EMS Assessment and Initial
Care of Burn Patients
Guidelines from the
American College of Surgeons and
American Burn Association
By Joe Lewis, M.D.
EMS Assessment and Initial
Care of Burn Patients
Stop Further Injury
A. Remove victim from source.
B. Extinguish or remove buring clothing.
C. Chemical Burns
1. Continuous water rinse or lavage
2. Prolonged eye irrigation scene
3. Remove contaminated clothing
4. Avoid injury wear clothes and PPE
EMS Assessment and Initial
Care of Burn Patients
Maintain ventilation
A. Administer humidified 100% oxygen by mask
to treat possible carbon monoxide poisoning.
B. Examine airway for signs inhalation injury;
1. Singed nasal hairs.
2. Carbonacious material in upper airway.
3. Edema or inflammatory changes in the upper
airway.
EMS Assessment and Initial
Care of Burn Patients
C. Maintain Airway
D. Consider Airway thermal injury if these
signs and symptoms are displayed:
– Difficulty breathing
– Sooty, expectorated sputum
– Strider
– Cough
– Nasal hair or oral mucosa burns
– Hoarseness
– Decreased PaO2: FiO2
EMS Assessment and Initial Care
of Burn Patients
Maintenance of peripheral circulation in patients
with circumferential burns.
A. Remove rings and braclets-give to family.
B. Clinical Signs of impaired circulation:
1. Cyanosis
2. Impaired/delayed capillary filling
3. Progressive neurologic signs: paresthesias and
paresis, i.e numbness and weakness.
4. Doppler extremity pulses.
EMS Assessment and Initial
Care of Burn Patients
Physical Examination
A. Check for associated injuries.
B. Estimate extent and depth of burn
-Rule of Nines- Childs head is
disportionately larger than adult head.
C. Estimate weight of the patient.
EMS Assessment and Initial Care of
Burn Patients
Initial Burn Wound Care
A. Clean and debride loose tissue.
B. For small burns <15% BSA use moist sterile
dressings.
C. For serious or large BSA burns use dry dressing
to avoid hypothermia.
D. Commercial burn dressing are great but a
standard hospital sheet works as well
E. Cover burns with dry sterile dressing or cover
with a clean sheet.
EMS Assessment and Initial
Care of Burn Patients
History
A. Circumstances of injury
B. Pre-existing illness
C. Medications
D. Allergies
E. History of enclosed space fire?
F. History of alcohol or drug use?
Adult Rule of Nines
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􀁺
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Head and neck 9%
Front torso 18%
Back torso 18%
Upper extremities 9% Each
Lower extremities 18% Each
Genitalia 1%
􀁺 Total 100%
Rule of Nines
Pediatric Rule of Nines
􀁺 Head and Neck 18%
􀁺 Front torso 18%
􀁺 Back torso 18%
􀁺 Upper Extremities 9%
􀁺 Lower Extremities13.5% each
􀁺 Genitalia 1%
􀁺 Total 100%
Severity of Burn Injury
1. Superficial or First Degree
– Epidermis
– No Blisters
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2. Partial Thickness or Second Degree
– Deeper dermal layers
– Blisters
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3. Full Thickness or Third Degree
– Full skin thickness
– Charring
4. Full Thickness
– Full thickness involving bones and muscles
Superficial Partial Thickness
Deep Partial Thickness
Deep Full Thickness
Determining Criticality of Burns
Minor - Superficial burns and small partial
thickness burns <15% BSA
Moderate - Partial thickness of >15%-30% BSA
small full thickness burns
Severe Partial thickness of >30% BSA + Full
Thickness >15% BSA
Burns to hands, feet, face, genital or with
circumferential patterns are critical
Inhalation injuries are always critical
Carbonacious Sputum
EMS Assessment and Initial Care
of Burn Patients
Intravenous Fluid Therapy
A. Required by patients with burns greater then
20% of total body surface.
B. Secure large bore IV in good vein.
C. Estimate fluid needs for 1st 24 hours postburn
D. Administer 1/2 of calculated volume in 1st 8hrs.
Calculations: Adults 2-4ml LR x weight in kilogram x
percent burn = 24 hour requirement. Children less
then 4 ml/kg/% plus maintenance fluids.
EMS Assessment and Initial Care
of Burn Patients
Analgesics per local protocol, currently none at
Schofield, but you could wait for City and County
and after they treat pain, you could transport, if they
agree.
EMS Assessment and Initial Care
of Burn Patients
Burn Center Criterion
Burn Size > 20% BSA in Patient <10 and > 50
Third degree Burn > 5% BSA
Airway or Inhalational Injury
Carbon Monoxide > 15%
Electrical or Lightening Injury
Deep Burns face, hands, feet, perineum or major
joints- hip. knee. elbow