How to Recognize and Treat 6 Degrees of Burns
The Six Degrees of Burns
These first-level burns include reddened skin and burning through the top layer or top few layers of skin, with some swelling but without blistering. They can be painful. If they cover a large area, then see your doctor for help.
According to the American Red Cross, small burns of this level can be treated with cool water or a cool compress. Electrical burns need a doctor's attention. If any burn becomes infected, see a physician.
You may possibly use a lidocaine spray to relieve pain or apply aloe vera, honey, lotion, or antibiotic ointments. Never use any kitchen oil or butter on a burn because they actually prevent healing.
These include reddened skin and raised blisters that should not be popped open, because of infection risks. See a doctor.
Second-degree burns can be examined by a physician, and the blisters are handled according to their best practices. You may receive a prescription for antibiotic ointment and gauze wrapping.
Third and Fourth-Degree Burns
In the third and fourth degree, bones may be damaged without charring. However, these burns may damage bones enough to disable a patient and, in some cases, may lead to death. Professional treatment is necessary. More extensive tissue damage exists in the fourth degree than in the third degree.
These two levels of injury usually result from prolonged exposure to fires, chemicals, or very hot liquids. Children and adults can be badly scalded and further burned by hot bath water or hot soup on a stove.
Third and fourth-degree burns are professionally cleaned and dressed when the patient reaches a hospital. Since these burns cause fluid loss, especially with 60% of the body burned as mentioned above, IV solutions are required to replace lost fluids and reduce the risk of complications.
In these burns, some tissue under the skin is also lost. Children's hospitals often maintain dedicated Burn Centers in which burn victims can receive the needed round-the-clock care by specialists.
Debridement after the initial treatment is the scrubbing away of dead skin, usually causing severe pain and much screaming. New methodologies are being developed that can reduce this level of pain, but they are not yet mainstream.
One method, developed in a clinic in Mexico, uses super-oxidized water and hydrotherapy to remove dead tissue and was developed in a clinic in Mexico. Some countries use fish skin to cover healing burns. Other specialists recommend hyperbaric oxygen treatment as an adjunct to speed healing with additional oxygen. Research is underway to develop more effective and less painful burn treatments.
Some cases require surgical removal of dead skin and underlying tissues, followed by skin grafting, a surgical procedure in which skin is transferred from the thigh or buttock and sewn over a cleaned burn. Some of the worst cases may require amputation of body parts.
The only difference between the two worst burn categories (fifth and sixth degree) is that the fifth-degree burn does not include charred bone.
The damage from these burns are too extensive and rarely respond to debridement and grafting.
Generally, by the time a body part burns to the sixth-degree, all tissues—from the outer skin layer (epidermis) down to the bone—are irrevocably damaged, and the bone itself is charred black.
Currently, no treatment exists for this level of damage.
The Worst Burns Do Exist
The two highest degrees of burns are not commonly mentioned because they rarely occur. They have mostly been used as specific medical pathology terms in autopsies of burned bodies, the highest level being similar to cremation. Attorneys often cite fifth and sixth-degree burns as found in autopsy reports used for legal actions. Anecdotal denials of the existence of the final two degrees may stem from a lack of knowledge of such pathology.
Uses of Fifth and Sixth-Degree Burns
These two degrees may have previously been limited to radiation victims of the historic Hiroshima and Nagasaki nuclear attacks, the radiation events of Soviet submarines like the K-19 in the 1960s, and in the Chernobyl disaster.
Future advances in modern weapons of war and aerospace technologies may require these final two burn degrees to be more widely used.
A common misconception is that there are only three degrees of burns. The reality is there are six; however most people will not survive burns past the fourth degree.— DOCCS/Diagnostic and Clinical Care Services of Brevaerd County, FL
The Pig Matrix of New Skin
Interestingly, fictitious medical procedures from Star Trek® resulted in stimulating research that produced an artificial skin. Today, that artifice can be laid over well-cleaned burn areas instead of using bandages. The body heals around it, after which, it dissolves.
Another technique involves the use of powdered pig-tissue matrix. It can be placed on human tissues to encourage new tissue growth at the site. This includes muscle, bone, an esophagus, skin, and many other types of tissue. In still other methods, a patient's own stem cells have been used to grow new skin.
