When the Story Doesn’t Match the Burn: EMS Guide to Recognizing Non-Accidental Burn Injuries

FieldBrief Issue 2
Published June 11, 2026

When the Story Doesn’t Match the Burn: EMS Guide to Recognizing Non-Accidental Burn Injuries

Anna Becks, MSN, RN, SANE-A is a Forensic Unit Manager in the MetroHealth Main Campus Emergency Department. She shares her expertise on this important topic – what to look for and how to document signs of abuse.

Burn calls are common for EMS and first responders, but not every burn is accidental. Some burn injuries may be linked to child abuse, elder abuse, domestic violence, neglect, human trafficking or other forms of victimization.

Your role is not to determine whether abuse occurred. Your role is to recognize when the injury, history, scene or patient presentation does not fit, provide appropriate care, document objective findings and communicate concerns to the receiving emergency department.

In Ohio, first responders who have reasonable suspicion that a child is being abused or neglected are mandated reporters and are legally required to report their concerns to the appropriate child protective services or law enforcement authorities. Proof of abuse is not required; reasonable suspicion alone is sufficient to trigger the duty to report.

Look at the full picture: the patient, the injury pattern, the reported history, the scene and the timing of care.

Potential warning signs include:

• A history that differs between the patient, caregiver or witnesses
• An explanation that does not match the patient’s age, abilities or injury pattern
• Burns involving the hands, feet, genitals, buttocks, inner thighs, back or other protected areas
• Burns shaped like a specific object, such as a cigarette, iron or lighter
• Clear lines of demarcation
• Delayed medical care
• Immersion-type scald burns
• Multiple injuries in different stages of healing
• Scene details that do not support the reported cause of the injury
• Symmetrical burns on both hands, feet, legs or buttocks

Use calm, objective questions to understand the reported cause of the injury. Examples:

• Can you tell me what happened?
• Do you feel safe where you are?
• Has anything like this happened before?
• How long ago did this happen?
• Is there anyone you don’t want with you right now?

Documentation should be factual, objective and specific. Include:

• Burn location, size and appearance
• Injury characteristics and patterns
• Other visible injuries
• Patient and caregiver behavior
• Relevant scene observations
• The patient’s exact words, when possible
• The reported cause of the burn
• Time of injury and time care was sought

Speak calmly. Explain what you are doing before touching the patient. Create privacy when safe. Avoid confrontational or “why” questions. Preserve the patient’s dignity and sense of control whenever possible.

Early recognition can change the course of care for a victim who may not yet be ready, safe or able to speak for themselves.

If you have questions or would like more information on how to care for people with non-accidental burns, please contact me at [email protected].