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BURN EMERGENCIES
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Layers of Skin
Epidermis - outermost layer of skin
Dermis - second layer
Subcutaneous layer - innermost layer
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Skin/Function
Protective barrier against infection and bacteria
Insulates and protects body organs from injury
Aides in body temperature regulation
Provides sensation transmission (cold, hot, pain,
and touch)
Waste elimination


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Airway, Breathing and Circulation
Most burn patients who die in the
prehospital setting will die from an
occluded airway, toxic inhalation, or other
trauma, and not from the burn itself.
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Classifying Burns by Depth
Superficial
Partial thickness
Full thickness
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Superficial Burns
1st-degree burn
Involves only epidermis
Sun burn, flash burn
Skin appearance
Pink to red, dry
Slight swelling, no blisters
Can be very painful, several days to heal
Not much emergency care required for small areas

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Partial Thickness Burn
2nd-degree burn
Involves epidermis and dermis
Caused by direct contact
Skin appearance
White to cherry red, moist, mottled
Damage to underlying vessels cause plasma and tissue
fluid to leak which form blisters
Intense pain resulting from nerve-ending damage

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Full Thickness Burns
3rd-degree burn
Involves all layers of skin
Can extend to muscle, bone or organs below
Contact with extreme heat
Skin appearance
White and waxy, dark brown or black and charred
Dry, hard, tough, and leathery (eschar)
3rd-degree burns may not be painful at all due to
destruction of nerve endings.
Be aware of partial thickness burns around the site that will
be painful

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Determining Severity of Burns
Classified as
Critical
Moderate
Minor
See chart on page 583
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Body Surface Area Percentage
Used to quickly determine the amount skin
surface or body surface area percentage of a
burn
Rule of nines-larger areas
Rule of palm-smaller areas
See page page 553
Remember these methods are estimates only
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Burn Injury Location
Face - airway compromise
Hands and feet - loss of function
Genitalia, groin - loss of genitourinary
function increase for infection
Circumferential burns
Encircle a body area
Circulatory compromise, nerve damage results
from constriction and swelling tissues
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Age & Preexisting Medical Conditions
Children under 5
Larger skin surface in relation to body mass
Potential for greater fluid and heat loss
Growth impairment
Adults over 55
Prolonged healing process
Underlying medical conditions may affect
response to burn injuries
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Assessment
Scene size-up
Stop the burning process (within first 10
minutes of injury)
Initial assessment
Attempt to remove any smoldering clothing or
jewelry
Do not remove article that are adhered to the
skin
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Do not keep burn immersed more than 2 minutes
(hypothermia)
Frightened burn victims first reaction is to inhale
deeply
Provide Big Os NRB mask (breathing
adequate)
BVM if inadequate
Assess circulation, determine BSA % and make a
transport decision
Assessment Cont..
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Treat for shock (Hypovolemic)
Reassess MOI
Begin focused history and physical exam
Alert - focused trauma assessment
Altered mental status, evidence of additional
injuries, rapid trauma assessment
Assess for any DCAP/BTLS
Remember to remove clothing as you go

Assessment Cont..
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Obtain SAMPLE history
Patient
Family
Bystanders
See questions on page 555
Assessment Cont..
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Signs & Symptoms of Superficial Burns
Pink or red, dry skin
Slight swelling
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Signs & Symptoms Partial Thickness Burns
White to cherry red skin
Moist and mottled skin
Blistering and intense pain

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Signs & Symptoms Full Thickness Burns
Dry, hard, tough, leathery skin that might
appear white-waxy to dark brown or black
and charred (eschar)
Inability to feel pain
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Inhalation Injuries
Singed nose hair
Facial burns
Burned specks of carbon in the sputum
Sooty or smoky smell on the breath
Respiratory distress accompanied by restriction of
chest wall movement, restlessness, chest tightness,
stridor, wheezing, difficulty in swallowing,
hoarseness, coughing, and cyanosis
Presence of actual burns of the oral mucosa
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Emergency Medical Care
Remove patient from source of burn and stop the
burning process
Assess mental status and apply Big Os
Classify severity of burn and make transport
decision
Cover area with dry sterile dressing
Other EMS Services 10% or less moist dressing
Keep patient warm and treat for shock or other
injuries
Transport to appropriate facility
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Special Considerations for Dressing a Burn
Use sterile burn sheet or white clean sheet
Never apply ointments, lotions, or antiseptic
to burns
Never attempt to break or drain blisters
Contamination
Fluid loss
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Burns of Hands and Toes
Remove all jewelry
Separate all digits with dry sterile dressings
Try to place hands in a position of function
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Burns to the Eyes
Thermal burn do not force open the eyes
Apply dry sterile dressing to both eyes and
bandage in place
Chemical burns
Flush with copious amounts of water for at
least 20 minutes
Flush from medial to lateral
Perform detailed physical exam
Perform ongoing assessment

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Chemical Burns
Protect yourself first
Dry chemicals such as lime should be
brushed off first before applying water
Flush chemical burns with copious amounts
of water ( be sure to consult Haz-mat guide
book)
Make sure fluid runs away from injury
Continue to flush while en route to hospital

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Electrical Burns
Can cause severe damage
Will always flow to ground seeking the path of
least resistance to exit the body
Can cause irregular heartbeats or cardiac arrest
Always assume the electrical source is still
charged
Never attempt to remove patient from electrical source
Never touch patient still in contact with electrical
source
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Emergency Care
Big Os
Monitor for cardiac arrest (AED)
Assess for twitching or seizure activity
Look for entrance and exit wound
Transport as soon as possible
Always assume critical injuries
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Circulatory System
Stress to heart
Increased capillary permeability
Decrease in fluid volume
Edema
Hypovolemic shock (hypoperfusion)
15 liters of fluid needed for a full or partial
thickness burn victim with a BSA of 50% in the
first 24 hours
NPO

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Respiratory System
Swelling
Fluid accumulation in lungs
Smoke inhalation
Circumferential burns to chest, restricts
expansion
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Renal System
Decreased blood flow to kidneys
Decreased urinary output
Waste formation in blood due to cell
destruction
Blockage in kidney may result
All or part of kidney forced to stop
functioning or die
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Nervous & Musculoskeletal System
Destruction of nerve endings causing loss of
function
Joint dysfunction due to scarring
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Gastrointestinal System
Nausea and vomiting due to shunting