Where’s the fire?

To say the understanding and control of fire was a critical point in human evolution would be an understatement. With the control of fire, soon after came the advent of cooking and advancements in socialization and warfare. Archeological evidence is not definitive on exactly when our hominid ancestors first mastered flame as a tool, but the earliest secure evidence for controlled burning occurred during the early Acheulean occupation, approximately 1 million years ago, and so fire exposed early civilizations to a new mechanism of injury—burns.

Degrees of burn injury

Most current surgical texts have separated themselves from the six degrees of burn injury first described by Guillaume Dupuytren, a French anatomist and military surgeon, in 1832.1 The lesser-known fourth-, fifth-, and sixth-degree burns involve thermal destruction of the fascia, muscle, tendon, and bone.1

The more clinically common thermal injuries are described in terms of degree or thickness. Superficial, or first-degree, burns involve only the epidermis. The most obvious example would be a sunburn. Second-degree burns can be classified into superficial and deep, partial thickness. Superficial partial thickness injuries extend into the papillary dermis, typically forming blisters. Underneath these blisters lies a pink, moist, blanching, and hypersensitive wound bed that will typically heal with proper wound care in two to three weeks. Deep partial thickness injuries extend into the reticular dermis and may also blister, but they typically have a dry, pink and white, mottled appearance. Even with proper wound care and therapy, these injuries may stall in the healing process and require excision and grafting. Full-thickness, or third-degree, burns involve the entire dermis and may extend into the subcutaneous tissue. These injuries appear dry, leathery, and firm and may be accompanied by charred tissue resembling parchment paper. These wounds are typically insensate due to destroyed nerve endings. Early excision and grafting of these injuries reduces morbidity, mortality, and hospital length of stay.2

Morbidity and mortality

From 2010 to 2012 annually an estimated 2,465 civilian fire fatalities resulted from 1,700 fires in residential buildings and an estimated 366,900 residential building fires in the U.S.3 Understandably, regional differences in economic status, housing construction, and heating devices influence the death rates resulting from residential building fires or house fires. The most common cause of such fatalities is careless smoking, followed by arson, and the third most common cause is defective or inappropriately used heating devices. Scalds are the most frequent type of thermal injury overall, but fire and flame injuries are the most frequent to require hospital admission.4 The total annual cost of burns, including medical costs and costs of lost productivity, is estimated to be $7.5 billion.4

To examine the occurrence of burn-related injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2013, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses codes. Specifically searched were records for injuries from fire/flame containing an external cause of injury code (E-code) E890–E899 (unintentional burn related injuries from conflagration, highly inflammable material, burning bedclothes, ignition of clothing, controlled fire, other specified fire, and unspecified fire). A total of 27,616 records were found, of which 21,252 contained a discharge status, including 16,210 patients discharged to home, 1,993 to acute care/rehab, and 1,324 sent to skilled nursing facilities; 1,725 died (see Figure 1). These patients were 73 percent male, on average 41.5 years of age, had an average hospital length of stay of 10.1 days, an intensive care unit length of stay of 12.6 days, an average injury severity score of 16.9, and were on the ventilator for an average of 11.3 days. The most frequent location of the fire was home (84.1 percent) with industry (4.5 percent) and recreation (4.4 percent) a distant second and third. (See Figure 2.)

Figure 1. Hospital discharge status

Figure 1

Figure 2. locations of injury

Figure 2

Protecting your home

Where’s the fire? Odds are it will be at home. If a fire starts in your home, you may have only two minutes to escape. The best way to protect yourself and your home is to find and remove fire hazards. Most (60 percent) house fire deaths occur in homes that lack working smoke detectors. Install smoke alarms on every level of your home, inside bedrooms, and outside sleeping areas. Test your smoke detectors and change the batteries regularly.

If a fire occurs in your home, get out, stay out, and call for help. For more prevention tips, visit the American Red Cross website.

Throughout the year, we will be highlighting NTDB data through brief reports published monthly in the Bulletin. The NTDB Annual Report 2014 is available as a PDF file. In addition, this website contains information about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.


Statistical support for this article has been provided by Chrystal Caden-Price, Data Analyst, NTDB.


  1. Lee KC, Joory K, Molemen NS. History of burns: The past, present and the future. Burn Trauma. 2014; 2(4):169-180.
  2. Lewis GM, Heimbach DM, Gibran NS. Evaluation of the burn: Management decisions. In: Herndon DN, ed. Total Burn Care, Fourth Edition. Philadelphia, PA; W. B. Saunders; 2012:126-127.
  3. U.S. Department of Homeland Security. Civilian fire fatalities in residential buildings (2010–2012). Topical Fire Report Series. 2014;15(2):1-9. Available at: www.usfa.fema.gov/downloads/pdf/statistics/v15i2.pdf. Accessed January 10, 2015.
  4. Pruitt BA, Wolf SE, Mason AD. Epidemiological, demographic, and outcome characteristics of burn injury. In: Herndon DN, ed. Total Burn Care, Fourth Edition. Philadelphia, PA; W. B. Saunders; 2012:19.

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