According to the NIH, in the United States, approximately 1.25 million people with burns present to the emergency department each year. People do not realize that summer fun carries with it an increased risk of many types of burns.
In this segment, Dr. Jeffrey Shupp, director of the Burn Center at MedStar Washington Hospital Center, joins the show to discuss how to prevent those summer burns and how the Burn Center is the only adult burn treatment facility in the Washington region, serving the District, southern Maryland, northern Virginia and eastern West Virginia.
Selected Podcast
How to Prevent Summer Burns
Featured Speaker:
Learn more about Jeffrey Shupp, MD
Jeffrey Wilson Shupp, MD
Jeffrey Shupp, MD, is the Director of the Burn Center at MedStar Washington Hospital Center and an attending surgeon in the Burns/Trauma section of surgery.Learn more about Jeffrey Shupp, MD
Transcription:
How to Prevent Summer Burns
Melanie Cole (Host): Several summertime activities can lead to burns. The most common type of summer burns come from overexposure to the sun and injuries from fireworks and grilling. According to the American Burn Association, approximately 450,000 individuals may seek treatment for burn injuries this year. My guest today, is Dr. Jeffrey Shupp. He’s the Director of the Burn Center at MedStar Washington Hospital Center. Welcome to the show, Dr. Shupp. What should we be aware of in the summer as far as burns? People tend to think of sunburns, but that’s not the only type of burn that you’re seeing in the summertime.
Dr. Jeffrey Shupp (Guest): That’s correct. A lot of times people associate burn injuries that would need to be treated at a burn center in the Winter months or when it’s very cold outside, but we do see a significant amount of patients that have been injured doing things that normally occur in the Summer, such as grilling on a barbecue grill, or having recreation activities that are near a campfire. Things like that are more common for us in the summer, and oftentimes we don’t see them as soon as we would like to see them as far as identifying patients that might need further care.
Melanie: What should people identify – and let’s start with the burns that come from maybe grills or campfires. Sometimes someone’s grilling, and they just burn themselves or burn their hand, or feel the heat come up on their face. When is it something that they should seek medical treatment about?
Dr. Shupp: The first thing we want everyone to know is that we don’t mind seeing everyone. If you’re concerned enough about an injury that occurred, don’t feel as though you are wasting our time or utilizing resources that you shouldn’t be. We would much rather see people that are concerned enough about their injury and then not need to see them again versus waiting too long.
As far as actual things about the wound that would make it more likely that you would do better with care at a burn center would be blistering of the skin, any burns to the face, or any burns to functional areas – over joints, in areas that are difficult for you to get a dressing on, for example. Those are all reasons to be seen and evaluated at a burn center. Like I said if you don’t need continued treatment or the burns aren’t as severe as you would have thought then you can always go back to your regular life and see your primary care doctor or what have you. I think one of the things during the summer is the delay in evaluation by the burn center that sometimes makes treatment a little more complicated.
Melanie: What should we do for ourselves, Dr. Shupp, in terms of burns even if it’s a minor – and explain a little bit about the grading of burns and how you are identifying different types of burns – what we should be doing based on whatever happens.
Dr. Shupp: Okay, so most people are familiar with first, second, and third-degree burns. A first-degree burn is basically a sunburn. The outer layer of the skin is red, but it doesn’t usually blister in real time. As we all know, sunburns can eventually peel and things like that, but it’s not a wet, fluid-filled blister like you would see with the next class of burns, which would be second-degree burns. This is an injury to the skin that involves both layers of the skin. The skin has two layers, and the second-degree burn is when the second layer of the skin is a little injured, but it usually heals, but it’s kind of hard to know that at the very beginning. Those second-degree burns can be at risk for infection and can be a source for the need for further care.
Third-degree burns is when both of the layers of the skin are, in fact, injured to the point where they are not able to heal. Most third-degree burns need some sort of surgical intervention so that the wounds can close in an appropriate amount of time. We talk about this timing because the other thing that people worry about with burns is scarring. The only thing we really know is the longer the wound stays open and doesn’t close, the more risk you are at developing scars. That’s really the battle we’re trying to fight in getting the burn wounds closed.
