a. First-Degree Thermal Burns.

Treat these burns with running cold water if you reach the burn within the first hour of injury and the total body surface area is less than 10 percent.

Any burn of greater body surface area (BSA) should not be cooled in the field due to the possibility of hypothermia. Burns of greater than 10 percent TBSA should be covered with dry sterile dressings.

b. Second-Degree Thermal Burns.

These burns are treated very much the same as first-degree burns. Leave blisters intact. Start an IV if the second-degree burns cover more than 15 percent of the patient’s body accompanied by first-degree burns covering more than 30 to 50 percent of the body.

c. Third-Degree Thermal Burns.

DO NOT immerse such burns in cold or lukewarm water.

Cover the burn with a dry sterile dressing. Then, cover the casualty with a blanket that will not stick to the burn area. Anticipate problems if the patient has facial burns, has been exposed to smoke or hot gases, has been unconscious in a burning area, coughs up sooty sputum, or has hoarseness, stridor, or a brassy cough.

Evacuate the casualty immediately. If evacuation is delayed, it may be necessary to cleanse the burn area and remove any foreign particles. A topical antibacterial ointment (silver sulfadiazine is preferred) can be applied well after the burning process has stopped. This step will usually not be done in the pre-hospital setting.

NOTE: A major problem in the severely burned patient is acute gastric distention. If the patient is intubated, insert a nasogastric tube to decompress the stomach.

DO NOT attempt to insert a nasogastric tube if the patient is comatose or stuporous and not yet intubated or in a patient who has had severe thermal injury involving the nasopharynx.