Burn Assessment Essentials

Why This Is Hard

Burns distract with dramatic skin findings while the airway swells silently and hypothermia creeps in. Early priorities are stop the burning process, protect airway, prevent hypothermia, estimate size, and choose the right destination — not perfect Lund-Browder artistry on scene.

Immediate Priorities

1. Scene safety (fire, electrical, chemical).
2. Stop the burning: extinguish, remove smoldering clothes/jewelry, chemical brush/flush per type and protocol.
3. Airway: soot, singed hair, hoarseness, enclosed space — early advanced airway readiness.
4. Breathing/circulation; CO/cyanide thinking in structure fires per protocol.
5. Cool small burns briefly with cool water per training; avoid prolonged wet cooling that causes hypothermia on large burns.
6. Dry clean dressings / burn sheets; keep warm.
7. Pain control per protocol.
8. Estimate TBSA (rule of nines / palm method education tools) for handoff and fluid pathways if authorized.

TBSA Themes

• Count partial- and full-thickness areas that matter for resuscitation thresholds — know what your system counts.
• Palm of patient ≈ 1% teaching aid for scattered burns.
• Overestimation is common — be honest for the burn center.

Key Points for Paramedics

• Electrical burns: look for entrance/exit, cardiac monitoring, hidden deep injury.
• Circumferential chest burns can restrict ventilation.
• Pediatric and elderly thresholds for burn center differ — know referral criteria themes.

Field Pitfalls

• Ice directly on burns; prolonged wet sheets on large TBSA.
• Missing airway edema after “they were talking at first.”
• Forgetting CO exposure in house fires.

Practice

Estimate TBSA on a paper diagram with a partner and compare. Related: Difficult airway.

Sources & Further Study

• ABA burn center referral education themes; your burn protocol.