Melanie: What about burn wound treatment at home? What is it we should do right away? People think they should put creams on them, or Vaseline, or ice, or water, or what should we do if we burn ourselves?
Dr. Shupp: It goes back and forth as far recommendations with cold water. We recommend temped water, which is Luke-warm to room-temperature water. That helps with alleviating the pain and allow you to clean off whatever debris might be there at the time. The secret is, a lot of our burn wound care that we do in the hospital is very simple, which is soap and water and ointments that moisturize the skin. We don’t use a lot of topical creams or ointments that have a lot of antibiotics to them. If you are being prescribed those types of ointments, then you should be being treated by a provider or physician.
There are a lot of home remedies out there. Oftentimes the home remedies make it more difficult for us, once we evaluate a patient, to determine the depth of the burn because a lot of things that we’re looking at are very subtle changes in the skin. If something’s been put onto the skin that masks that, then it makes it more difficult for us to evaluate it and worst case, sometimes we have to remove whatever it might be, and that adds more irritation and pain to the area.
Aloe-containing products for very superficial burns are probably okay. Again, the skin does better when it’s in a moist environment, so things we can do to keep it from drying out would be good. If there is a lot of exposed dermis – that pink part of the skin after that upper part of the skin has blistered away, exposed. Those are the types of wounds we really want to be seeing early to help guide and make recommendations for care.
Melanie: Do you keep a burn covered or open?
Dr. Shupp: We keep burns covered unless they are on the face area.
Melanie: What about sunburns because this is very common, and people don’t even realize they’re getting them when they are getting them. When does a sunburn become something you really need to seek professional help about and give us your best advice for preventing sunburns.
Dr. Shupp: My best advice for preventing sunburns are to limit your exposure, which I’m sure everyone would be laughing at that because it’s hard to do when you’re having fun, and you’re participating in recreational activities outside. The next rule of thumb is to apply sunscreen regularly. We get caught up in the SPF level and the amount of time that the sunscreen is active for, but in all reality, if you’re in and out of the water, you’re washing a lot of the product off. The most frequent application as possible would help to prevent -- and then, taking breaks throughout the day to see how much irritation is on the skin. Oftentimes if you come in for just 30 minutes all of a sudden, your skin feels different because you’re not in the sun anymore, and you’re like, “Oh, my goodness, I have had a lot of sun exposure.” Take those checkpoints throughout the day. Don’t just wait until the end of the day and have a worse sunburn.
As far as seeking treatment, if you’re able to stay hydrated and your pain control is adequate, most patients do fine at home. If you get to the point where a lot of your skin has been injured, and it’s difficult to move, and it’s difficult to stay hydrated, then that’s the type of patient that sometimes finds themselves at the hospital. Those things are what are making it difficult. The skin itself usually is fine unless there are areas of injury or the patient had had a previous burn, then we can see where the sun actually causes blistering and deeper burns. That’s very rare.
Melanie: And for burn wounds – you mentioned infection earlier in the segment. What should someone be looking for to keep these free from infection or prevent their risk of getting an infection?
Dr. Shupp: The easiest thing is to keep them clean and keep them covered. If they are in difficult to dress areas – for example, like the armpit, or the back of the knee – then those are all good reasons to come to the burn center. A lot of the care that we provide is very nuanced and the amount of experience that a nurse or a technician who has been putting dressings on patients with burns for decades can be underappreciated.
A lot of times I’ll see patients who have a perfectly reasonable care plan for a burn injury, but the whole thing just comes undone because the dressing didn’t stay in place or the tape wasn’t sticky enough, or they couldn’t get enough of the ointment that was prescribed to them. These are all common things that lead someone coming in a delayed manner that maybe we could have addressed from the get-go and had a much better experience and kept the wounds in better shape for healing.
