Treating Patients with Burn Injuries

Classifying burns and basic treatment

Toni Milan, BSIT, Paramedic, Respond Right EMS Academy

Patients with burn injuries require special attention to properly assess the injury and provide the appropriate emergency care.  As and EMT or paramedic it is important to understand the type of burn and how they affect all age groups.

A person’s skin has three layers: the epidermis, the outermost layer; the dermis, the second layer which contains small capillary beds and sensory structures; and the hypodermis (or subcutaneous layer), which is composed of fatty connective tissue containing larger blood vessels.

Burns are classified according to the depth of the burn.  First-degree burns are superficial involving on the epidermis.  These burns tend to be very painful due to the pain receptors that are still intact in the underlying dermis.  Superficial burns are commonly caused by a flash, hot flame, hot liquid or the sun.  This type of burn will present with dry, pink and/or red skin.  The skin will be soft and tender to touch.

Second-degree burns, or partial-thickness burns, involve the epidermis and portions of the dermis.  These burns will tend to cause pain for the patient since the pain receptors are still intact.  Partial-thickness burns are further classified by superficial and deep.  Superficial partial-thickness burns can be caused by hot liquids or objects, chemical substances, or the sun.  The patient will present with moist, pink skin.  Thin-walled blisters will be visible and the skin will be soft and tender to touch.  Deep partial-thickness burns will present with thick-walled blisters that will often rupture.  The patient may complain of decreased pain if the pain receptors in the dermis have been damaged.  The skin will be red and blanched white.

Third-degree, or full-thickness, burns involve all layers of the skin.  This type of burn will usually not cause much pain for the patient because the nerve endings have been destroyed.  Full-thickness burns can result from contact with extreme heat, contact with certain chemicals or electricity.  The patient’s skin will be white, waxy to dark brown or black and will be dry, hard, and tough.

Fourth-degree burns can be categorized as burns that extend completely through all layers of the skin, into the tendons, ligaments, muscle, bone, blood vessels, and nerves.  A common cause would include electrical burns.

Treating a patient with burns requires determining the severity of the burn and maintaining a patent airway with adequate ventilation and oxygenation.  Most burn patients who die in the pre-hospital setting will die from an occluded airway, toxic inhalation, or other trauma. ¹

A general basic protocol for managing burn injuries is as follows:

1. Remove the patient from the source of the burn and stop the burning process.
2. Establish and maintain an airway, adequate breathing and oxygenation.
3. Classify the severity of the burn and transport immediately if critical.
4. Cover the burned area with a dry sterile dressing.
5. Keep the patient warm and treat for other injuries as needed.
6. Transport the patient to an appropriate burn facility.

There are certain criteria that make a burn a critical burn.  Keep the following criteria in mind and make sure to transport these patients to the appropriate burn center:

• Full-thickness burns involving hands, feet, face, eyes, ears, or genitalia.
• Burns associated with the respiratory tract.
• Full-thickness burns covering more than 10% of the body surface.
• Partial-thickness burns covering more than 25% of the body surface area in adults.
• Partial-thickness burns greater than 20% in children less than 10 years old and adults more than 50 years old.
• Chemical burns or high-voltage electrical burns.
• Burns complicated by fractures or major trauma.
• Moderate burns in young children or elderly patients.
• Circumferential burns to any body part, such as arms, legs, or chest.

Make sure to always follow your local protocol set forth by your medical director.

If you are interested in learning more about becoming an EMT or paramedic contact Respond Right EMS Academy at 314-713-1645.

1.  Prehospital Emergency Care, 10th Ed, Mistovich, J, Karren, K, Hafen, B