How to assess a burn

➔ Ensure the safety of the patient and carer/clinician by removing patient from source of injury.

➔ Immediately conduct a primary ABCDEF assessment (see below).

➔ Next, stop the burning process by flushing with body temperature running water or by using water-soaked towels for 20 minutes. Do not use cold water, ice or frozen materials 


Conduct secondary assessments

➔ Conduct a burn assessment to determine the Total Body Surface Area of the burn (TBSA), as well as the mechanism, location, depth and size.

•  The burn wound is expressed as a percentage of the total body surface area (TBSA). The most common methods used to estimate the TBSA are the Palmar Surface method, the Lund and Browder chart and the Wallace Rule of Nines.
• The palmar surface method is a simple method to estimate burn area. The patient’s hand with closed fingers represents approximately 1% of the body surface area. It is effective for estimating the area of small burns (<15%) or large burns (>85%). In large burns, the burnt area can be quickly calculated by estimating the area of uninjured skin and subtracting it from 100. When estimating TBSA, do not include simple erythema (reddening of the surrounding skin) in your calculation.

Cause, location and depth

➔ Document the cause of the burn, when the burn occured and what has been done so far.



➔ Location of the burn: 


• The location of a burn can increase the complexity of the burn management. 

• Burns that are over joints, on hands, feet, face, the perineum or genitalia should be referred to a specialist. 

• If the burn is on a limb, then assess for circulation/blood supply.

➔ Measure the depth of the burn: 


• Burn depth is classified based on the amount of tissue damage
• Burn depth is typically determined based on a visual assessment. 
• Superficial partial thickness burns do not extend through all the layers of skin.

-Superficial – only the epidermis is damaged – often associated with sun burns with no blisters. 


-Superficial partial thickness – extends to upper layers of the dermis, is painful and blisters are present. 


• Deep partial thickness – extends into the deeper layers of the dermis, but not into subcutaneous tissues, often seen with hot fat or oil burns. 

• Full thickness burns extend through all layers of skin and into subcutaneous tissues and requires specialist intervention. 

• Severe full thickness burns extend to bone and muscle. 

• It may be necessary to deroof blisters/debride dead skin to be able to visualise the wound bed and accurately assess wound depth.⁵

➔ Conduct a wound assessment using a validated wound assessment tool.


➔ Conduct a holistic patient assessment to determine comorbidities, allergies, etc.


➔ Check for tetanus vaccine status. 


➔ Conduct a pain assessment.


➔ Conduct a complete physical exam to check for other injuries, including inhalation injuries. 


➔ It is important to remove jewellery or clothing which may have a tourniquet effect if edema becomes an issue or can be a source of thermal insulation preventing the burn from cooling. 


➔ Also evaluate the burn pattern for consistency with the history of injury to evaluate for Non-Accidental Trauma. If this is suspected, it should be reported in accordance with local laws and regulations. 



Complications with even small burns in children can be fatal (toxic shock syndrome) and should be referred.⁶

How to develop a treatment and care plan

➔ A treatment or care plan should be developed in partnership with all members of the care team and the patient.



➔ When developing a treatment plan consider the following: 


• Mitigate factors that delay healing including wound infection, presence of hypergranulation tissue, wound  desiccation and systemic issues.
• Superficial burn injuries can be extremely painful. All burns patients should have an individualised pain management plan. If pain is unresolved and persistent, refer.
• Patients often describe pain when they are actually experiencing itching. Burn itching, especially nighttime itching can be long lasting and very intense.
• Burn wound itching often begins at wound closure and peaks at 2-6 months after injury and can be exasperated by heat, stress and physical activity.
• Treatment for burn itch includes skin moisturisers, adequate hydration, topical antihistamines, oral antihistamines and analgesics.
• A patient’s nutritional status can affect how well the burn wound heals. Encourage patients to:

-Eat a high-calorie/high-protein diet.

-Maintain hydration – drink 6–8 glasses of water a day and avoid caffeine and alcohol.

-Stop smoking.

-Attend to basic principles of cleanliness and good personal hygiene and keep fingernails short.

• Burn injuries – even minor ones – can have a devastating impact on the psychological health of a patient. Depression has a significant prevalence in burns patients as a consequence of their injury and the impacts on their lives. Refer for dietician and counselling support if there are concerns about a patient’s nutritional or psychological status.

