I don’t actually remember where this question came from, or why my son asked it. I mean, I suspect it was inspired by playing a video game. Or maybe from watching cartoons. I just have “If my hand set on fire, would it hurt? How bad?” in my notes, with no context whatsoever.
That happens, sometimes. I’ve got a bunch of questions I jotted down, and many of them lack context. But, in this case, it makes a fun follow-up to my last article.
Sources of burns
To start answering his question, let’s start with how you can get burned. More things than just fire can burn you, after all – just ask your skin, after a day at the pool without sunscreen. In fact, the John Hopkins Medical Library provides four different sources of burns:
- Thermal burns. These burns are due to heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring. Hot metals, scalding liquids, steam, and flames, when coming into contact with the skin, can cause thermal burns.
- Radiation burns. These burns are due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as X-ray.
- Chemical burns. These burns are due to strong acids, alkalies, detergents, or solvents coming into contact with the skin or eyes.
- Electrical burns. These burns are from electrical current, either alternating current (AC) or direct current (DC).
So, if my son’s hand was to be set on fire, he’d experience a thermal burn. Alternately, if he got a sunburn he’d have a radiation burn, if he poured lye on his hand he’d have a chemical burn, and if he stuck his finger in a live lightbulb socket he’d get an electrical burn. He’d also have parents doing their best to stay calm until he was taken care of, but that leads into an entirely different question of the “would you still love me if I did something stupid?” type.
(For the record, he’s never actually asked that question. But the answer is: “Yes, I would. I might not be happy with your behavior, but I’d still love you. Now take your fingers away from that electrical socket.”)
Ultimately, each of these sources of burns has some unique characteristics. But they all have the same basic effects.
Let’s talk about skin
Your skin has three layers: the epidermis, the dermis, and the hyodermis. The epidermis is the outer layer, composed of four to five layers of skin cells that protect the underlying layers. These cells manufacture and store keratin, a tough and fibrous protein that also (in a slightly different form) makes up our fingernails and hair and the horns of a rhinoceros. The epidermis also contains the skin pigment melanin, meaning that much of our conceptions of race aren’t even skin deep. The living layers of the epidermis are covered with layers of dead, keratinized cells that flake off over time. Beneath the epidermis is the dermis, two layers of connective tissue that contain blood and lymph vessels, nerves, hair follicles, sweat glands, and other structures. Finally, the hypodermis is connective tissue filled with more blood vessels and subcutaneous fat that serves to connect the skin to the bones and muscles.
“Solid burn, Branch.”
Returning to the John Hopkins Health Library, we learn that there are three classifications of burns – and you’ve probably heard what they are: first-degree, second-degree, and third-degree. Each of these relates to how deep the burn penetrates into the skin. First-degree burns are also referred to as superficial burns, and only affect the epidermis. It’ll be red and painful, dry to the touch, and lacking blisters.
Second-degree burns are also referred to as partial thickness burns, and both the epidermis and dermis are damaged. The skin will still appear read, but it is likely to be blistered and swollen.
Third-degree burns are also called full thickness burns, and this is where it gets really bad. The hypodermis is also damaged in a third-degree burn, and parts of the body below the hypodermis may also be involved. Parts like muscles, tendons, and bones (some sources call this a fourth-degree burn when this occurs). Third-degree burns will look whie or charred, and there tends to be no feeling in the burn site. Why? because the nerves have been destroyed.
Burns are further classified by burn percentage, which estimates the total area of the body affected by the burn. This is done on a “rule of nines”, in which body coverage is estimated in multiples of 9.
The chart doesn’t call out a hand specifically, but it would probably be considered 4.5%.
How much would it hurt?
There are a number of pain scales. The one I found first, and will be using as an example, ranks from 1-10 (well, technically 0-10, but 0 is “No pain. feeling perfectly normal.”). So, here’s the levels:
- Very light barely noticeable pain, like a mosquito bite or a poison ivy itch. Most of the time you never think about the pain.
- Minor pain, like lightly pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails. Note that people react differently to this selftest
- Very noticeable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don’t notice the pain. You have adapted to it.
- Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the simulated pain is initially piercing but becomes dull after that.
- Strong, deep, piercing pain, such as a sprained ankle when you stand on it wrong or mild back pain. Not only do you notice the pain all the time, you are now so preoccupied with managing it that you normal lifestyle is curtailed. Temporary personality disorders are frequent.
- Strong, deep, piercing pain so strong it seems to partially dominate your senses, causing you to think somewhat unclearly. At this point you begin to have trouble holding a job or maintaining normal social relationships. Comparable to a bad non-migraine headache combined with several bee stings, or a bad back pain.
- Same as 6 except the pain completely dominates your senses, causing you to think unclearly about half the time. At this point you are effectively disabled and frequently cannot live alone. Comparable to an average migraine headache.
- Pain so intense you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Suicide is frequently contemplated and sometimes tried. Comparable to childbirth or a real bad migraine headache.
- Pain so intense you cannot tolerate it and demand pain killers or surgery, no matter what the side effects or risk. If this doesn’t work, suicide is frequent since there is no more joy in life whatsoever. Comparable to throat cancer.
- Pain so intense you will go unconscious shortly. Most people have never experienced this level of pain. Those who have suffered a severe accident, such as a crushed hand, and lost consciousness as a result of the pain and not blood loss, have experienced level 10.
I couldn’t find any pain chart rankings for burn pain, partially because pain is a subjective (although real) phenomena. The Chicago Clinic explains, however, that
Burn pain can be one of the most intense and prolonged types of pain. Burn pain is difficult to control because of its unique characteristics, its changing patterns, and its various components. In addition, there is pain involved in the treatment of burns as the wounds must be cleansed and the dressings changed. Studies have concluded that the management of burn pain can be inadequate, and such studies have advocated more aggressive treatments for pain resulting from burns. Lastly, some burns can be mentally traumatic and/or physically disfiguring and lead to psychological pain that must be addressed, as well.
So there’s that.