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Layers of Skin
• Epidermis - outermost layer of skin
• Dermis - second layer
• Subcutaneous layer - innermost layer
• 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

Airway, Breathing and Circulation
• Most burn patient’s who die in the
prehospital setting will die from an
occluded airway, toxic inhalation, or other
trauma, and not from the burn itself….
Classifying Burns by Depth
• Superficial
• Partial thickness
• Full thickness
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

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

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

Determining Severity of Burns
• Classified as
– Critical
– Moderate
– Minor
• See chart on page 583
Body Surface Area Percentage
• Used to quickly determine the amount skin
surface or body surface area percentage of a
• Rule of nines-larger areas
• Rule of palm-smaller areas
• See page page 553
• Remember these methods are estimates only
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
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
• Scene size-up
• Stop the burning process (within first 10
minutes of injury)
• Initial assessment
– Attempt to remove any smoldering clothing or
– Do not remove article that are adhered to the
• Do not keep burn immersed more than 2 minutes
• Frightened burn victims first reaction is to inhale
– Provide Big O’s NRB mask (breathing
– BVM if inadequate
• Assess circulation, determine BSA % and make a
transport decision
Assessment Cont..
• 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..
• Obtain SAMPLE history
– Patient
– Family
– Bystanders
• See questions on page 555
Assessment Cont..
Signs & Symptoms of Superficial Burns
• Pink or red, dry skin
• Slight swelling
Signs & Symptoms Partial Thickness Burns
• White to cherry red skin
• Moist and mottled skin
• Blistering and intense pain

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
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
Emergency Medical Care
• Remove patient from source of burn and stop the
burning process
• Assess mental status and apply Big O’s
• Classify severity of burn and make transport
• Cover area with dry sterile dressing
– Other EMS Services 10% or less moist dressing
• Keep patient warm and treat for shock or other
• Transport to appropriate facility
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
Burns of Hands and Toes
• Remove all jewelry
• Separate all digits with dry sterile dressings
• Try to place hands in a position of function
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

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
• Make sure fluid runs away from injury
• Continue to flush while en route to hospital

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
– Never attempt to remove patient from electrical source
– Never touch patient still in contact with electrical
Emergency Care
• Big O’s
• 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
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

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