Melanie: And tell us about the burn center at MedStar Washington Hospital Center.
Dr. Shupp: Here is the only regional adult burn care center in the Greater Metropolitan area. We treat the entire spectrum of thermal and thermal-like injuries from very thick, large, total body surface area patients to ambulatory injuries. We have a dedicated staff of surgeons, therapists, nurses, and an entire dedicated unit and team where all we do is focus on patients who have burn injuries.
A lot of the things that go into some of the recoveries from burns isn’t the wound, it isn’t the ointment that someone picked -- because even in the burn center community, everyone always debates about the type of topical ointment -- but the one thing that is consistent is that multidisciplinary care leads to better outcomes and better functional recovery. Being able to have dedicated staff to help the patient and support the patient through recovery -- whether it’s a hand therapist or a nutritionist to improve the patient’s nutrition to optimize it for wound healing, or whether it’s the psychologist or the psychiatrist who helps the patients through – those resources are literally at the patient’s fingertips the moment they walk through the door at any regional burn center.
It’s sometimes something that people don’t think about until they put themselves in that position where they hit the ignitor button on their grill, and a big ball of flames comes out. They back away in time and they’re like, “Wait a minute. What if that went a totally different way? Where would I have ended up?” [COUGHS] Excuse me. It’s something that we like to brag about, but it’s also an integral part of our care delivered here.
Melanie: And in just the last few minutes, Dr. Shupp, wrap it up with your best advice about preventing burns in the first place in the summertime and what you want people to know about burns and their risk of getting burned in the summer.
Dr. Shupp: I think the most important thing is to realize that it’s the common things that we do that go awry that leads to injury. Most of the time, when I talk to a patient about something that has happened that caused the burn – well, I’ve done it that way 500 times, or I always start the grill that way, or we have bonfires every weekend, and nothing like this has ever happened. As we go through these months in the summer where we’re spending more time outdoors, we’re doing more entertaining with fuel sources and fire, that you just always take a pause before being around that type of exposure because it can happen at any time to anyone. That amount of awareness is something that I would just like everyone to have as they’re doing these types of activities. And it’s not just burns; it’s dehydration, it’s exposure to lightning, it’s these things that happen all the time that we don’t become injured from is usually when something happens. That type of awareness is something I think everyone should just keep in their mind when they’re doing these activities.
Melanie: Thank you, so much, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.
How to Prevent Summer Burns
Melanie Cole (Host): Several summertime activities can lead to burns. The most common type of summer burns come from overexposure to the sun and injuries from fireworks and grilling. According to the American Burn Association, approximately 450,000 individuals may seek treatment for burn injuries this year. My guest today, is Dr. Jeffrey Shupp. He’s the Director of the Burn Center at MedStar Washington Hospital Center. Welcome to the show, Dr. Shupp. What should we be aware of in the summer as far as burns? People tend to think of sunburns, but that’s not the only type of burn that you’re seeing in the summertime.
Dr. Jeffrey Shupp (Guest): That’s correct. A lot of times people associate burn injuries that would need to be treated at a burn center in the Winter months or when it’s very cold outside, but we do see a significant amount of patients that have been injured doing things that normally occur in the Summer, such as grilling on a barbecue grill, or having recreation activities that are near a campfire. Things like that are more common for us in the summer, and oftentimes we don’t see them as soon as we would like to see them as far as identifying patients that might need further care.
Melanie: What should people identify – and let’s start with the burns that come from maybe grills or campfires. Sometimes someone’s grilling, and they just burn themselves or burn their hand, or feel the heat come up on their face. When is it something that they should seek medical treatment about?
Dr. Shupp: The first thing we want everyone to know is that we don’t mind seeing everyone. If you’re concerned enough about an injury that occurred, don’t feel as though you are wasting our time or utilizing resources that you shouldn’t be. We would much rather see people that are concerned enough about their injury and then not need to see them again versus waiting too long.
