen. Those noodles are sticky. They stick to you. They're not in the most stable containers.
There have been a lot of research studies from the American Burn Association about that tiny little base and the big round top. They're not the most stable things, so when our teenagers get them out of the microwave they spill really easily, especially if they set them on their lap and they recline to play Nintendo or whatever. Then, they spill in their lap. Again, that fluid that comes out of the microwave is superheated. It's incredibly hot and it will burn in seconds.
Interviewer: Other surprise sources of scalds?
Annette Matherly: Probably the other thing especially regarding microwaves is the movement of the molecules. We've had some patients that have come in. They've gotten something out of the microwave and those molecules are still moving, and if they don't attach to the outer cup area or dish area then they can explode. Other than that, it's kids experimenting, the Peeps they'll put in the microwave that explode.
Interviewer: They're getting sticky.
Annette Matherly: They're constantly looking for new challenges and new trouble, so be cautious with anything hot.
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