Nolan Alexander (Host): Welcome to  Community Connect: presented by TGH. I'm Nolan Alexander. With me today is Dr. Ram Velamuri, Associate Professor of Plastic Surgery and Medical Director at the Tampa General Regional Burn Center, as we talk about burn awareness and safety. Dr. Velamuri, how are you today?

Dr. Ram Velamuri: I'm doing great. Thank you for having me.

Host: It's our pleasure. And in this episode about burn awareness safety, let's start by explaining the levels of burns. What's the difference between first, second, and third-degree burns?

Dr. Ram Velamuri: Well, the difference between first, second, and third-degree burns are explained in a very simple way. A first-degree burn just involves the topmost layer of your skin, which is called the epidermis. The best example of that is like a sunburn. So when you're staying in Florida, you go to the beach, you hang out for a long time, you get a first-degree burn, and that's like a tanning booth kind of experience, which didn't go well.

A second-degree burn is something that basically involves most of the layers of the skin except the fat. So basically, if you look at the layers of the skin, we call them epidermis, dermis, and fat. So when most of the dermis or part of the dermis is involved, we call that a second-degree burn.

And lastly, the worst of all is the third-degree burn, which basically involves all the layers of your skin, extending all the way down to the fat, which is the most devastating kind of injury that you get in our patient population.

Host: Are there any warning signs that indicate a burn needs professional attention immediately?

Dr. Ram Velamuri: So, the warning signs that indicate professional treatment are actually outlined by the American Burn Association. The American Burn Association has a specific referral criteria for when you need to seek medical attention. So, any burns that are greater than 15% of the body, any third-degree burns, any burns that involve the hands, the face, the private parts, the feet, you know, the eyes, sometimes we get burn injuries where people don't get cutaneous injuries, but they actually end up having inhalation injury. For example, people who inhale a lot of smoke in house fires. There's also certain kind of burns like pediatric burns and, you know, in patients who have lots and lots of medical problems, we're an aging population, so the diabetics, the people with heart problems, all of them in our opinion should seek medical attention at a burn center.

Host: So, what you're saying, there are situations where you may need to seek medical attention, even on the surface or what you see with your eyes may not indicate it.

Dr. Ram Velamuri: Absolutely. There's an iceberg phenomena. What you see on the top does not reflect how bad the problem is. So, these indications are absolutely important to seek medical attention.

Host: What are the biggest mistakes people make when they're trying to treat burns themselves?

Dr. Ram Velamuri: The biggest mistakes that people make when they're trying to treat burns are, number one, assuming that they are going to basically heal on their own without seeking the proper expertise. Number two is trying to utilize techniques which are not standard of care. For example, somebody has got a pan on fire, all right? And they've got burns, they are running around with the pan in the house, or they're basically taking water and pouring it on the grease, which can create an explosion, exothermic reaction. And then, that can cause worse injuries.

The other thing that we see is when people are intoxicated or surrounded by fireworks, and they assume that these burns are actually not painful, but some of these burns are actually third-degree, because third-degree burns usually are not very painful because all the nerves are pretty much burned down. So, there are certain scenarios where we recommend people avoid doing things that they may be comfortable with, but leaving it up to the experts and coming to seek medical attention.

Host: So, you just said the most severe burns sometimes are not painful.

Dr. Ram Velamuri: Exactly.

Host: Well, opposite of fireworks that we see usually around Independence Day. With the cooler weather and the winter months, it's prime bonfire and fire pit season. How many people are injured by these types of fires each year? And what steps can people take to prevent burns when they're out enjoying a bonfire in the beach?

Dr. Ram Velamuri: So, the number of patients we see from bonfire injuries per year vary from close to about 40 to 50 a year. We are a verified burn center by the American Burn Association that sees about 300 to 350 admissions a year, along with close to a thousand visits in our clinic and our emergency rooms.

Winter is dangerous, especially in a place like Florida where people are outside surrounded by bonfires, getting intoxicated, losing their ability to have critical thinking, and then actually leaving kids around bonfires. These are all tragedies that we end up seeing during this time of the year. I always tell everybody, whoever talks about burn prevention, that alcohol and bonfires do not go well.

