Jan 13, 2015

Interviewer: If you're even considering not using that barrier around your glass fireplace, you really need to listen to this. It's coming up next on The Scope.

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Interviewer: I think people know glass fireplaces are hot, but I think a lot of times people don't understand exactly how dangerous and life-changing they can be for your child.
Dr. Amalia Cochran is a burn surgeon here at The University of Utah, and you've personally taken care of a lot of kids with this injury - hands to the glass fireplace. Tell me about that.

Dr. Cochran: This is something that, with us getting into the depths of winter, that we're seeing a lot of right now. We find that we have these toddler aged children who are either at their own homes or they're at grandma or grandpa's house and there's a glass-fronted fireplace and they're toddling around and their balance may not be that good. And we end up with little palms against the glass that's on the front of that glass fireplace.

Interviewer: And how hot is that? Can you compare that burn to anything else in the home?

Dr. Cochran: There is nothing else in the home that routinely gets up to temperatures like this. The best estimate that we have is that that glass heats up to about 1300 degrees Fahrenheit. If you compare that to your oven where it's 450 degrees Fahrenheit when you're baking bread, you can see that's a magnitude of three differences.

Interviewer: And I think a lot of people think of the pot of boiling water as the quintessential burn danger in the house, but this is much hotter than even that.

Dr. Cochran: This is almost a factor of 10 times hotter than boiling water.

Interviewer: So, would it be fair to say this is the most dangerous burn danger in most houses?

Dr. Cochran: I would argue that it is one of the greatest burn dangers in most houses simply because the severity of the burn that can be inflicted form heat like this and who the target population usually is.

Interviewer: Okay. So, you've taken care of kids with this injury. Tell me what types of injuries you see from that kind of heat.

Dr. Cochran: The injury that's the most common, of course because of the age group that is involved, is little hands ending up on that glass in front of the fireplace. So what will happen is that these children will end up with very deep burn injuries to their palms and to their fingers. The problem with that is twofold. One is, of course, that they are at an age where they are developing a lot of hand function, so this can become a very significant functional issue over time. Then the other more acute issue is that a lot of them do require surgical management of these injuries.

Interviewer: So you were even mentioning that you reconstruct hands because of this. What is that even about?

Dr. Cochran: Right. I was talking about that just a few days ago. I had a child I was taking care of who, when she was 13-months-old, burnt her palm on a glass-fronted fireplace and it did heal in without needing grafting at the time of the injury. But two years later she was starting to show some limitations on how that hand worked for her. She didn't have full range of motion and wasn't able to do all the things that we want a 3-year-old to be able to do.

Interviewer: So, not only the pain - and I can't even describe what that must feel like for a toddler at 1500 degrees - but it goes well beyond after that burn's healed.

Dr. Cochran: Absolutely, there are a lot of rehabilitation considerations that come into play and then of course there is this need for long-term follow up of scarring.

Interviewer: So really something that will affect somebody for the rest of their life. It's not just like a cut and you put a Band-Aid over it and it heals and it's gone.

Dr. Cochran: Unfortunately, it's not. For some kids, they do get that lucky. But there are a huge number of them that we end up following throughout all of their growth process up into young adulthood simply to make sure their hands stay functional. And that if they still want to grow up and be a concert pianist or a baseball player that they have the ability to do that.

Interviewer: Oh, man. How common are these injuries, really? Is it stuff that happens a lot?

Dr. Cochran: They are more common than we all thought they were for a long time. We recently worked with four other burn centers here in North America to try and get our data put together and we found that over a five year time period that we were seeing about 80 injuries per year just between those five burn centers. That's not a small number. Granted, we're all burn centers that are in cold climates - that was a deliberate choice. But seeing about 80 of these a year and particularly if you look at, again, the age group that we're dealing with, this is a really tough injury that's more common than people thought it was.

Interviewer: All right, part of the goal of this conversation was to really have people realize how terrible of a lifelong injury this can be. Now let's talk about what you can do. I understand that there are some new... well if you get a new glass fireplace in 2015, there's a barrier there.

Dr. Cochran: Absolutely. The Consumer Safety Product Commission, starting on January 1st of 2015, has a new rule by which there has to be a barrier in front of these glass-fronted fireplaces so that they can't be easily accessed by small children. That will help us with new fireplaces that are going in. Of course, it does not solve the issue of all of those fireplaces that are already out there.

Interviewer: And what do you recommend for that? Because I'm thinking, I have one of these glass fireplaces and one of the great things is it's pretty without that barrier.

Dr. Cochran: The issue becomes, of course, really one of people needing to go out and buy a screen, which will be commercially available, so that they can retrofit their glass-fronted fireplace. If they either have young children in their home, or if they have young children who routinely visit.

Interviewer: And if you don't have children, don't have children who routinely visit, you're probably okay?

Dr. Cochran: You're probably okay. I have a glass-fronted fireplace in my living room, I don't routinely have small children around my home. I'm probably not going to put a barrier in.

Interviewer: So it sounds to me that it might make the fireplace a little less convenient, not quite as pretty but, man, if you have children around the house.

Dr. Cochran: It's absolutely a great safety thing because otherwise, if people don't have a barrier in place, we tell them that, "You've either got to find a way to really mind every single thing the children are doing and any..."

Interviewer: And that's easy.

Dr. Cochran: Yeah, and any of us that have spent time around 2-year-olds know that 2-year-olds are wily little creatures and they're going to end up wherever they want to end up and there's not much you can do about it. So then you're other option that you're faced with is maybe not using that gas fireplace, which again, it's a nice atmosphere thing. It just creates a certain mood, and it has nice warming properties to it.

Interviewer: So, if a child does end up getting a burn injury, you were saying that specialty care is absolutely necessary.

Dr. Cochran: It is almost uniformly necessary, at least for these injuries because they typically involve the hands. First line of defense would be, of course, run cold water over it, put a cool towel on it, something to help stop the burning process and be seen emergently at either a nearby emergency room or with someone's pediatrician or an InstaCare type facility. But, ultimately, most of these injuries end up needing to be seen by us, both to be seen by the surgeons as well as to be seen by our burn therapists who are used to rehabilitating these little hands.

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