As far as actual things about the wound that would make it more likely that you would do better with care at a burn center would be blistering of the skin, any burns to the face, or any burns to functional areas – over joints, in areas that are difficult for you to get a dressing on, for example. Those are all reasons to be seen and evaluated at a burn center. Like I said if you don’t need continued treatment or the burns aren’t as severe as you would have thought then you can always go back to your regular life and see your primary care doctor or what have you. I think one of the things during the summer is the delay in evaluation by the burn center that sometimes makes treatment a little more complicated.
Melanie: What should we do for ourselves, Dr. Shupp, in terms of burns even if it’s a minor – and explain a little bit about the grading of burns and how you are identifying different types of burns – what we should be doing based on whatever happens.
Dr. Shupp: Okay, so most people are familiar with first, second, and third-degree burns. A first-degree burn is basically a sunburn. The outer layer of the skin is red, but it doesn’t usually blister in real time. As we all know, sunburns can eventually peel and things like that, but it’s not a wet, fluid-filled blister like you would see with the next class of burns, which would be second-degree burns. This is an injury to the skin that involves both layers of the skin. The skin has two layers, and the second-degree burn is when the second layer of the skin is a little injured, but it usually heals, but it’s kind of hard to know that at the very beginning. Those second-degree burns can be at risk for infection and can be a source for the need for further care.
Third-degree burns is when both of the layers of the skin are, in fact, injured to the point where they are not able to heal. Most third-degree burns need some sort of surgical intervention so that the wounds can close in an appropriate amount of time. We talk about this timing because the other thing that people worry about with burns is scarring. The only thing we really know is the longer the wound stays open and doesn’t close, the more risk you are at developing scars. That’s really the battle we’re trying to fight in getting the burn wounds closed.
Melanie: What about burn wound treatment at home? What is it we should do right away? People think they should put creams on them, or Vaseline, or ice, or water, or what should we do if we burn ourselves?
Dr. Shupp: It goes back and forth as far recommendations with cold water. We recommend temped water, which is Luke-warm to room-temperature water. That helps with alleviating the pain and allow you to clean off whatever debris might be there at the time. The secret is, a lot of our burn wound care that we do in the hospital is very simple, which is soap and water and ointments that moisturize the skin. We don’t use a lot of topical creams or ointments that have a lot of antibiotics to them. If you are being prescribed those types of ointments, then you should be being treated by a provider or physician.
There are a lot of home remedies out there. Oftentimes the home remedies make it more difficult for us, once we evaluate a patient, to determine the depth of the burn because a lot of things that we’re looking at are very subtle changes in the skin. If something’s been put onto the skin that masks that, then it makes it more difficult for us to evaluate it and worst case, sometimes we have to remove whatever it might be, and that adds more irritation and pain to the area.
Aloe-containing products for very superficial burns are probably okay. Again, the skin does better when it’s in a moist environment, so things we can do to keep it from drying out would be good. If there is a lot of exposed dermis – that pink part of the skin after that upper part of the skin has blistered away, exposed. Those are the types of wounds we really want to be seeing early to help guide and make recommendations for care.
Melanie: Do you keep a burn covered or open?
Dr. Shupp: We keep burns covered unless they are on the face area.
Melanie: What about sunburns because this is very common, and people don’t even realize they’re getting them when they are getting them. When does a sunburn become something you really need to seek professional help about and give us your best advice for preventing sunburns.
Dr. Shupp: My best advice for preventing sunburns are to limit your exposure, which I’m sure everyone would be laughing at that because it’s hard to do when you’re having fun, and you’re participating in recreational activities outside. The next rule of thumb is to apply sunscreen regularly. We get caught up in the SPF level and the amount of time that the sunscreen is active for, but in all reality, if you’re in and out of the water, you’re washing a lot of the product off. The most frequent application as possible would help to prevent -- and then, taking breaks throughout the day to see how much irritation is on the skin. Oftentimes if you come in for just 30 minutes all of a sudden, your skin feels different because you’re not in the sun anymore, and you’re like, “Oh, my goodness, I have had a lot of sun exposure.” Take those checkpoints throughout the day. Don’t just wait until the end of the day and have a worse sunburn.
