As the weather warms, get a refresher on how to handle severity, depth and special populations when it comes to burn care.
FieldBrief Issue 2
Published June 11, 2026
Burn Basics in the Field
Summer brings an increase in burn injuries from fireworks, bonfires, grilling accidents and other outdoor activities. Here’s a refresher on burn assessment and treatment in the field.
“Emergency providers should continue to follow Advanced Burn Life Support protocols from the American Burn Association, as well as regional protocols,” says Stacy Cantale-Thomas, APRN-CNP, burn specialist at MetroHealth. “As a certified burn center, we are always happy to share more guidelines and what we do in our practice to support field teams.”
Assessing Burn Injuries in the Field
Determining burn depth and severity can be challenging on scene. Burns often continue to evolve during the first 24 to 72 hours, making early assessments difficult.
As with any patient encounter, start with the ABCs and address immediate life threats first.
During your assessment, consider:
- Burn depth
- Total body surface area (TBSA) affected
- Mechanism of injury
- Associated traumatic injuries
- Signs of inhalation injury
Patients injured in explosions, structure fires or motor vehicle crashes may have traumatic injuries in addition to burns.
“Don’t get distracted by the burn itself,” Cantale-Thomas says. “Continue your primary assessment and look for other injuries that may require immediate intervention.”
Initial Burn Treatment
Before transport, identify and remove the source of injury whenever possible. Then focus on preventing further tissue damage and stabilizing the patient.
Depending on the mechanism of injury, field treatment may include:
- Removing the patient from the source of heat
- Stopping the burning process
- Removing smoldering clothing and jewelry
- Flushing chemical burns with copious amounts of water
- Removing chemical contaminants as quickly and safely as possible
- Covering burns with clean, dry dressings
- Establishing IV access for fluid administration when indicated
- Providing pain management according to protocol
Avoid applying ice directly to burns, which can worsen tissue damage. And avoid fluid overload during burn care. (See Burn Care MythBusters about fluid resuscitation.)
Managing Pediatric Burns in the Field
Pediatric burns can worsen quickly, making prompt assessment and transport especially important.
Providers should also remain alert for signs of abuse or injuries that don’t match the reported mechanism. Compare the reported cause of injury with the wound pattern and information provided by caregivers.
Cantale-Thomas says MetroHealth is seeing an increase in pediatric burns caused by microwave-heated toys filled with gel. When these toys rupture, the hot gel can cause serious second- and third-degree burns.
“These injuries can be worse than families expect,” she says. “The gel retains heat and can continue causing tissue damage as exposure time increases with prolonged contact.”
Cool the burn with water when appropriate but focus on removing as much gel as possible and transporting the patient for further evaluation.
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MetroHealth Medical Center is a State of Ohio Approved Continuing Education Site #1202
Key Takeaways
- Burn depth and severity can be difficult to determine in the field.
- Follow standard ABC assessments and evaluate for additional traumatic injuries.
- Remove ongoing sources of heat or chemical exposure when safe to do so.
- Avoid ice and excessive cooling measures.
- Watch closely for signs of inhalation injury.
