Do you dial 911 for major burns?

What are the signs of a major burn?

Major burns, also known as third-degree burns, are extremely serious injuries that require emergency medical treatment. There are several signs that indicate a burn is major:

  • Destruction of all layers of skin – With major burns, both the epidermis and dermis layers of skin are damaged. This exposes the underlying fat, muscles, and even bones in severe cases.
  • White, blackened, or charred skin – The skin will often appear white, blackened, or charred as all pigmentation is destroyed.
  • Lack of sensation – Due to the destruction of nerve endings, the burned area will have no sensation. There is an inability to feel pain or detect light touch.
  • Lack of blistering – Major burns destroy the overlying layers of skin before blistering occurs. This differentiates them from more superficial partial-thickness burns.
  • Difficulty moving – If the burn affects a joint area, movement may be restricted due to damage to tendons, ligaments or muscles.

If a burn victim exhibits any of these signs, it indicates full-thickness damage to the skin and underlying tissues. This level of burn requires immediate emergency care.

When should you call 911 for a major burn?

911 should be called right away if someone suffers a major burn. Even a few minutes can make a difference in preserving function and minimizing scarring. Calling 911 promptly ensures the fastest possible emergency medical response.

Specifically, 911 should be called if:

  • The burn covers more than 5% of the body in adults or more than 10% in children.
  • The burn affects the head, face, hands, feet, genitals or joints.
  • The burn is caused by chemicals, explosions or electricity.
  • Signs of a major burn are present – charred skin, lack of sensation, difficulty moving etc.
  • Inhalation injury is suspected due to burns to the mouth or nasal hairs being singed.
  • The victim loses consciousness or has difficulty breathing.
  • Signs of shock such as pale, cool, clammy skin or weakness and dizziness are present.

For any major burn, it is vital to be evaluated by emergency medical professionals as soon as possible.

What first aid can you provide while waiting for help?

While waiting for emergency responders after calling 911, the most important first aid steps include:

  • Stop the burning by removing the victim from the heat source or extinguishing flames on clothing.
  • Remove anything constricting from the burned area, including rings, belts and restrictive clothing.
  • Cool the burn with cool – not cold – running water for 10-15 minutes.
  • Cover the area loosely with a sterile bandage, clean towel or sheet.
  • Monitor breathing carefully. Perform CPR if breathing stops.
  • Watch for signs of shock and elevate feet if present.
  • Do not apply ice, butter, oils, creams or any home remedies to the burn.
  • Avoid breaking blisters or removing dead skin if blisters have formed.

Also be prepared to provide key details to emergency responders such as:

  • The cause of the burn
  • The exact time the burn occurred
  • How much of the body surface is affected
  • Any current symptoms or changes in consciousness

Providing appropriate first aid while monitoring the victim’s condition and airway can be lifesaving until emergency care arrives.

What emergency care is provided for major burns?

Once emergency medical services arrive, they will quickly assess the severity of the burn, provide oxygen support, start IV fluids and transport the victim to a hospital burn center.

Emergency care focuses on:

  • Airway stabilization – Endotracheal intubation may be required if swelling is obstructing the airway.
  • Circulatory support – Large amounts of IV fluids are given to stabilize blood pressure and perfuse tissues. Blood products may be needed.
  • Wound care – Antibiotic ointments can be applied to less severe areas. Severely burned areas are covered lightly with sterile dressings.
  • Pain control – Opiate pain medications are provided intravenously.
  • Monitoring for shock – Blood pressure, pulse, respiratory rate and mental status are closely watched.

Speedy transport to a specialized hospital burn unit is a top priority, where intensive treatment can continue.

What happens after admission to a hospital for major burns?

At the hospital, the emergency response continues in the burn unit. Priorities include:

  • Airway protection – Endotracheal intubation or tracheostomy is performed if needed.
  • Fluid resuscitation – High volumes of specialized IV fluids are given to restore circulatory volume.
  • Antibiotics – Broad spectrum antibiotics are started to prevent wound infections.
  • Tetanus prevention – Tetanus immune globulin and vaccines are given if the patient’s tetanus protection is inadequate.
  • Daily wound care – Daily debriding and cleansing of wounds under anesthesia in the operating room.
  • Skin grafting – Early excision of burns and grafting improves outcomes.
  • Nutritional support – High-calorie nutritional formulas are provided through feeding tubes.
  • Physical and occupational therapy – To retain joint mobility and prevent contractures.