As far as seeking treatment, if you’re able to stay hydrated and your pain control is adequate, most patients do fine at home. If you get to the point where a lot of your skin has been injured, and it’s difficult to move, and it’s difficult to stay hydrated, then that’s the type of patient that sometimes finds themselves at the hospital. Those things are what are making it difficult. The skin itself usually is fine unless there are areas of injury or the patient had had a previous burn, then we can see where the sun actually causes blistering and deeper burns. That’s very rare.
Melanie: And for burn wounds – you mentioned infection earlier in the segment. What should someone be looking for to keep these free from infection or prevent their risk of getting an infection?
Dr. Shupp: The easiest thing is to keep them clean and keep them covered. If they are in difficult to dress areas – for example, like the armpit, or the back of the knee – then those are all good reasons to come to the burn center. A lot of the care that we provide is very nuanced and the amount of experience that a nurse or a technician who has been putting dressings on patients with burns for decades can be underappreciated.
A lot of times I’ll see patients who have a perfectly reasonable care plan for a burn injury, but the whole thing just comes undone because the dressing didn’t stay in place or the tape wasn’t sticky enough, or they couldn’t get enough of the ointment that was prescribed to them. These are all common things that lead someone coming in a delayed manner that maybe we could have addressed from the get-go and had a much better experience and kept the wounds in better shape for healing.
Melanie: And tell us about the burn center at MedStar Washington Hospital Center.
Dr. Shupp: Here is the only regional adult burn care center in the Greater Metropolitan area. We treat the entire spectrum of thermal and thermal-like injuries from very thick, large, total body surface area patients to ambulatory injuries. We have a dedicated staff of surgeons, therapists, nurses, and an entire dedicated unit and team where all we do is focus on patients who have burn injuries.
A lot of the things that go into some of the recoveries from burns isn’t the wound, it isn’t the ointment that someone picked -- because even in the burn center community, everyone always debates about the type of topical ointment -- but the one thing that is consistent is that multidisciplinary care leads to better outcomes and better functional recovery. Being able to have dedicated staff to help the patient and support the patient through recovery -- whether it’s a hand therapist or a nutritionist to improve the patient’s nutrition to optimize it for wound healing, or whether it’s the psychologist or the psychiatrist who helps the patients through – those resources are literally at the patient’s fingertips the moment they walk through the door at any regional burn center.
It’s sometimes something that people don’t think about until they put themselves in that position where they hit the ignitor button on their grill, and a big ball of flames comes out. They back away in time and they’re like, “Wait a minute. What if that went a totally different way? Where would I have ended up?” [COUGHS] Excuse me. It’s something that we like to brag about, but it’s also an integral part of our care delivered here.
Melanie: And in just the last few minutes, Dr. Shupp, wrap it up with your best advice about preventing burns in the first place in the summertime and what you want people to know about burns and their risk of getting burned in the summer.
Dr. Shupp: I think the most important thing is to realize that it’s the common things that we do that go awry that leads to injury. Most of the time, when I talk to a patient about something that has happened that caused the burn – well, I’ve done it that way 500 times, or I always start the grill that way, or we have bonfires every weekend, and nothing like this has ever happened. As we go through these months in the summer where we’re spending more time outdoors, we’re doing more entertaining with fuel sources and fire, that you just always take a pause before being around that type of exposure because it can happen at any time to anyone. That amount of awareness is something that I would just like everyone to have as they’re doing these types of activities. And it’s not just burns; it’s dehydration, it’s exposure to lightning, it’s these things that happen all the time that we don’t become injured from is usually when something happens. That type of awareness is something I think everyone should just keep in their mind when they’re doing these activities.
Melanie: Thank you, so much, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.