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There are an estimated 1.2 million burn injuries per year in the United States. Of these, 50,000 patients are hospitalized and 4500 fire-related deaths occur. According to the 2012 Burn Repository Data, encompassing cases from 2002 to 2011, approximately 70% of patients who required admission were men with a mean age of 32 years. Children under 5 represented 19% of cases while patients older than 60 accounted for 12% of admissions. The overall mortality rate was 3.7%.1

Risk factors for mortality from burn include age greater than 60, burn greater than 40% BSA, and the presence of inhalation injury. Mortality was 0% with zero risk factors, 3% with one risk factor, 33% with two risk factors, and 90% with all three risk factors.2 A variety of types of injury can result in a burn, requiring some variation in management strategies.


  • List types and causes of thermal, chemical, and electrical injuries.

  • Describe the initial prehospital evaluation and management of thermal injuries.

  • Describe the initial prehospital evaluation and management of exposure to acids and bases.

  • Describe the initial prehospital evaluation and management of electrical injuries.

  • Describe the initial prehospital evaluation and management of blast injuries.



The depth of injury is generally a function of pressure, temperature, and time of exposure. Contact burns can occur from contact with an extremely hot surface, usually for a brief period of time. These are most often occupational injuries. However, prolonged exposure to lower temperature objects can also cause deep tissue burns and generally occur in elderly patients or those with epilepsy.3 First-degree burns are limited to the epidermis and cause erythema and pain similar to sunburn. Blisters do not form. Second-degree burns, also known as partial-thickness burns, involve epidermis and dermis. Blisters form early and if the area is denuded, the underlying dermis will be red and moist due to enhanced blood flow to this layer. The dermis will also retain its elasticity. Since nerve tissue remains viable, pain and proprioception remain intact. Third-degree burns, also known as full-thickness burns, involve all skin layers. The dermis will become charred and tough with the texture of leather. Sensation will be absent since the nerves are burned and the skin loses elasticity. Fourth-degree burns involve all skin layers and muscle or bone (Figure 58-1). These are usually seen in patients who were trapped or unconscious at the time of injury.

FIGURE 58-1.

Depth of injury. (Reproduced from Hettiaratchy S, Papini R. Initial management of a major burn: II – assessment and resuscitation. BMJ. 2004;329(7457):101-103. With permission from BMJ Publishing Group, Ltd.)


Of particular importance to EMS physicians ...

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