whether heat or cold, causes injury to skin, tissues,
blood vessels, vital organs, and, in some cases,
the whole body. In addition, contact with the
suns rays, electrical current, or certain chemicals
cause injuries similar in character to burns.
True burns are generated by exposure to ex-
treme heat that overwhelms the bodys defensive
mechanisms. Burns and scalds are essentially the
same injury, burns being caused by dry heat, and
scalds by moist heat. The seriousness of the in-
jury can be estimated by the depth, extent, and
location of the burn, the age and health of the
victim, and other medical complications.
Burns can be classified according to their
depth as first-, second-, and third-degree burns,
as shown in figure 4-71. With a first-degree burn,
the epidermal layer is irritated, reddened, and
tingling. The skin is sensitive to touch and
blanches with pressure. Pain is mild to severe.
Edema is minimal. Healing usually occurs natu-
rally within a week.
A second-degree burn is characterized by
epidermal blisters, mottled appearance, and a red
base. Damage extends into, but not through, the
dermis. Recovery usually takes 2 to 3 weeks, with
some scarring and depigmentation. This condi-
tion is painful. Body fluids may be drawn into
the injured tissue, causing edema and possible a
weeping fluid (plasma) loss at the surface.
Third-degree burns are full-thickness injuries
penetrating into muscle and fatty connective
tissues or even down to the bone. Tissues and
nerves are destroyed. Shock with blood in the
urine is likely to be present. Pain will be absent
at the burn site if all the area nerve endings are
destroyed and the surrounding tissue, which is less
damaged, will be painful. Tissue color will range
from white (scalds) to black (charring burns).
Although the wound is usually dry, body fluids
will collect in the underlying tissue and if the area
has not been completely cauterized, significant
amounts of fluids will be lost by plasma weep-
ing or by hemorrhage, thus reducing circulation
volume. There is considerable scarring and possi-
ble loss of function. Skin grafts may be necessary.
Of greater importance than the depth of the
burn in evaluating the seriousness of the condi-
tion is the extent of the burned area. A first-degree
burn over 50 percent of the body surface area
(BSA) may be more serious than a third-degree
burn over 3 percent. The Rule of Nines is used
to give a rough estimate of the surface area
Figure 4-72.Rule of Nines.
affected. Figure 4-72 shows how the rule is ap-
plied to adults.
A third factor in burn evaluation is the loca-
tion of the burn. Serious burns of the head, hands,
feet, or genitals will require hospitalization.
The fourth factor is the presence of any other
complications, especially respiratory tract injuries
or other major injuries or factors.
The corpsman must take all these factors into
consideration when evaluating the condition of
the burn victim, especially in a triage situation.
After the victim has been removed from the
source of the thermal injury, first aid should be
kept to a minimum.
Maintain an open airway.
Control hemorrhage, and treat for shock.
Remove constricting jewelry and articles
Protect the burn area from contamination
by covering it with clean sheets or dry
dressings. DO NOT remove clothing
adhering to a wound.