Burns Thermal/Radiation




  • Exposure to heat/gas/chemical
  • Inhalation injury
  • Time of Injury
  • Past medical history
  • Medications
  • Other trauma
  • Loss of consciousness


Significant Findings:


  • Pain
  • Swelling
  • Dizziness
  • Loss of consciousness
  • Hypotension/shock
  • Airway compromise/distress
  • Singed facial or nasal hair
  • Hoarseness/wheezing




  • Superficial (1st⁰) : red and painful (don't include in TBSA)
  • Partial thickness (2nd⁰) : blistering
  • Full thickness (3rd⁰) : painless, charred or leathery skin
  • Thermal
  • Chemical
  • Electrical
  • Radiation







  • 15% TBSA 2nd/3rd Degree Burn
  • Burns with Multiple Trauma
  • Burns with definite airway compromise
  • When reasonable or reasonably accessible, transport to a Burn Center or Level I Trauma Center






  • 5-15% TBSA 2nd/3rd Degree Burn
  • Suspected Inhalation injury or requiring intubation for airway stabilization
  • Hypotension or GCS < 14
  • When reasonable or reasonably accessible, transport to a Burn Center or Level I Trauma Center




  • < 5% TBSA 2nd/3rd Degree Burn
  • No inhalation injury
  • Not intubated
  • Normotensive
  • GCS>14




  • Oxygen
  • Consider Spinal Immobilization
  • Fly critical and serious burns to a burn center if possible
  • If eye involvement flush with water or Normal Saline for 10-15 min
  • Remove rings, bracelets, and other constricting items
  • Cover Burn with Dry sterile sheet or dressings
  • Protect burns /wounds with sterile dressing; do not attempt to remove clothing that is adhered to the burn area
  • Identify entry and exit sites ; apply sterile dressings
  • Consider 12-Lead EKG


Critical or Hypotensive ?


  • No


    • Notify receiving facility or contact Medical Control


  • Yes




    • Notify receiving facility or contact Medical Control


    • The IV solution should be changed to Lactated Ringers if it is available. It is preferred over Normal Saline.
    • Formula example and a rule of thumb is; an 80 kg patient with 50% TBSA will need 1000 cc of fluid per hour.


Critical or Serious Burns


  • > 5-15% total body surface are (TBSA); 2nd or 3rd degree burns
  • 3rd degree burns > 5% TBSA for any age group
  • circumferential burns of extremities
  • electrical or lightning injuries
  • suspicion of abuse or neglect
  • inhalation injury
  • chemical burns
  • burns of face, hands, perineum, or feet
  • any burn requiring hospitalization.


  • These burns will require direct transport to a burn center, or transfer once seen at a local facility where the patient can be stabilized with interventions such as airway management or pain relief if this is not available in the field or the distance to a Burn Center is significant.




  • Serious, critical, and circumferential burns should be transported directly to a burn center by ATU whenever feasible
  • Burn patients are Trauma Patients, evaluate for multisystem trauma. Most injuries immediately seen will be a result of collateral injury such as heat from the blast, trauma from concussion, etc.. Treat collateral injury based on typical care for the type of injury displayed.
  • Assure whatever has caused the burn, is no longer contacting the injury. (Stop the burning process!)
  • Early intubation is required when the patient experiences significant inhalation injuries.
  • Potential CO exposure should be treated with 100% oxygen and transported to a hyperbaric chamber located at Greenville Memorial.
  • Circumferential burns to extremities are dangerous due to potential vascular compromise secondary to soft tissue swelling.
  • Burn patients are prone to hypothermia - never apply ice or cool burns, must maintain normal body temperature.
  • Evaluate the possibility of child abuse with children and burn injuries.
  • Chemical burns: Remove chemical first if possible. Flush as soon as possible with the cleanest readily available water or saline solution using copious amounts of fluids.
  • Electrical: Attempt to locate contact points, (entry wound where the AC source contacted the patient, an exit at the ground point) both sites will generally be full thickness.
  • If able, identify the nature of the electrical source (AC vs. DC), the amount of voltage and the amperage the patient may have been exposed to during the electrical shock.
  • Anticipate ventricular or atrial irregularity, to include V-tach, V-fib, heart blocks, etc.
  • Radiation: Determine the exposure type: external irradiation, external contamination with radioactive material, internal contamination with radioactive material. If available, determine exposure (generally measured in Grays/GY).

Critical (RED)

Serious (Yellow)

Minor (Green)