Interested in learning more about how to develop a treatment and care plan?

Research shows that patients who are included in planning their treatment and educated on effective self-care are more likely to adhere to their treatment plan. Learn more about how to include the patient and their caregivers in the Wound Care Pathway.

How to manage a burn

➔ The first dressing change should be 48 hours after injury and then every 3–5 days thereafter, depending on how healing is progressing.

• Cleansing, debridement, deroofing, dressing changes and physiotherapy can be very painful. If not already given, analgesia should be provided well before any interventions are performed, ensuring the pain relief has reached its full effect prior to the procedure
• All burns should be cleansed to remove foreign bodies, soluble debris, necrotic tissue or slough.
• Irrigation at 4-15 psi is the preferred method for cleansing burn wounds. Irrigate the wound using copious amounts of normal saline or warm tap water, mild soap and water or wound irrigation solutions containing topical antiseptics. Cleansing wipes and pads may also be used.
• Debride the wound and wound edges to remove necrotic tissue, reduce the risk of infection and encourage epithelialisation. The method of debridement should be appropriate to the location of wound, the amount of tissue to be removed and the skill of the practitioner.
• Blisters greater than 1cm2 should be deroofed^1,5,7 Blisters filled with cloudy serous fluid or blood should be deroofed. Blisters in locations that are prone to breakage should be deroofed. Blisters on the palm of the hand should be left intact unless they restrict movement, as they will be very painful to deroof. Analgesia should be given well before any deroofing procedure. After deroofing any remaining dead skin should be removed with sterile scissors.
• Giving routine prophylactic antibiotics for burns is NOT recommended. If infection is suspected consider taking a swab for microbiology, using the Levine Method. Topical antiseptics/antibiotics can be used empirically to prevent infection.

Scar management

• Healed burns can be sensitive, develop dry, scaly skin and have irregular pigmentation and are also vulnerable to re-injury. 

• The area should be moisturised daily with a non-perfumed emollient for a minimum of 3 months and up to 12 months in some cases. 

• Scars are less pliable than normal skin and may limit mobility. 

• Treatment can include, moisturising, massage, pressure garments, physiotherapy and surgery. 

• Keloid scarring is a risk factor, especially for patients with brown or dark skin tones. 

• Hypertrophic scarring is a risk factor for deep burns or burns with delayed healing and can negatively affect patient Quality of Life (QoL).

• If hypertrophic or keloid scarring is suspected, refer.

How to choose dressing and additional therapy

➔ A burn dressing should: 


• Maintain a moist wound environment.
• Remove exudate and protect against infection.
• Contour easily and retain close contact with the wound bed. 

• Be easy and painless to apply and remove. 

• Not adhere to wound bed and protect new skin. 

• Reduce frequency of dressing changes.
• Where a burn injury is a mixture of depths, choose a dressing based on the predominant depth. 

• Avoid alginate, paraffin gauze dressings and adhesive tapes as they tend to adhere to the skin. 

• There is evidence that silver dressings promote healing in burn wounds. Follow local guidelines on the use of SSD and silver dressings.


Dressing selection should be based on patient needs and preferences and local policy/protocol/formularies. The following chart breaks down some of the basic theory around dressing types and how they can help manage symptoms for patients with burn wounds.

➔ Always use an aseptic or non-touch application technique on application and removal.

➔ Ensure dressings do not impede patient mobility and are secured to avoid slippage

➔ Advise patients to keep dressing dry and clean.



➔ Dressing should be changed within 24–48 hours after initial injury and every 3–5 days thereafter, depending on how healing is progressing. 



➔ Dressings should be changed immediately if they become painful, odorous, or saturated. It is important to remind patients to contact their care provider if any of these complications occur.

How to monitor progression

➔ Taking photos of the wound will help monitor healing progress and may be useful if specialist advice about assessment and treatment needs to be sought.

➔ If a non-complex burn wound has not healed in 2-weeks, refer.



➔ Monitor for complications, such as spreading infection or toxic shock syndrome, if suspected refer.

➔ Provide patients and caregivers with written information about the key stages of their management including wound care, pain & itch management and clear warnings signs as to when to seek additional care.

For a glossary of general wound care terms consult The Wound Care Pathway: