Understand skin burn severity.
DERMATOLOGY Do you know what to do in the crucial moments following a skin burn? While dining at a Chinese restaurant, a family ordered entrees that were placed on on a Lazy Susan. When someone in the party spun this functional centerpiece around too quickly, hot soup splashed into the lap of an infant. With the skin on her bare red thighs peeling, parents drove their baby to the hospital. What would you have done?
Most people know they should seek emergency care for severe burns. But many are not aware that a first-degree burn can become more series based on diameter or location. There is much conflicting first-aid burn treatment information on the Web. Armed with a well-stocked kitchen and a list of wives' tales, many people dowse burns with honey, butter, egg whites, mayonnaise or ice cubes. Such home remedies may exacerbate infection. Oils, like butter trap heat and make a burn deeper over time.
Cool water soothes minor burns but applying cold water or ice to larger, deeper wounds might cause adverse health reactions like hypothermia or frost bite. Bursting blisters is also ill-advised. Trauma departments don't even recommend ointments for serious burns.  The first thing to do is separate yourself from the source of the burn. Then assess whether the skin is in tact, joints are involved or if the diameter is greater that 3 inches. When in doubt about the seriousness of a burn, phone emergency personnel (911 in the U.S.).
Who Gets Burned Where
The American Burn Association estimates that nearly half a million victims received burn related medical treatment in 2011. About 55 percent of the estimated 45,000 U.S. acute hospitalizations in recent years were admitted to 125 hospitals with specialized burn care facilities. 
Skin burns transcend the life of a firefighter. Are you ever in a kitchen or around heat, chemicals or perhaps electrical machinery at home or work? Are you responsible for the lives of employees or children in the presence of flammable materials?
In U.S. homes, the kitchen is the most common are where burn injuries occur for children up to four years old. The next most common burn injury home location is the bathroom — beware of those wall heaters, hair driers, electric razors, particularly when in close proximity to water. More than 600 children die every year in fires and other burn injuries. Hot tap water burns cause more deaths and hospitalizations than burns from any other hot liquids. Set hot water heater thermostat between 110° and 115°F.
Hot Water Causes Third Degree Burns
- 1 second at 156ºF
- 2 seconds at 149ºF
- 5 seconds at 140ºF
- 15 seconds at 133ºF
You don't have to be in the home to get burned. Sunburns may initially resemble a first-degree burn but cover a larger area. Burn severity can migrate if not properly cared for. Will embarrassment prevent you from consulting a dermatologist or medical doctor for sunburns? Proper treatment may reduce or prevent dehydration, hypothermia, pain and extensive peeling.
Plan Your Escape Route
At age 12, I witnessed a classmate's home burn to the ground. Everyone got out safely but there was amazement over how quickly the kitchen fire spread. As an adult, I had the unfortunate task of identifying the remains of a dear friend burned and asphyxiated by fire. Within 2 minutes, a single-story home can be filled with black smoke that prevents visibility. Most deaths take place within the first 5 minutes of a fire.
In case of fire, human lives are more precious than material possessions. The number-one cause of fire deaths is smoke inhalation. A damp cloth held over your nose and mouth as a filter can provide an additional minute or so of breath. If you are trapped and there is a door between you and the fire, close it and block the bottom with towels or clothing to reduce the amount of smoke seeping into your room. Filter your breathing. To signal first responders, hang a white sheet or garment out of the window if on an upper floor or physically unable to climb through a first-story window.
Many feel more comfortable leaving doors open when they go to sleep. It is actually advised to keep them closed in case of fire. They may be the only barrier between you and the flames. If trapped in a building and uncertain of where the fire is located, don't blindly open doors in an effort to escape. Tap a closed door, not the metal handle, with the backside of your non-dominant hand to determine whether it is warm. Do not open a hot door since a vacuum of fresh air can suck in smoke and flames. As you make your way out, close doors behind you to slow progression of fire.
Remember that smoke rises. In a smoke-filled room, travel near the floor where the freshest air remains. People may become disorientated in the dark. Practice your escape route with the lights out or your eyes closed to simulate a home filled with black smoke. If possible, find a source of fresh air like a window. Plan an exit strategy for your office too. Make yourself aware of emergency exits and stairwells when in high-rise buildings even temporarily. 
