Diagnostic Assessment — Right Hand - Thermal Burns
Example 1 of 1 · fictitious patient (Veteran N)
Diagnostic Assessment
Right Hand - Thermal Burns
Balance of Probabilities SOP: Heat-induced Burn No. 2 of 2024 Reasonable Hypothesis SOP: Heat-induced Burn No. 1 of 2024
ADF History
The veteran, Chef (Army Catering Force), 09 January 2009, 27 Mar 2016.
Occupational History
Military chefs are exposed to various occupational hazards including direct contact with hot surfaces, boiling water, cooking oils, steam, and other heat sources during food preparation activities. Kitchen environments involve constant exposure to thermal hazards through cooking equipment, hot liquids, heated surfaces, and food preparation processes that can result in thermal burn injuries to exposed skin areas including hands and forearms.
History
The veteran the veteran a Chef in the Australian Defence Force, suffered thermal burns to his right forearm and hand on 13 Mar 2014 while performing cooking duties when he accidentally spilled boiling water over his forearm during dinner preparation.
Timeline
- 13 Mar 2014 - the veteran suffered thermal burn to right forearm while cooking dinner when he accidentally spilt 95-degree water over his forearm. The burn stretched more than a hand's width from wrist to near elbow, with an area around 50 cent piece size that had turned white. He performed appropriate first aid by running the forearm under cool water for 25 minutes. Emergency department assessment and treatment was required with tetanus booster and wound dressing. The incident occurred during his occupational cooking duties while preparing dinner as part of his military chef responsibilities.
- 14 Mar 2014 - Follow-up assessment found the veteran with 03/08 pain and a palm-sized burn on the distal aspect of forearm presenting as superficial light red with white areas. No signs of blisters or broken skin were noted, and no purulent discharge was observed. The member was afebrile with no other concerns. He was provided with wound management education and instructions on signs of infection. The diagnosis was right arm - burn and right hand - burn.
Symptoms
At the time of injury, the veteran experienced immediate thermal burn injury from 95-degree water contact, resulting in a palm-sized burn extending from wrist to near elbow with areas that turned white, indicating deeper tissue involvement. He experienced 03/08 pain on follow-up assessment. The burn presented as superficial light red areas with white zones, consistent with mixed superficial and partial-thickness thermal burns. From the current assessment, the veteran experienced a significant occupational thermal burn injury that required emergency department treatment and ongoing wound care.
Imaging
No imaging was performed for this condition as clinical assessment and wound evaluation were sufficient for diagnosis and management of the thermal burn injury.
1. What is the formal diagnosis of the condition claimed above?
Right Hand and Forearm Thermal Burns (superficial and partial-thickness). DVA SOP: Heat-induced Burn No. 2 of 2024 (Balance of Probabilities). ICD-10 code: T23.2.
Heat-induced burn is an injury to the skin and external body covering tissues due to transfer of energy into the tissue with external contact with flame, or heat. Thermal burns result from contact with hot liquids, steam, hot surfaces, or flames, causing damage to skin and underlying tissues. Burns are classified by depth, with superficial burns affecting the epidermis and partial-thickness burns extending into the dermis. The severity depends on temperature, duration of contact, and area affected.
The temporal relationship shows an acute occupational thermal burn injury occurring during cooking duties as a military chef on 13 Mar 2014, representing a direct occupational hazard of military kitchen operations.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 13 Mar 2014 during cooking duties when he spilled boiling water on his forearm. [Chart Review - STEPHAN MACKENZIE.docx, Right Hand timeline]
When did the veteran first present to a health / medical provider for this condition? 13 Mar 2014 to Emergency Department staff for assessment and treatment of thermal burns. [Chart Review - STEPHAN MACKENZIE.docx, Right Hand timeline]
When was the condition confirmed / formally diagnosed? 13 Mar 2014 by Emergency Department staff through clinical examination, with follow-up confirmation 14 Mar 2014 by Military Medical Personnel. [Chart Review - STEPHAN MACKENZIE.docx, Right Hand timeline]
When did the veteran first present to you (or your practice) for this condition? 12 Jun 2018
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed by Emergency Department staff and Military Medical Personnel through clinical examination of the thermal burn injury. The burn was described as palm-sized, stretching more than a hand's width from wrist to near elbow, with areas that had turned white indicating deeper tissue involvement. Follow-up assessment revealed superficial light red areas with white zones, 03/08 pain, no signs of blisters or broken skin, and no purulent discharge. Treatment included tetanus booster, specialized wound dressing, and wound care education. [Chart Review - STEPHAN MACKENZIE.docx, Right Hand timeline]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Factor 9(1) - having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn - MET
- The veteran had direct exposure to 95-degree boiling water while performing cooking duties, which caused immediate thermal burn injury with erythema and tissue damage at the affected area of the right hand and forearm.
This thermal burn injury is directly causally related to military service through occupational exposure to heat sources during cooking duties as a military chef. The incident occurred while performing assigned military duties involving food preparation, representing a clear occupational hazard of military kitchen operations. The veteran was engaged in cooking dinner as part of his military chef responsibilities when the accidental spill of boiling water occurred.
Sequelae
This condition is not a sequelae of another known condition but represents primary occupational thermal burn injury during military cooking duties.
Unintended Consequence
This condition is not an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
There is no evidence of inability to obtain appropriate clinical management for this condition. The thermal burn was appropriately and promptly treated with emergency department assessment, tetanus booster, specialized wound dressing, and follow-up care with wound management education. The factor is NOT MET.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
