Scald Burns

When my daughter was ten years old, her braces got broken one night at softball practice.  Since she couldn't comfortably eat anything solid until she could get to the orthodontist, she was going to make herself a bowl of instant macaroni and cheese instead of having the chicken dish originally planned for dinner.  We had all gotten in the habit of making the instant mac-and-cheese by starting with water from the hot water dispenser in our kitchen.  It was one of those boxy units with a 5 gallon bottle on top and two spigots, one blue for chilled water and one red for hot water.  Because she misread the instructions on the packet, she filled the 2-cup Pyrex measuring cup up to the 2-cup line instead of the 2/3-cup line that she needed.  A drop of hot water splashed off the top of the now-full measuring cup, and landed on her hand, causing her to flinch, and drop the measuring cup down the front of her softball pants.  The thick nylon fabric instantly wicked the hot water to her skin, and held it there.  Within seconds, she was suffering from first, second, and third degree burns on her legs.  What followed was five days in an isolation room in the burn ward at Valley Medical Center, six weeks of missed school, and months of physical therapy.

This is a classic chain-of-events accident.  If she had been able to eat the regular dinner, she wouldn't have made macaroni and cheese.  If she hadn't misread the instructions, she probably wouldn't have splashed her hand, causing the larger hot water spill.  If she hadn't been wearing conforming nylon softball pants, the water may well have just soaked her clothes but not stuck to the skin.  But everything lined up for a catastrophic accident.  The one causal factor that we really should have seen coming, however, was the temperature of the water coming out of the hot water dispenser.  Most of these dispensers put out water at temperatures between 140 and 195 degrees Fahrenheit.  Indeed, the one we had didn't even have a thermostat to adjust the temperature.  It was fixed, and when I tested it later, it was at about 165 degrees.  This temperature is chosen for the convenient making of tea or other hot drinks.  But it is also surprisingly dangerous.

Scald burns can occur at temperatures as low as 120 degrees.  The time to injury decreases as the temperature increases.  And children get injured faster than adults.  With 160 degree F water, an adult will suffer second and third degree burns in as little as half a second, and children will suffer third degree burns in as little as 0.2 seconds.  This was, I'm sad to say, news to me.

X Axis: Time in Seconds to Injury, Y Axis: Temp in Degrees Fahrenheit.

(From www.tap-water-burn.com/pamphlet/images/plate2b.jpg)

I can understand that the convenience of quick hot beverages makes this a perfectly acceptable risk to people who are aware of it.  The problem is all the people, like us, who were completely unaware of how fast injury can occur, and how serious it can be.  These dispensers absolutely should not be where small children can get at them, and older children and adults should be taught just how dangerous the hot water coming out of them is.

Another critical bit of information most people lack is how to treat burns once they happen.  What should you put on a burn?  The answer is "cool water, and nothing else."  Actually, if you have sterile medical saline immediately available, you can use that to irrigate the burn area.  But unless you have sterile saline, use cool tap water.  Never put any sort of spray, ointment, or home remedy on a burn.  And if you're not sure if you should call 911, do it.  Burns are serious injuries, requiring immediate care, careful professional treatment, and sterile isolation.  Even "minor" burns, if they break the skin, should be carefully cleaned and bandaged, in order to prevent infection and a host of secondary complications.  Err on the side of caution.

Because my daughter's burns were uncontaminated when she arrived at the hospital, they were able to use a beta-glucan collagen matrix dressing on them, which was at that time a relatively new treatment.  As a result, she suffered through far fewer dressing changes than if she had gone through regular daily bandage changes, and her legs healed with almost no visible scarring.  She was extremely fortunate, and she is now a vocal opponent of the use of any sort of "burn cream" or other treatment that can make the kind of outcome she enjoyed impossible.

Scald burns are the number one type of burn accident among children.  The Alisa Ann Ruch Burn Foundation launched an information campaign several years ago called "Hot Liquids Burn Like Fire."  If you know someone that has a hot water dispenser, tell them about this.  Spread the word.  Burns are horrible, and often, they are preventable.