Let's talk BURNS · Rescue Academy

Let's talk BURNS

Burn Depth

Burns are classified by how deep they go into the skin.

Superficial burns, or 1st-degree burns, affect only the outer layer of skin. They are red, dry, painful, and do not have blisters. A sunburn is a common example.

Partial-thickness burns, or 2nd-degree burns, involve the epidermis and part of the dermis. These burns are usually red or pink, moist, blistered, swollen, and very painful.

Full-thickness burns, or 3rd-degree burns, destroy the epidermis and dermis. They may appear white, waxy, leathery, brown, or charred. These burns may have little or no pain in the center because the nerve endings are destroyed.

Major Burn Concerns

EMS providers should focus on stopping the burning process, assessing the airway, supporting breathing and circulation, estimating burn size, covering burns with dry sterile dressings, preventing hypothermia, and transporting to the appropriate facility.

Inhalation Injury

Inhalation injury should be suspected with facial burns, singed nasal hairs, soot in the mouth or nose, hoarseness, stridor, black sputum, or burns from an enclosed-space fire. Airway swelling can worsen quickly, so early recognition is critical.

Rule of Nines

The Rule of Nines is used to estimate the percentage of body surface area burned in adults. The adult body is divided into sections such as the head, arms, trunk, legs, and groin. For burn calculations, only partial-thickness and full-thickness burns are counted. Superficial burns are not included.

Parkland Formula

The Parkland formula estimates fluid needs for major burns:

4 mL × body surface area burned × weight in kg = total fluid for the first 24 hours

Half of that amount is given in the first 8 hours from the time of the burn, and the other half is given over the next 16 hours.

Burn Shock

Large burns can cause fluid to shift out of the bloodstream and into the tissues, leading to hypovolemic shock. Signs may include tachycardia, weak pulses, anxiety, delayed capillary refill, cool skin, and late hypotension.

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