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f. Do not pack wounds in ice. Start cooling within 30 minutes of the injury, but
do not continue for longer than 30 minutes. If the burn is 9% TBSA or below, the
cooling can be applied for longer than 30 minutes if needed for pain control.
(Recommendation category 1A) Rosen's Emergency Medicine, Concepts and
Clinical Practice, 5
th
Ed, page 807, Mosby 2002.
g. Elevate burned extremities to minimize swelling. Swelling retards healing and
encourages infection. Have the patient gently and regularly move burned areas as
much as possible.
h. Ibuprofen is probably the best oral over-the-counter analgesic for burn pain
(including sunburn).
i. If you have no ointment or dressings, leave the burn alone. The burn's surface
will dry into a scab-like covering that provides protection.
III. GUIDELINES FOR EVACUATION
Superficial burns, even extensive ones, rarely require evacuation. Although they do not
require urgent evacuation, blistered burns greater than 1% TBSA are difficult to keep
clean in the wilderness and should be evacuated. Partial thickness burns covering less
than 15% TBSA must receive definitive care, but seldom warrant urgent evacuation. Full
thickness burns need definitive medical care to heal best, but do not usually require
urgent evacuation unless they are extensive. Partial thickness and full thickness burns
covering more than 15% TBSA are often a threat to life, requiring urgent evacuation.
Any serious burn to the face or above the nipple line may have burned the patient's
airway, and must be considered an urgent evacuation. Urgently evacuate patients with
deep burns to hands, feet, genitals, eyes, mucous membranes or circumferential burns.
Urgently evacuate chemical and electrical burns.
