Burns and Scalds First Aid: Assessing Severity and Identifying Red Flags

1) Burn depth: what you can see and feel

Burn depth describes how many layers of skin are injured. You do not need medical tools to make a useful first estimate—focus on color, pain, blisters, and whether the skin looks dry/leathery. Depth can be mixed (different areas look different), and burns can worsen over the first 24–48 hours, so reassess.

Superficial (epidermal) burns

• Color: Pink to red, evenly colored.
• Pain: Tender and painful to touch.
• Blisters: None.
• Moisture/texture: Dry surface; may peel later.
• Example: Brief contact with a hot pan edge causing a red, sore patch without blisters.

Partial-thickness burns (involving deeper skin layers)

• Color: Bright red to mottled pink; may look patchy.
• Pain: Often very painful; can be extremely sensitive to air or water.
• Blisters: Common (clear fluid blisters or weeping).
• Moisture/texture: Moist, shiny, or weeping; may look swollen.
• Example: A scald from hot tea that forms blisters within minutes to hours.

Full-thickness burns (through the full skin thickness)

• Color: White, waxy, brown, or charred/black; may have a “marbled” look.
• Pain: May be less painful in the center (nerves damaged), with painful edges.
• Blisters: May be absent; if present, skin may look tough and fixed.
• Moisture/texture: Dry, stiff, leathery; may not blanch (doesn’t turn white then pink when pressed).
• Example: Prolonged contact with a heating pad causing a dry, pale, leathery patch.

Practical tip: If you see a burn that is dry/leathery, white/brown/charred, or oddly not very painful in the center, treat it as potentially full-thickness and prioritize urgent evaluation.

2) Estimating burn size using the person’s palm

Burn size helps determine urgency. A beginner-friendly method is the palm estimate: the injured person’s palm (including fingers) is roughly 1% of their total body surface area (TBSA). This works best for scattered or small burns.

Step-by-step: palm method

1. Identify the area to count: Estimate only the skin that is actually burned (red/blistered/leathery), not the surrounding normal redness from irritation.
2. Use the patient’s hand: Place (or imagine placing) their palm-and-fingers over the burn area.
3. Count “palms”: Each palm-sized area ≈ 1% TBSA.
4. Add separate patches: If there are multiple spots, add them together.
5. Write it down: Example: “About 3 palms total” is useful information to share when seeking care.

Quick examples

• One palm-sized blistered scald on the forearm: ≈ 1% TBSA.
• Two palm-sized patches on the thigh plus one on the calf: ≈ 3% TBSA.
• A large continuous area: If it looks like “more than 10 palms,” it is already significant—treat as higher risk and seek medical advice.

Important: For children, the palm method still works because it uses their hand, not an adult’s.

3) Special locations and high-risk burn patterns

Some burns are more dangerous because they threaten breathing, function, circulation, or long-term mobility—even if the total size is small.

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Face and neck

• Why it matters: Swelling can affect the airway; eyes and lips are delicate.
• What to look for: Burns around mouth/nose, hoarseness, coughing, soot around nostrils, difficulty breathing, swelling of lips or tongue.

Hands and feet

• Why it matters: High risk of stiffness and loss of function; small blisters can limit movement.
• What to look for: Blisters over joints, increasing tightness, reduced ability to bend fingers/toes.

Genitals and perineum

• Why it matters: High infection risk and swelling; urination and hygiene can become difficult.
• What to look for: Rapid swelling, difficulty urinating, significant pain.

Major joints (elbows, knees, ankles, wrists, shoulders)

• Why it matters: Healing across joints can cause tight scars and reduced range of motion.
• What to look for: Blistering or deeper burns directly over the joint, pain with movement, increasing stiffness.

Circumferential burns (burns that go all the way around)

• Why it matters: Swelling under a tight, burned “ring” of skin can reduce blood flow or breathing mechanics.
• Common sites: Arms, legs, fingers, chest/torso.
• What to look for on limbs: Increasing tightness, numbness/tingling, cool skin beyond the burn, worsening pain, weak pulse, delayed capillary refill (press a fingernail/toenail and see if color returns slowly).
• What to look for on chest: Trouble taking a deep breath, increasing chest tightness.

Chemical and electrical exposures (high-risk situations)

Even when the skin looks mild, these mechanisms can cause deeper injury. If the burn followed a chemical splash or electrical source, treat it as higher risk and seek urgent guidance, especially if pain is severe, the area is expanding, or there are systemic symptoms (weakness, dizziness).

4) Patient factors that change urgency

The same burn can be more serious depending on who is injured. Consider these factors when deciding how quickly to seek care.

5) Actionable red-flag checklist (urgent or emergency care)

Use this checklist after you have estimated depth, size, and location. When in doubt, choose the safer option.

Call emergency services now (emergency care)

• Any trouble breathing, hoarseness, persistent cough, or swelling of lips/tongue after a burn.
• Burns to the face/neck with swelling or signs of airway involvement.
• Full-thickness signs: white/brown/charred areas, leathery/dry stiff skin, or a center that is oddly not painful.
• Circumferential burns of an arm/leg/finger or around the chest, especially with tightness, numbness, coolness, or weak pulses.
• Electrical injury (even if skin looks small), especially with fainting, chest pain, irregular heartbeat sensation, confusion, or weakness.
• Chemical exposure with ongoing pain, spreading injury, eye involvement, or uncertainty about the chemical.
• Large size: more than about 10 palms (≈10% TBSA) in adults, or a clearly extensive burn in a child.
• Signs of shock: faintness, clammy skin, confusion, very fast breathing, or collapse.

Seek urgent medical evaluation (same day / urgent care)

• Partial-thickness burns with blisters that cover more than 3 palms (≈3% TBSA) or are rapidly expanding.
• Any burn on: hands, feet, genitals/perineum, or over major joints—especially if blistering or limiting movement.
• Increasing pain, swelling, or tightness over the first hours (especially on limbs).
• Burns in infants, older adults, or people with diabetes/immunosuppression that are blistering or more than a palm in size.
• Eye involvement (pain, redness, tearing, blurred vision) from heat, steam, or chemicals.
• Concern for infection developing later: increasing redness spreading beyond the burn, warmth, pus, fever, or worsening pain after initial improvement.

Document to communicate clearly when seeking care

• Depth estimate: superficial vs blistered (partial-thickness) vs leathery/white/charred (full-thickness).
• Size estimate: number of patient-palms.
• Location: note any special areas (face, hands, feet, genitals, joints) or circumferential pattern.
• Mechanism: hot liquid/steam, contact, chemical, electrical.
• Time since injury and whether symptoms are worsening.