Helping Burn Victims Achieve Justice

Many burn survivors and injury burn survivors have a long road to travel when it comes to recovery.  Hope and faith are inevitably part of this process. You can overcome some of the toughest hardships when you are committed to doing so — even though there will be setbacks, and mentally,

Why me?  What did I do to deserve this?  Common thoughts for a burn survivor.  There are several resources available to help you through this difficult time of challenge (check the sidebars for the links).

Let’s discuss the different types of burns for the uninitiated:

Types of Burns

Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications.  Muscle, bone, blood vessel, and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerve endings. Depending on the location affected and the degree of severity, a burn victim may experience a wide number of potentially fatal complications including shock, infection, electrolyte imbalance and respiratory distress.

Beyond physical complications, burns can also result in severe psychological and emotional distress due to scarring and hardness, and inelasticity. The most common system of classifying burns categorizes them as first-, second-, or third-degree. Sometimes this is extended to include a fourth or even up to a sixth degree, but most burns are first- to third-degree, with the higher-degree burns typically being used to classify burns postmortem.

The following are brief descriptions of these classes:

• first degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns only involve the epidermis.
• second degree burns manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.
• third degree burns occur when most of the epidermis is lost with damage to the underlying (superficial) fascia. Burn victims will exhibit charring of the dermis, and sometimes hard eschar will be present. Third-degree burns result in scarring and victims will also exhibit the loss of skin hair and sweat glands.
• fourth degree burns damage muscle tissue and char the hypodermis and may result in a condition called compartment syndrome, which threatens both the life of the limb and the patient. Grafting is required if the burn does not prove to be fatal.
• fifth degree burns result in fascia (superficial) being burnt off, leaving blackened muscle. Fat, nerves, veins, and arteries have been destroyed and the burn area is paralyzed as a result. Amputation is required if the burn does not prove to be fatal.
• sixth degree burns leave blackened bone and damage marrow tissue.

Other Classifications of Burns

A newer classification of “Superficial Thickness”, “Partial Thickness” (which is divided into superficial and deep categories) and “Full Thickness” relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.

Nomenclature	Traditional nomenclature	Depth	Clinical findings
Superficial thickness	First-degree	Epidermis involvement	Erythema, minor pain, lack of blisters
Partial thickness — superficial	Second-degree	Superficial (papillary) dermis	Blisters, clear fluid, and pain
Partial thickness — deep	Second-degree	Deep (reticular) dermis	Whiter appearance, with decreased pain. Difficult to distinguish from full thickness
Full thickness	Third- or fourth-degree	Dermis and underlying tissue and possibly fascia, bone, or muscle	Hard, leather-like eschar, purple fluid, no sensation (insensate)

Burns can also be assessed in terms of Total Body Surface Area (TBSA), which is the percentage affected by partial thickness or full thickness burns (superficial thickness burns are not counted).