And the other important thing to remember is after about six to eight hours when the fire is out, there's still pieces of coal, there's still pieces of stones that are still hot. So, what everybody may end up doing, they make the mistake of actually walking without any proper footwear and walking on these hot pieces of stone and coal and sustaining third-degree burns to their feet.

Host: If someone does get burned at a bonfire, what should they do right away?

Dr. Ram Velamuri: If somebody got burned at a bonfire, the first thing we do is recommend seeking urgent medical attention. Call 911. They will get in touch with the fire crew. They will arrive. They will evaluate you and take you to the nearest emergency room. And sometimes you may be lucky that you may be brought straight to the burn center. So, the first thing we recommend is seek medical attention. Do not try to be heroic and stopping the fire. Protect yourself first.

Host: Okay. That is important. What else is important for communities to understand about burn safety and treatment?

Dr. Ram Velamuri: So for communities to understand about burn safety and treatment, there's a plethora of points that I can discuss. You know, if you look at our burn center, we see a lot of burns in children from hot water, scalds, ramen noodles, coffee mugs fell on the child's foot. We unfortunately also see some patients, some kids who are surrounded by fireworks when they're not supposed to be it. Regardless of 4th of July, we see this sometimes throughout the year. Just like recently around New Year's time, we got a couple of admissions from firework injuries to small children.

We also recommend when it comes to things that we see in terms of prevention, the barbecues, standing outside and grilling indoors, it's scary. Imagine there are people who actually grill inside their house. So, whether it's like fireworks, whether it's bonfires, whether it's hot water, again, for kids and for adults or elders who are diabetics, who don't have sensation, kindly please check the temperature of the water that you bathe your child in or you put your foot in. There are special kind of rubber ducks that actually can give you signals whether the water is too hot or too cold, because remember, it just takes a matter of seconds to be exposed to extremely hot water. And in children with such thin skin or adults with no sensation, they are just going to get third-degree burns right away. So, these are a lot of points I bring up. We could probably have a whole podcast on just things that we see, but these are some of the key points.

Host: Yeah, I think we could, I think, go between first, second, and third-degree burns. And you've already educated me on so much here in just 10 or so minutes. Well, what resources or support is available for people that are recovering from burns?

Dr. Ram Velamuri: The resources and support that are available are pretty much an amazing aspect of our burn center at Tampa General. So, we have two things I would like to highlight. We have something called as Camp Hopetáke, which is a camp that is run by our burn coordinator, Ashley Rowe, and our entire burn center with leadership every summer for children usually between six and 16 or 17 who are burn survivors. All these beautiful kids come in, have like a good week of fun activities where they socialize with each other, they look at each other and actually reflect upon the fact that they're not abnormal. They're just beautiful human beings who have just had a traumatic experience, who are pretty much going to live like normal members of society. So, we have this amazing one-week camp that we have for kids.

And then, we also have something called as our Burn Survivor Meeting, which is basically run under the guidance of the Phoenix Society of Burns, where every month we have adult survivors just come and meet in a group and just discuss challenges. You know, these could be patients who've been burned almost 20 years ago, 25 years ago. And they come and talk to the ones who have just been burned six months ago. So, that kind of like interaction between the individuals on both sides is just so reassuring, especially for our patients with traumatic burn injuries who have a larger percentage of their body burned.

Host: Is there anything else you'd like to add to this topic today, Doctor?

Dr. Ram Velamuri: Yes. I think the most important thing I would like to bring up to our amazing community is to please be safe. And if there's just two things I would recommend is alcohol and a bonfire is something that can be a devastating injury. These are notorious to cause massive burns with high mortality, high morbidity, where patients end up not only having challenges in surviving, but they end up losing limbs, they get amputated, they get extensive skin grafts.

And kids and fireworks, I just plead with the population to just pay attention to your surroundings. Look after yourselves and your loved ones and try to stay away from a burn center unless you need attention where we're always happy to take care of you.

Host: I completely agree. Doctor, thank you so much for your time today. We truly appreciate it.

Dr. Ram Velamuri: Thank you so much. I appreciate all of you guys. Thank you.

Host: That was Dr. Ram Velamuri. For more information, please visit www.tgh.org/burn. If you enjoyed this episode, please be sure to like, subscribe, and follow  Community Connect: presented by TGH on your favorite podcast platform. I'm Nolan Alexander, and this is Community Connect. Thanks for listening.