When Burns Get Out of Hand
People have limbs amputated and even die from complications associated with burns, like smoke inhalation, gangrene, infection, and hypothermia. Don't try to put out a grease fire with water. It will only spread the flames. Restaurants and offices lack the resources of trauma and burn care centers. Therefore, during the first crucial minutes, victims must wait for nearby emergency response teams. Often, what people do preceding medical triage affects patient outcome.
When the unexpected occurs, due to chemical, fire, electricity, hot liquids or radiation, life-or-death decisions must quickly be made. Having a posted sign allows employees or medical personal to familiarize themselves with various scenarios and recognize when to treat burns locally or call for medical help. Appropriate information should be visible in each urgent care department, chemical laboratory, restaurant kitchen, hair dresser's salon, and public health classroom.
Learn Skin Burns Like The Back of Your Hand
In consultation with Nicole Bernal M.D., director of the UC Irvine Regional Burn Center,  I illustrated a new poster entitled Understanding Skin Burn Severity. The goal is to present critical information in a patient-friendly format that can be used as diagnostic tool for medical personnel. A patient that is given 5 or 10 extra minutes in the reception area or exam room can become sufficiently educated to comprehend the discussion when the doctor enters for the consult. This poster is a welcomed complement to centers for dermatology, cosmetology, food service, fire department, trauma, wound care, and medical education or any chemical facility — especially when the poster is preserved in a DeuPair Frame.
Most people are only aware of first- through third-degree burns. The Skin Burn Severity anatomy poster describes and illustrates four degrees of burns. Appearance varies depending upon cause of the wound. Depicted are both surface and cut-away side views to demonstrate progressive damage through epidermis, dermis and subcutaneous tissues.
Rule of Nines
Perhaps you have heard news reports for burn victims having more than 18, 36 or 54 percent burns over their bodies. I used to assume that doctors were using complex math equation to measure skin surface area. The Skin Burn Severity poster includes a "Rule of Nines" chart for quickly estimating total adult body surface area (BSA) has been burned on a patient.
With this standardized "rule," seven major areas of the adult body are assigned a value of either 9 or 18 percent for a total of 99. Though we may attribute more importance to the remaining genital/perineum area, it receives the final 1 percent. This chart paired with other poster illustrations are helpful to trauma personnel when explaining remedies with patients and family and when monitoring wound progression.
For children under one years old, the head is assigned a value of 18% with 14% for each leg. For every year above one, add 0.5% to each leg and subtract 1% from the head until reaching adult values of 9% for the head and 18% for each leg.
An alternative method to calculate the BSA is to compare it to the size of the patient's palm, which equates to approximately 1% BSA. For example, if a burn area is the size of five palm surfaces, the burn would be roughly 5% BSA. This method can be used to estimate the BSA for both adults and pediatrics. In most cases, it may be more useful to use the rule of nines when evaluating larger burn areas and the "palm" method for smaller burn injuries. 
Most everyone gets an occasional minor burn. I burned a finger not long ago while cooking. Quick reflexes come in handy. Skin is a thermo-protective layer for internal organs. When that barrier is compromised, negative effects can result, including dehydration, infection, shock, even death. Recognizing serious burns and planning what to do in an emergency can keep you and your family more than A Bit More Healthy. Strategically placed, the Skin Burn Severity anatomy poster can be one of the most important pieces of paper to have hanging around when you get burned.
Special thanks to Nicole Bernal M.D. for her review of the poster content, tireless work in behalf of roughly 600 burn patients each year to UC Irvine Regional Burn Center, and her informative interview in the Los Angeles Times.  Do you know where the burn centers approved by the American Burn Association are in your area?  If you learned something from this article or this video, let me know in your comments below.
- Burns: First Aid. mayoclinic.com
- Burn Incidence and Treatment in the United States: 2011 Fact Sheet. ameriburn.org
- During A Fire. videojug.com
- UC Irvine Regional Burn Center. healthcare.uci.edu
- Rule of Nines. emtresource.com
- What happens after people set themselves on fire? latimes.com
- ABA Burn Center Verification. ameriburn.org