What happens after people set themselves on fire?

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It is a horrific and arresting tactic for protesters trying to get attention to a cause: Setting themselves on fire.

Buddhist monks have set themselves alight in Tibet to protest for religious freedom. Jobless Moroccans reportedly ignited during protests over lack of opportunity in the North African nation.

The Arab Spring protests began after a Tunisian street vendor set himself on fire after sparring with local authorities. And in Moscow, a woman set herself on fire in front of Russian government headquarters this week, her reasons unknown.

We often see the headlines about people around the world setting themselves on fire. But what happens afterward? Nicole Bernal, acting director of the UC Irvine Regional Burn Center, walked us through it.

What happens to the body when it is set on fire?

As you can imagine, it’s an excruciatingly painful thing to go through. Your skin is burning.

After about an hour or two, the body has a wonderful way to protect itself. It kind of walls off the pain. It’s basically adrenaline. Your body goes into a certain amount of shock. Once the burn becomes severe, it’s burned down to the nerves so you don’t initially have any sensation in those burned areas. Then the adrenaline kicks in. It’s our mind’s way to protect us from the tragedy that we went through.

If they make it through, recovery is a very painful process with all the skin grafts and multiple surgeries.

What gets damaged when you undergo a severe burn?

There’s this huge inflammatory response caused by the burned skin. Your body reacts to that by shunting all blood and fluid to that area. But because your skin would normally hold in your body fluid, it leaks out everywhere. If you’re not taken to a burn center, which can replace that fluid, you basically die of shock from loss of fluid inside your vessels.

If you look at the palm of your hand, that is 1% of your total body. For an adult, your body will start to have this inflammatory response as soon as more than 25% of the body is burned. It’s as little as 10% for a pediatric patient. The ones that are the most sensitive to these fluid shifts are pediatric patients and patients over the age of 60.

The optimal age where we get the best outcomes are patients from the age of 20 to 50. If you have any other kind of medical problem -- if you’ve had any heart problems, diabetes, any of those things, your body is not prepared, does not have the reserves to take this kind of stress.

In many of these cases, people are putting gasoline or some other kind of accelerant on before lighting a match. How does that affect their injuries?

If they’re doing it on top of clothing, the fire is going to burn hotter and cause a much deeper burn. A lot of times that leads to amputations of extremities, like the hands and the feet.

If someone does survive, what health problems would they face later in life?

It all depends on the percentage that’s burned. Lets say someone that has a 50% burn, they can expect probably an initial hospitalization of about three months and probably 10 to 15 surgeries.

The first surgeries they have, we literally have to cut away all the burned material. I would say for the first two to three weeks you’re completely asleep on the ventilator. That burned skin is causing an inflammatory reaction in the body. If we can get all of the burned tissue cut away in the first five days, we can improve survival tremendously. You prevent that tissue from getting infected.

Then we put a temporary covering on, which is typically donated cadaver skin. You have to put some kind of covering over the wounds to prevent an infection until we can take the patient’s own skin and do a skin graft.

A skin graft is a skin transplant -- taking healthy skin from another part of body, just the top layer. The top layer can always grow back. It’s like creating a really bad rug burn. Every time we do the surgery, what everyone says hurts more than anything is the donor site [where we remove skin to cover the burned area], because that’s where the nerves are still intact.

There are other countries where they don’t have tissue banks like we do. In Egypt, for instance, they do use live donors instead, but the skin will always be rejected [by the body].

You need a minimal amount of unburned skin to make a skin graft. If burns are worse than 80%, we can take a biopsy and grow their skin. It’s really cool. It’s allowed us to save lives. Hopefully in the future we’ll be able to grow skin that nobody reacts to, without doing a biopsy.

How has burn treatment changed in the last 10 years?

The biggest thing that’s led to more survival is early excision -- getting those burns excised or cut away within the first week. That can stop the inflammatory response in the body.

What are the chances of survival from a severe burn like this?

If 80% or less of your body is burned and you’re 40 years or younger, we can give you about a 50/50 chance of survival. If you get more than 80% burned or are older, your survival rate drops immediately to only 20%.

A lot depends on if they can get to a burn center in the first four hours, getting that fluid into them so they don’t go through severe dehydration. If you don’t get it started right away, their kidneys stop, their heart stops.

What are the most common causes of severe burns here in Southern California?

One thing that’s unique to the Southern California area is that a lot of the pediatric cases are contact burns from hot coals and fires and things left out on the beach. You wouldn’t be doing anything like that in Iowa.

When we look at everything else, it’s anything from gasoline explosions -- say from people working on cars -- to house fires. And you do have the occasional self-inflicted burn, usually a psychiatric patient. I can say in the last year, we’ve seen one or two cases.

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Woman in Moscow sets self ablaze

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Video said to show jobless Moroccans setting themselves on fire

-- Emily Alpert in Los Angeles