Schoolchildren catch up on how to avoid burns, react to fires

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Because the pandemic disrupted school schedules, Central New York kids between the ages of 5 and 8 missed out on fire prevention education that normally takes place at elementary schools.

Today I'll be talking with a fire life safety educator and juvenile fire-setter intervention specialist from the Clark Burn Center at Upstate. Kara Judd is also a lieutenant in the Cazenovia Fire Department.

Welcome to "The Informed Patient," Ms. Judd.

Kara Judd: Thank you so much. Thanks for having me.

Host Amber Smith: These kids who would've been in kindergarten, first, second grade during the height of the pandemic, what are fire prevention educators seeing in terms of burn injuries in this age group?

Kara Judd: Yeah, we are seeing some incidental findings. Of course, anytime you're looking at data to really have a solid picture of a change in statistics, or a shift, you have to do a longer-term study and have data from several sources, etc. But anecdotally, just based on the work that we are being asked to do and some of the injuries that we are seeing, we can correlate that, because the schools were closed down, and they did not have the traditional fire prevention education that they normally would have, there is a spike in some of these burn injuries that we are seeing come in, particularly from things like candles, lighters. We always see a high incidence of scalds, which is not necessarily related to prevention, but in some cases could be mitigated with education.

Host Amber Smith: What about fire-starting behavior?

Kara Judd: Yeah, so a part of my job as a juvenile fire-setter intervention specialist is to identify and work with children who are exhibiting fire-setting behaviors. And oftentimes this is not intentional, or there's no crime associated with it. It's really, truly, kids that are experimenting or are maybe just not understanding that fire is a tool, not a toy.

Recently I've seen more of those behaviors in this younger age group. Now, we're used to seeing it in some of the older kids because, when you get older, you have, of course, which is developmentally appropriate, less supervision, and they tend to experiment a little bit more with things.

And sometimes, again, that's very innocent behavior. But we do see that in the older kids and in the teenage population.

When we're seeing it in younger kids, ages 5 through 8, where we don't normally see those type of behaviors, it did start me wondering why we're seeing this, because it's not as common in that age group.

And so that's what led me to take a peek at what was missing. And that's where I found this kind of anecdotal link. Fire prevention education typically happens, very often, at least yearly in elementary schools, all over the place. Regardless if your fire district is covered by a career or a volunteer or a combination department, they're typically very involved.

And even if the fire department doesn't make a visit to the school during October, which is Fire Prevention Month nationally, oftentimes the teachers are talking a little bit about fire safety and fire prevention education.

So, a combination of not having traditional schooling in the last three years and some of the kids being completely on Zoom school, and also, even when the pandemic was kind of tapering off in terms of how we were isolating ourselves, schools still continued to not have outsiders come in, due to concerns for the health care crisis.

So when that happened, you really look at, OK, well, how old were those kids when they should have been starting to get this? So three years ago, that was the kindergarten class, right? And now we have those kids that are now 8 years old, who are exhibiting some fire-setting behaviors.

Host Amber Smith: So what do you advise parents or caregivers to do with this population of children who missed on this? Can they make up for it in some way?

Kara Judd: Absolutely. One of my favorite aspects of my job when I work with young children is their overwhelming desire to learn. And they're just like little sponges. They want to learn. They want to know information. And there's a lot of ways that you can deliver the information to them so that it's useful to them but doesn't frighten them from the dangers of fire and burn injuries.

So, NFPA, that's National Fire Protection Association, they have a website for safety, nfpa.org (a kids' version is at sparky.org), where parents can go, and there's free resources including videos, printables, games, all those kinds of things that talk about fire safety, having an escape plan in your home and how to recognize what's hot and what's not. You can even print little games to play with the kids, for what's hot and what's not, so they can learn about safety and not having an increased risk of burn injuries.

Host Amber Smith: That's good to know. So getting back to the types of lessons that typically would be taught in elementary schools, is there one thing that you want children to learn or to take away with them?

Kara Judd: There's a couple things. In terms of fire-setting behaviors, the most important thing in that age group is what's a tool and what's a toy? I think that families get into a normal routine, where it's very common for them to, for example, have candles around the house that are lit. They think nothing of it.

Many families go camping. That's a really common thing that families here do. So they have bonfires and things like that, and the kids witness their parents lighting candles, moving candles around the home to different places, lighting bonfires, all those kinds of things.

