Preventable Sun Burn Injuries

By Mary Lee Johnston, Staff Safety Writer

SANTA CRUZ DESK - Nancy, the new lifeguard was just hired four weeks into camp and tried to catch up to other waterfront staff in the tanning department. The first day out, she wore an SPF 4 tanning gel and burned to a crisp. She spent the next two days in the health center under cool packs, moaning.

Cabin Three's 12-year-old boys had an overcast day for their afternoon hike. The campers applied their own sunscreen, some in the shape of funny faces, others missed key areas like ears, knees, and cheekbones. The lack of sunshine made sunscreen seem less important - until they tossed and turned at lights-out with irritable, itchy sunburned blotches.

'Sunburn is a preventable injury' says Linda Erceg, RN, Concordia Language Villages, Minn., who holds her staff as accountable for sunburns as other injuries.

Why is sunburn a big deal?

Sunburn indicates a person has been overexposed to the sun. Overexposure is dangerous for a number of reasons. The immediate concerns might be dehydration, sun/heat, and scarring depending on the severity of the burn. An even greater concern is the long-term effect of a severe sunburn, namely skin cancer.

Malignant melanoma is a life-threatening, relatively rare form of skin cancer. According to the Environmental Protection Agency, it takes only two severe sunburns for a child's chances of developing melanoma later in life to double. In 1994, approximately 32,000 new cases of melanoma were detected, 6,900 people died from this skin cancer.

More common forms of skin cancer are basal-cell carcinoma (BCC), which usually does not spread to other organs but can extend below the skin to the bone. Squamous-cell carcinoma (scc) is the second most common and tends to spread more often. The cure rate for both BCC and SCC is 95 percent or better with early detection.

Most people associate skin cancer with lying out in the sun for hours each day. While sunbathing is certainly not a healthy activity, skin cancer is actually more associated with recreational and sporadic sun exposure.

According to the Skin Cancer Foundation, 50 to 80 percent of lifetime sun exposure occurs before age 18. Regular use of Sun Protection Factor (SPF) 15 sunscreen during childhood can reduce by 78 percent the incidence of the most common types of skin cancer.

Protection and prevention

The first step to protecting staff and campers from sunburn (or any injury) is to educate them. Nancy should have applied an SPF 15 sunscreen or a sunblock several times that day. Was sunscreen available? Is there a camp-wide policy (not just waterfront) concerning sunscreen? Does Nancy understand why it's important?

Who supervised the application of sunscreen to campers in Cabin Three before the hike? How long was the hike? Should sunscreen or sunblock have been reapplied?

Getting in the habit of using sunscreen or sunblock, no matter what the outdoor activity or how sunny the day, is crucial to preventing sunburn at camp. If campers are too young (or irresponsible) to apply it themselves, have staff apply it for them. Staff should apply it to their own hands first then rub it on the campers' skin. Don't forget the following extra sensitive areas:

• scalp (swab sunscreen along the part in the hair)
• areas around the eyes (special products are made for the eye area)
• nose and cheek bones
• ears
• lips
• hands
• back of neck and shoulders
• knees and feet.

Safe sun recommendations from the American Academy of Pediatrics:

• Use a sunscreen with an SPF of 15. Apply the sunscreen liberally and often during hours of exposure.
• For nose and shoulders, use zinc oxide for a complete physical block. (It comes in bright colors campers love.)
• Schedule outdoor activities before 10 a.m. and after 3 p.m.
• Use protection on cloudy days too. Nearly 80 percent of the sun's radiation can reach campers under an overcast sky.
• Use extra caution around reflective surfaces, such as water, sand or cement.

Other things to think about:

• Are campers taking medications that make them more sensitive to the sun?
• Radiation increases by 4 to 5 percent with every 1,000 feet above sea level.
• The closer you are to the equator, the stronger the sun's rays.

Does your camp offer family programs such as infant swim? Remember:

• Keep babies under 1 year of age out of the sun as much as possible.
• Don't use a sunscreen with an SPF of 4 or more on babies under 6 months old.

Products

The level and ingredients of sunscreen or sunblock are as important as using it. The purpose of any sun product is to protect the skin against the harmful ultraviolet (UVB and UVA) rays of the sun. Sunburn is primarily caused by UVB rays, which are most intense during peak sunlight hours (10 a.m. to 3 p.m.).

UVA rays also contribute to skin damage and are constant throughout the day and seasons. The Sun Protection Factor (SPF) number on sunscreen tells you how much protection you get against sunburn. When you check labels, look for oxybenzone, which protects against UVB plus short UVA rays, and avobenzone which shields against long and short UVA rays.

Chemical sunscreens absorb UV radiation well but may cause allergic reactions. Physical sun blockers (products with titanium dioxide) stop and reflect rays like a mirror and are generally nonirritating.

Another product to consider is a Sun Alert Ultraviolet Warning Badge. The single-use, waterproof sticker is applied after sunscreen to skin or to clothing, and changes color to signal when to reapply sunscreen or stop exposure.

How long is too long?

The EPA, the National Weather Service and the National Oceanic and Atmospheric Administration have developed a UV index. The index predicts the level of UV radiation in each of 58 cities around the country and gauges it on a scale of 1 to 15 for the peak hours of sun.The lower the index number, the longer the allowed exposure time. If the UV index is 0-2, a person with sensitive skin (pale white to light brown in an unexposed area) can stay in the sun approximately 30 minutes before suffering serious damage. That same person can remain in the sun for 7.5 minutes at a UV index of 8, and for only 4 minutes when the UV index is 15. Are staff members aware of the sun's intensity each day?

Treatment

If all protection and prevention efforts fail, you will most likely have irritable staff and campers to treat.

For a minor sunburn, apply wet compresses of cool tap water three or four times a day. Compresses help to reduce inflammation and swelling. Promote healing with a non-greasy lotion or try a cooling after-sun gel. Drink plenty of water to replace fluids lost.