Patients with major burns require intensive, coordinated specialty care for weeks to months in order to optimize healing and outcomes. After hospital discharge, long-term rehabilitation and reconstructive surgeries are often needed.

Are there complications to watch for with major burns?

Major burns result in immense physical stress and metabolic changes, making affected patients prone to significant complications:

  • Infection – Pneumonia, wound infections and sepsis are common due to loss of protective skin and suppression of the immune system.
  • Fluid and electrolyte imbalances – Massive fluid shifts occur which can lead to edema, dehydration and electrolyte disturbances.
  • Heart problems – Increased stress on the heart can result in dysrhythmias and heart failure.
  • Lung problems – Pulmonary edema, pneumonia and acute respiratory distress syndrome can develop.
  • Blood clots – Immobility promotes dangerous blood clots in the legs which can travel to the lungs.
  • Gastrointestinal bleeding – Stress ulcers and bleeding frequently occur.
  • Anemia – Ongoing blood loss into damaged tissues causes severe anemia.

Close monitoring and timely treatment of complications improves the chances of survival in major burn patients. Supportive critical care is needed while the body recovers from the profound trauma.

What factors influence the prognosis with major burns?

The prognosis after a major burn depends on several key factors:

  • Total body surface area (TBSA) burned – More extensive burns cause higher rates of morbidity and mortality.
  • Depth of burn injury – Third and fourth-degree burns result in more serious consequences than superficial burns.
  • Patient age – Very young and older patients have higher risks of complications.
  • Location of burn – Functional and cosmetic outcomes are worse for facial, hand and joint burns.
  • Cause of burn – Electrical, chemical and inhalation burns have higher risks of mortality.
  • Pre-existing conditions – Chronic diseases negatively impact recovery.
  • Speed of treatment – Faster emergency care and transport to a burn center improves prognosis.

While major burns remain serious and life-threatening injuries, advances in critical care, surgical techniques and rehabilitation allow many patients to ultimately recover good functionality and quality of life.

What are typical long-term effects of major burns?

Individuals who survive major burns face a long recovery process that often continues for years after the initial injury. Common long-term effects include:

  • Scarring and contractures – Burn scars can be disfiguring and cause restricted mobility of affected joints.
  • Chronic pain – Persistent burning, stinging or tingling neuropathic pain is common.
  • Physical impairments – Weakness, reduced endurance and loss of fine motor skills can linger.
  • Sensory changes – Tactile sensitivity, numbness or hypersensitivity are frequent.
  • Psychological issues – Body image distress, anxiety, depression and post-traumatic stress are very prevalent.
  • Greater infection risk – Recurrent infections, especially pneumonia, remain a concern.

Reconstructive surgeries, rehabilitation, physical and occupational therapy, and mental health support continue for months to years after the initial burn injury. This improves functional and psychosocial outcomes over time.

How can major burns be prevented?

Many severe burns can be prevented through safety awareness and caution:

  • Keep children away from hot liquids, stoves, campfires, fireplaces, heaters etc.
  • Have a “kid-free zone” of at least 3 feet around the stove.
  • Set your water heater temperature no higher than 120oF.
  • Install smoke detectors on every level of the home.
  • Develop and practice a home fire escape plan.
  • Keep flammable materials away from open flames.
  • Wear short or tight-fitting sleeves when cooking.
  • Never leave cooking food unattended.
  • Allow microwaved food to cool before eating.
  • Pre-treat new flammable clothing with a fire retardant.

At work, strict adherence to safety regulations and protective gear requirements can protect against occupational burns. Prompt first aid for any burn, no matter how minor, improves outcomes. Public education is key to reducing serious burn injuries.


Major burns, involving full-thickness destruction of the skin, should always be considered a true medical emergency requiring professional emergency care. Call 911 without delay if signs of a major burn are present after an injury. Appropriate first aid should be started right away while waiting for emergency responders. At the hospital, intensive management in a specialized burn unit is needed to treat the profound trauma inflicted by major burns and try to maximize the chances of survival and eventual recovery. While major burns cause severe immediate and long-term effects, many patients can regain acceptable quality of life over time with extensive rehabilitation and reconstructive treatments. Increased public awareness on burn safety and prevention strategies is critical to reduce the incidence of these devastating injuries.

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