And the kids don't realize that it's an adult job to do those things, right? Those are adult things. They see matches and lighters around the home; they don't recognize that those are just for adults. And a lot of times it's just such a normal daily routine for the families that they don't think about stopping to teach the kids that they're not to touch those things.

I think that also for parents, you need to really look carefully if you're seeing something that's kind of odd and you don't have an explanation for it. For example, we have seen cases where we've gone to do an intervention after a larger fire incident has happened in the home. And what we found through the investigation is that, maybe a month ago, several weeks ago, the parents started to find what they thought were little black marks on the carpet, for example. And those were scorch marks, but the parents were not thinking about fire-setting behaviors. It was just not on their radar. And you might have a child that's just making a little campfire for the Barbie, and that goes completely unnoticed because they keep a Dixie cup of water from the bathroom in their bedroom and put it out.

And, you know, the parents are none the wiser, but they might see these little black marks and not know how did that happen? So, thinking about fire safety and fire prevention in your home and putting it in the forefront of your mind is really the first step because parents, I think, and many adults just do not think that a fire emergency is ever going to happen in their home.

So, that's extremely important. Look for those signs. Think about the toys that you have in your house and the tools that you have in your house, and make sure that you understand that the children have a distinction between the two.

Really sending the message that lighters and matches are for adult handling only is very important to do.

And, of course, we always, always, always want to make sure that families have working smoke alarms in their homes and that they're tested regularly and that the family has a fire escape plan.

Host Amber Smith: Is there a good age for fire safety education? I imagine the younger kids are fascinated, but maybe by the time they're teenagers, they've sort of lost interest.

Kara Judd: One of the projects that I started here when I took this position is called Rural Teen Outreach. So we're finding that teenagers, especially, are getting flash burns from things like brush fires and fires where they're adding an accelerant, like gasoline or kerosene.

So, you're 100% correct, right? The kids, when we roll up with that big red truck at the elementary school, oh boy, you feel like a million bucks because you're the celebrity for the day, right?

And then a lot of schools don't ever have us come back in the older grades. And what we are finding is now the end result of that is we've got our highest injury for adults is 30- to 40-year-old males who are getting injured by gasoline fires.

Why is that? Because they didn't learn that. They learned "stop, drop and roll" and "hot and not," and the basic little-kid things, and then nobody ever gave them any other fire education.

So I started Rural Teen Outreach, where I go out and I talk about when you're starting to mow the lawn, and you're starting to do yard chores, and you're handling gasoline, what are gasoline's properties?

How does it burn? How can it hurt you? We started talking about it.

So this is the age group that's talking about.

We need to talk to them about cooking safety. They're alone, they're babysitting, they're alone with other kids. They need to know how to get out and what to do in an emergency.

And then I talk to them about juvenile fire-setting behavior, and I actually have a slide where a 14-year-old was killed because him and his buddy were just lighting pieces of paper off in a factory, an abandoned factory, and they got trapped. So, just innocent play that they didn't think was going to come to any harm, one kid died and the other kid was prosecuted, and it ruined his whole life. So, those kids actually are captivated by the material because it directly applies to them in their lives.

Host Amber Smith: So you get into gasoline safety and space heaters, things like that?

Kara Judd: Yep. Because these are the kids that are starting to use those kind of things, especially in our rural communities, you see that a lot more. And kids that work on farms, and they don't think anything of it; you know, it's their daily life, but nobody's taught them that gasoline has a 12-foot vapor trail.

Host Amber Smith: This is Upstate's The Informed Patient podcast. I'm your host, Amber Smith.

I'm talking with Kara Judd from the Clark Burn Center at Upstate. She's also a fire lieutenant with the Cazenovia Fire Department.

Let's talk about what's important and age appropriate for young elementary schoolers. Why is it important to explain that fire is hot?

Kara Judd: Kids are naturally curious and, again, they like to emulate what they see their parents doing, right? That's why toys for that age group are like trucks and kitchen sets and imaginary play. They like to do what they see adults doing. So it's extremely important for parents to have those teachable moments about not touching candles, because they get very hot, and your skin is very sensitive to it.

We do see children that come in with typical burn injuries. We call those contact burns, so where kids are touching a hot surface. Another great example for teachable moments for those kids is if you have them helping you in the kitchen, make sure that you have a kind of area that's taped off, away from hot surfaces. So if the kids are joining you in the kitchen during cooking time, they are back away from the things that can burn them, and explain why. Explain why they have to stay away from the stove when it's hot, and that hot things can hurt their skin and burn them.

