Burn Assessment

Why this matters

Burns pull attention to the skin. The airway can still swell. A large wet burn can make the patient cold. Stop the burning. Protect the airway. Prevent hypothermia. Estimate the size. Choose the right destination. You do not need a perfect hospital burn chart on scene.

Clinical sequence

1. Make the scene safe. Think about fire, electricity, and chemicals.
2. Stop the burning. Put out flames. Remove smoldering clothes and jewelry, including rings on burned fingers. Brush off dry chemical, then flush, as the chemical and your protocol require.
3. Watch the airway. Soot in the mouth, singed nasal hair, hoarseness, or an enclosed-space fire means get ready for a difficult airway. Hearing the patient talk once does not clear that risk.
4. Support breathing and circulation. In a structure fire, think about carbon monoxide and cyanide as your protocol directs.
5. Cool smaller thermal burns with cool running water, not ice. First-aid teaching often uses up to about 20 minutes. On a large TBSA, limit wet cooling so the patient does not get cold. Then cover dry and keep them warm.
6. Use dry clean dressings or burn sheets. Keep the patient warm.
7. Treat pain per protocol. This site does not list a milligram dose.
8. Estimate TBSA with the rule of nines or the palm method. Use that number for the handoff and for any fluid pathway your protocol authorizes.

TBSA Themes

• Count partial-thickness and full-thickness burn when you estimate the size used for resuscitation thresholds. Leave out superficial, first-degree burn. That skin looks like sunburn, still has sensation, and has no blisters.
• The patient's palm, including the fingers, is about 1% TBSA. Use it for scattered burns.
• Crews often overestimate size. Give the burn center an honest number.

Key points

• Electrical burns: look for entrance and exit wounds, put the patient on a monitor, and assume deep tissue injury you cannot see.
• A burn that goes all the way around the chest can restrict breathing.
• Children and older adults meet burn-center criteria at different sizes. Know the referral themes your region uses.

Common errors

• Putting ice directly on a burn, or leaving wet sheets on a large TBSA for the whole ride.
• Missing airway swelling after the patient was talking at first.
• Forgetting carbon monoxide after a house fire.

Practice

Related: Difficult airway.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

• NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; your protocol decides
• ABA Guidelines for Burn Patient Referral — inhalation, high-risk anatomy, pediatrics; follow your destination protocol, not a homepage as an order
• AHA 2025 Part 10: Special Circumstances — electrocution and fire-related special resuscitation (cyanide) sit next to burn airway clocks
• Cool running water (not ice) is first-aid evidence for smaller thermal burns, often taught as up to about 20 minutes. Limit wet cooling on large TBSA to prevent hypothermia. Count partial- and full-thickness burn for TBSA resuscitation estimates; superficial/first-degree is usually excluded.
• Your burn protocol and regional burn-center plan.