Wilderness Medical Society snowmass 2005 Page 197
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Chapter 7
BURN MANAGEMENT
Recommendations are considered Category 1B, except where indicated 1A, by the WMS
Panel of Expert Reviewers
I. GENERAL INFORMATION
The most likely source of major burn trauma in the outdoors is from scalds from hot
liquids. Thermal injuries from stoves, carbide lights and lanterns, hot utensils, and
campfires are generally not extensive. Burns from UV exposure are possible during
cloudy days. UV is more intense at high altitudes and low latitudes and can be enhanced
by reflection from snow, water, and sand.
II. GUIDELINES FOR ASSESSMENT AND TREATMENT
Every aspect of burn treatment depends on assessment of the depth and extent of the
injury. Although this assessment may be an estimate, it is the basis for deciding how the
patient will be treated, and whether evacuation is required, and how urgently.
A. Assessment
(1)Depth: Superficial burns involve the epidermis only. The skin color is red to pale and
no blister forms. Partial thickness burns have blisters in addition to the red discoloration
of the skin. Full thickness burns have a pale or charred skin color and do not have blister
formation. The initial level of pain in a burned area can give a clue as to how deep the
burn is. Partial thickness burns are frequently very painful, deep partial thickness burns
can have little pain, but still have pressure sensation. Full thickness burns are painless and
have no pressure sensation (skin nerves are destroyed).
(2)Extent: Use the Rule of Nines, in which each arm represents approximately 9% of a
person's total body surface area (TBSA), each leg 18% (the front of the leg 9%, and the
back of the leg 9%), the front of the torso represents 18% the back of the trunk 18%, the
head represents 9%, and the groin 1%. For infants and small children, the head represents
a larger percentage (18%) and the legs a smaller percentage (13.5%). For smaller areas,
use the Rule of Palmar Surface: the patient's entire palmar surface (surface of palm and
fingers) equals about 1% TBSA. Only count partial thickness and full thickness burns in
the estimate of total body surface area burned.
(3)Pain: In addition to depth and extent, also include an assessment of pain. Adequate
control of pain is a treatment goal and indicator of the ability to manage a burn wound
while in the wilderness. If you cannot manage the pain, your treatment is inadequate.
(4)Location: Burns to the face, genitals, palms or soles require evacuation.
B. Initial Care:
(1) Stop the Burning Process. The faster the better, within 30 seconds if possible. Heat
can continue to injure tissue as long a material with a temperature above 65°C is in
contact with the skin. No first aid will be effective until the burning process has stopped.
Smother flames, if appropriate, then cool the burn with water with due regard to causing