Hot water when you're making soup or boiling water on the stove: That's a really common risk for burn injury for young children, is they see the parents doing the cooking activity, and they reach up, not realizing that the pan is hot. So that can cause spills, that can create very devastating scald injuries for kids as well. So, really just teaching them what's hot and showing them an example, you know, the iron versus an ice cube. This is something that's cold to touch. This is something that's hot to touch.

Host Amber Smith: How do you teach kids about how fast fire can spread?

Kara Judd: So, that's a really tricky topic. I know that some families are very uncomfortable talking about fire because they don't want to scare the kids, but what we have really found is that kids that are informed and know what to do. Even in really young kids, we see with technology these days, 3-year-olds can operate an iPhone better than some adults, so teaching them at a young age how to call 911 for help, when they need help in an emergency, is a skill that even young children can learn. And it helps actually make them feel empowered to do something, instead of feeling scared about it.

One of the things that we really want people to understand is that fire doubles in growth every 30 seconds. Kids really don't understand that fire is only a tool and should not be played with because of that. It's not something that can be easily controlled by a young child. It's not something that can be easily controlled by an adult, either, but definitely not by a kid.

So, we really want kids to understand that. Even simple terms: Fire gets bigger; fire doesn't get smaller. We need to not play with fire because we don't want the fire to get bigger. Fire is something that only adults should take care of.

Host Amber Smith: What do kids need to know about how to react if they're in a fire? I know you already mentioned they need to be taught to call 911 in an emergency, but if they recognize that they wake up, and the house is on fire, what's the first thing you tell them to do?

Kara Judd: We teach the kids if they hear that smoke alarm go off that they need to act, and that's a really important thing. There's so much ambient noise in our homes these days. Dishwashers beep, washers and dryers beep, video games beep. They need to recognize first and foremost what the sound of the smoke alarm means. So, the smoke alarm sounds different than anything else in the house.

If it's going off during cooking or accidentally or because somebody overcooked the toast, a lot of times, unfortunately, parents just hush it and don't give the family an opportunity to react when it's a non-emergency. So I always say, learn what the beep means. You want to start to get up and move when you hear the beep.

So, we want the kids to have an escape plan. We teach them to find two ways out of every room that they're in and to have a family meeting place away from the house. It can be a big tree, it can be a big rock, it can be the mailbox. If it's away from the house, it can be the neighbor's porch, anything like that.

We want to give them a plan. Other things, depending on the age, for kids probably 5 and up, if they're in their bedroom when they hear the smoke alarm go off, we want them to go to the door and feel it with the back of their hand first, before they open it. And again, this is where that hot and not training comes in. If the door is hot, we do not want to open it. We want to stay where we are and wait for help. If it's not hot, then you can stay low and go. These are other little terms that we use. That keeps the kids low on their belly, under the smoke, where they'll have the best chance of breathable air, and they can crawl to where their escape plan is.

Now, a lot of times parents are like, "I don't want to do a fire drill in my house because I don't want my kids to be scared." Kids do fire drills in school all the time and think nothing of it, right? I am, well, well, well past my school years, but if I go back to my school right now where I went to elementary school and that fire alarm rang, I would've known exactly where to go and what to do because we did it so much, it becomes muscle memory.

We hear that fire alarm go off in school, we stand up, we line up, we go to the flagpole. They only know that because they do it over and over and over again. If they're doing it at home, when there is an emergency, they're going to be able to have that muscle memory and have the best chance of an early escape.

Host Amber Smith: I've heard that some kids have a natural impulse to hide when they're scared. And so I wonder, do you address that, or is there a way to disrupt that sort of impulse that they may have?

Kara Judd: That's a great question, and yes, that's a very common problem that we see with children. So as firefighters, when we do have the opportunities to go in the school, one of the things that we like to do is make sure that we start out in our regular, basic uniform and then slowly put on our turnout gear and our mask and our air packs, so the kids can see what a firefighter responding to an emergency, a fire emergency at their home, would look like and sound like.

We also tell them that when they hear us calling out for them, because as firefighters, when you go in for search, you're yelling, "Fire department! Fire department!" you want the people to know where you are.

We teach the kids that that's what we will be doing, and they need to come towards the sound of our voice or yell out to us, but not hide. We always tell them, stay low. If you cannot come out of your door, just get low, and yell out to us so that we can hear you and get to you. But yes, we do want to make sure that kids are not afraid of the firefighters who are coming to help them, because our turnout gear and our masks can be intimidating.

