Treating Workplace Burn Injuries

By Barb Ditmer, COTA

Work-related burns account for 20-25% of all serious burns requiring hospital attention. In these types of injuries most damage is done to the skin, but there can also be deep muscle and tissue damage as well. Electrical and chemical burns are two types of workplace burns that often require rehabilitation therapy after the initial treatment at the hospital.

Electrical burns account for approximately 3%-12% of the burn injuries every year and many of these burns occur at the workplace. An electrical burn is categorized two ways; a low or high voltage burn. A low voltage burn is a burn that is 1000 volts or less; a high voltage burn is a burn that is 1000 volts or higher and has an entrance and exit wound. The severity of the burn is dependent on the type of current, strength of the current, and the duration of the current.

Because electrical currents travel through the least resistive pathway with the bone being the most resistive structure, the soft tissue adjacent to the bone is where the injury occurs. The damage from an electrical or chemical burn can cause soft tissue necrosis, muscle, tendon, and nerve involvement.

Deep muscle and tissue injuries can cause compression syndromes and an evaluation to rule out compartment syndrome/carpal tunnel syndrome is a very important part of the evaluation process.

Rehabilitation for a burn injury is dependent on the severity of the burn, but most often the treatment includes:

• Wound Care
• ROM
• Splinting
• Scar Management
• Managing Acute or Delayed Neuropathies
• Can Include Neuropsychological Complications

Chemical burns are similar to electrical burns with the severity of the burn dependent on the type of chemical, the amount, the concentration of the chemical and duration. The most common chemical substance is from alkalis and the most frequent agent is sulfuric acid. Chemical burns also cause tissue damage and the damage continues as long as the chemical is in contact with the skin and water is the emergent treatment for most chemical burns. However, precise identification of the chemical is necessary for definitive treatment and determining the depth of a chemical burn may difficult due to the delay in presentation.

Compartment syndromes are also common with chemical burn injuries but there are other risk factors that may occur with a chemical burn, such as pulmonary and renal damage.

Some common chemicals which can cause burns are:

• Batteries
• Toilet Bowl Cleaners
• Pool Cleaners
• Rust Removers
• Petroleum Solvents
• Bleach
• Oven Cleaners
• Cement and Tile Cleaners

Steps for the common chemical burn injury:

• Remove clothing and begin water irrigation, continue until chemical is removed from the skin
• Identify the chemical
• Seek immediate medical attention

Many electrical and chemical burns can be successfully managed in our outpatient clinic but if further complications arise such as post-surgical infection, vascular insufficiency, or gangrene/necrosis, an advanced wound healing approach may be the best option.

At The Centre for Working Hands, our physicians are now able to offer advanced treatment options for non-healing wounds. Dr. Downs and Dr. Viscardi recently received advanced training in wound healing and hyperbaric medicine at the National Healing Institute at Ohio State University. They are participating surgeons at The Wound Healing Center, the only physician-driven wound clinic in St. Joseph County.