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Classifications of Burns
Health professionals, including emergency medical technicians, determine the severity of burns by source, degree, percentage area burned, location of burn, and age and health status of the patient.
Agents and sources of burns include:
Thermal - via flame, hot objects, hot liquids, flash burns from explosions, sunburns
Electrical - including AC or DC current via contact or arcing, lightning strikes
Chemical - includes various acids, bases, and caustics or other types of hazardous materials
Then the depth of the burn is determined according to "degree":
First Degree - Limited to the outermost layer of skin known as the epidermis; usually superficial, some reddening of skin, no blisters; can be painful.
Second Degree - Penetrates deeper to the second layer known as the dermis; Reddening of skin, blistering; Burn can also appear whitish or mottled; Very painful.
Third Degree - Deep tissue destruction down to subcutaneous layer; Skin appears charred and leathery, or dry and white; Can be either very painful or painless if enough nerve endings are destroyed
Percentage of burn area is usually determined by the Rule of Nines, where body parts are given percentage values as a factor of the number nine. For example, the upper extremities are given a value of 9 each, the front and back of the trunk 18 (9 X 2) each, the head 9, the lower extremities 18 each, and the genital area a percentage of 1 (these values change slightly for children).
The Rule of Palm can also be used where the patient's palm is considered to be approximately 1% of body area.
Burns of the face, fingers or toes, and circumferential burns (encircling a body part) are considered more serious. The groin, buttocks, and medial thigh areas are also considered of special concern since there is a greater chance of infection secondary to the actual burn injury.
The age of the patient is taken into consideration since those that are very young, or the elderly, are less able to recover from these types of injuries. Their reactions to these burns are also more severe - a fair or moderate burn to a young adult can be fatal to these other age groups.
Finally, health status of patient is also determined - those with underlying medical conditions such as respiratory ailments, heart disease or diabetes, will react more severely to burn injuries.