Host Amber Smith: Is the stop, drop and roll still taught as a way to deal if you yourself have been put on fire? Are you still training kids to stop, drop and roll to put the fire out?

Kara Judd: We do still touch on that, absolutely. There is a little bit of a shift to trying to keep kids away from open flame, so you try to teach them not to even expose themselves to get to that point in the first place.

Some fire departments have a hard time teaching stop, drop and roll because again, they don't want to frighten the kids, but you can really taper it the way that you use your language, right? So instead of saying, "When your clothes catch on fire, stop, drop and roll," because I don't know about you, but as a child, I thought my clothes catching on fire and quicksand were going to be huge concerns in my life. And, until I was a firefighter, I never was on fire. So, hopefully it's a very rare event, but you want to kind of soften your language while you're educating in this age group and say, "If you got too close to the fire, and you noticed that your clothes had some fire on them, then what you want to do is immediately stop, drop and roll away from the fire. This will make the fire go out."

So, you just have to explain it very calmly and really choose your phrasing carefully, and the tone in the way that you deliver. And again, really heavily focus on, "That's something that probably won't happen if you stay back away from the campfire and don't get too close. And if you stay away from the stove and don't get close."

Host Amber Smith: In terms of prevention, how much can kids under 10 do to prevent fires? Are there any messages you're trying to get across?

Kara Judd: Absolutely. We want to, again, make sure that the kids are giving matches or lighters that they find, out in the house, that they have easy access to, hand them right to the parent or tell a parent, there's a lighter on the table, or I found matches in the driveway, whichever, so that adults can handle them.

Additionally, again, we want to make sure that the kids themselves are not handling, lighting or moving candles around the home.

And we want to make sure that we're creating that safe space in kitchen areas and fire areas where the kids are back away from open flame. Those are really common things that young kids can do. Of course, additionally, we want to make sure that kids at that age learn about what 911 is and how to access it.

Host Amber Smith: Before we wrap up, can you tell us about the common types of burn- or fire-related injuries that you typically see in young children? I'm interested in what's involved in the treatment once they're at the Clark Burn Center.

Kara Judd: The most common pediatric burn injury that we see is scald injuries, so kids that are injured in hot water, so this can be a bath that's been run too hot. We want everybody's hot water heaters to be at 120 degrees or below. Always, always, always test the bath water before you let a child get into it or before you place a baby into the water, test it every single time. Your water temperature can have surges. You just never know. You can run a bath 800 times, and on the 801st time, the water's going to be too hot. .So make sure you test every single time.

We have kids, again, very commonly, pulling pans of hot soup or hot water or hot tea down on themselves. Or if someone is carrying a baby and is drinking a hot cup of tea or coffee, for example, the baby can knock that cup, so we always tell families, don't carry children when you're carrying hot liquids. If you have hot liquids around children, keep it in a travel cup to minimize spillage and injury that way.

When kids are injured from a burn or scald injury, it is a very intensive, and we call it a lifelong, injury.

Obviously children are still growing into their skin, their skin is still growing with them, so they are likely, will have a lot of surgeries ahead of them for grafting as they grow. They will have to wear compression garments to protect their new skin as they're continuing to heal. The kids that we treat get a lot of occupational and physical therapy to help reduce any kind of contracture over joints so that they can continue to move and grow and develop normally.

Obviously, there's a huge psychological component to these types of traumatic burn injuries, so we have a wonderful team of child life specialists here who help, work with the children and the families to learn both about their medical procedures that they're going to have related to their burn care and how to cope with the trauma of the injury itself.

So we have an amazing team that works with the kids, but all of us collectively will 100% say at all times that we would rather not have to treat the burn injury. That's why I'm here. I'm trying to put us all out of work, right? We, ideally, don't want to have anyone come in to see us injured. We're really trying to do a lot of focus on community risk reduction so that we can push these numbers downward, so that families and kids do not have to suffer with these long-term burn injuries.

Host Amber Smith: Well, Kara Judd, I hope this helps, and I appreciate you making time for this interview.

Kara Judd: Thank you so much. We appreciate you helping us get the word out, and we're happy to answer any questions from anybody. We can be reachable in Instagram, Facebook or via our website (https://www.upstate.edu/burncenter/index.php). Just reach out and message us. And we offer outreach programs for schools, fire departments, and we're happy to answer questions from families as well.

Host Amber Smith: My guest has been Cazenovia Fire Lt. and Fire Life Safety Educator and Juvenile Fire-Setter Intervention Specialist Kara Judd from the Clark Burn Center at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.