Dressings and bandages are typically used to cover burns in order to help the body maintain its normal heat and to resist infection. In the 1980s, a child in our Cincinnati Children's Hospital Burn Unit was hypnotized to raise his second-degree-burned arms in front of him at shoulder height and maintain them there without tiring. This technique worked for him for two important weeks and resulted in fewer bandages needed. His arms did not rub against his body to aggravate the damage, and he felt less pain. Overall, when the wound is left alone, healing is quicker.
Extreme Care Needed
With third-degree burns, skin grafting and more extensive plastic surgery are often needed. These procedures may take up to several years to complete.
Infections can be a long-standing problem. Amputations are still sometimes necessary, and the fitting of prostheses can take prolonged periods of time and require help with funding.
Severely burned children are often supported in their home communities with fundraising events sponsored to provide money in the absence of adequate insurance coverage.
The Severity of Burn Injuries
An extensive burn injury is one of the most painful types of damage that the human body can suffer and in children, it is heartbreaking. In a house fire, the screams of a burning child that cannot be found are haunting. The screams of agony from a child in a hospital burn unit undergoing the scrubbing away of dead and burned skin with metal brushes is nerve-shattering.
The skin grafting surgeries are lengthy, often taking months or years. Not all grafts are successful. Not all plastic surgeries can save a 2-year-old's twisted, scarred face that may no longer have a nose or ears. Fingers heal together or are burned off. Feet sometimes become charred stumps. Limb amputation sometimes becomes necessary, even in the truth of all this, the public hopes for the newest technologies to come to the rescue in these cases.
In the 2010s, fire prevention is still many times more effective than any treatment of third-degree burns.
The little girl was just three years old.
On the Friday before Palm Sunday, her teen brother was watching her, her four-year-old sister, and the dogs. The mom, dad, and a middle-school sister were away. Suddenly, a fire broke out upstairs in the two-story home. The brother saved the 4-year-old and the dogs but was cut-off from the youngest child by the fire.
He stood on the sidewalk screaming for help. A passerby jumped from his car and entered the house, heard screams, but could not navigate through the flames.
The fire department arrived; one of the men was burned, himself, as he extracted the youngest victim from the second-floor inferno.
She was rushed to the children's hospital 100 miles away, where she was diagnosed with third-degree burns over 60% of her body. Her mom, dad, and sisters moved into a Ronald McDonald House next door but sat by her hospital bed most of the time. Her brother went to another city to stay with a friend.
What caused the fire on the second floor? It could have been an electrical wiring problem in the rental property that also had an unfinished basement with only a dirt floor; building codes may not have been met in other ways. The struggling family in Michigan had to find a new residence.
Landlords that own rental properties such as houses, apartments, converted garages, and other residences have the responsibility to provide fire-safe living arrangements according to the law.
Smoke detectors must be installed in these residences, checked at least yearly, and maintained in workable condition at all times. Electrical wiring throughout the building in these residences must be up to code according to legal standards.
Sixty-percent body coverage by third-degree burns in a three-year-old is serious. All layers of the skin are burned through across more than half of the body, leaving the patient open to infection, dehydration, shock, the possible need for a tetanus shot, and in extreme cases, loss of limb(s) and face. Fat, muscle, and other elements beneath the skin may also be damaged.
A fourth-degree burn includes fire damage below all layers of skin and into the muscle, tendons, and ligaments. This damage creates a carbonized appearance similar to charcoal.
Persons struck by trains have been carbonized throughout their bodies with these burns and have been subjects of an old traffic safety film, Signal 30.
Call your local Red Cross for additional information and first aid training. Call or visit your healthcare professional or hospital for burns above the first-degree and even for first-degree damage covering large areas of the body.
- American Red Cross First Aid Training.
- n.a. (October 2013). Burns. MedLine Plus at the US National Library of Medicine. Retrieved June 5, 2017.
- Inglish, Patty: First hand witness to Dreffs Family fire disaster and aftermath in Bay City, Michigan from April 15, 2011 to the present.
- Memory Alpha, Star Trek® Fandom. Retrieved June 6, 2017.
- Morgan, Walker. Fourth, Fifth & Sixth Degree Burns. Retrieved May 10, 2016.
- Ohio State Highway Patrol and the Highway Safety Foundation. Signal Thirty. 1959.
Questions & Answers
© 2011 Patty Inglish MS