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Health condition · Clinically reviewed

Burns, depth, TBSA, Parkland fluids and specialist care.

From a scald at home to major thermal, chemical, electrical or inhalation injury - what the plan looks like in a modern UK burns service.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against British Burn Association, NICE and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including Parkland fluid resuscitation, silver dressings and dermal substitutes.

Key facts

Burns at a glance.

The essentials, in plain English - the types of burn, how depth and area are described, and how the modern UK system responds.

  • What it is

    A thermal, chemical, electrical, radiation or inhalation injury to skin and deeper tissues that disrupts the skin barrier.

  • Types

    Thermal (roughly 85%), chemical, electrical, radiation and inhalation injury - each behaves differently and needs a tailored plan.

  • Depth matters

    From superficial epidermal through partial thickness to full thickness and fourth-degree - depth drives dressings, grafting and scarring.

  • TBSA

    Total body surface area is estimated using the Wallace rule of nines, the Lund and Browder chart, or the patient's palm (about 1%).

  • Fluid resuscitation

    Parkland formula - 4 mL x kg x %TBSA Ringer's lactate over 24 hours, half in the first 8 hours, titrated to urine output.

  • UK burn services

    15 designated centres including Chelsea and Westminster, Broomfield Essex, Wythenshawe, Frenchay Bristol, Queen Victoria East Grinstead and Alder Hey.

Why this guide matters

The first hour shapes the next year.

Cooling, fluids and airway decisions taken in the first 60 minutes decide whether a burn heals cleanly or leaves a lifelong scar. The three points below shape the rest of this guide.

  • Cool water within the first hour

    Twenty minutes of cool running water in the first hour reduces depth and scarring - the single most valuable first aid in burns care.

  • The airway comes first

    Facial burns, hoarseness or stridor after a fire in an enclosed space mean early laryngoscopy and often intubation before oedema shuts the airway.

  • Escalate to a burns unit early

    The UK has 15 designated burn services - Chelsea and Westminster, Broomfield, Wythenshawe, Frenchay, Queen Victoria and others. Refer early rather than late.

How burns are assessed

From ABCDE to a clear plan.

The steps a UK emergency and burns team will normally follow, in order - so you know what to expect and why.

  1. 01

    Resuscitating

    ABCDE and fluid resuscitation

    Airway, breathing, circulation, disability and exposure first. Two large-bore cannulas, warmed Ringer's lactate and Parkland calculation from time of burn.

  2. 02

    Resuscitating

    Estimate burn depth and TBSA

    Wallace rule of nines for adults, Lund and Browder for children, or the patient's palm as roughly 1% for scattered burns.

  3. 03

    Resuscitating

    Look for inhalation injury

    Soot in nostrils or mouth, singed nasal hair, facial burns, hoarse voice or stridor mean early laryngoscopy and a low threshold to intubate.

  4. 04

    Confirming

    Baseline investigations

    FBC, U and Es, creatine kinase, coagulation, ECG, chest X-ray, carboxyhaemoglobin, cyanide where suspected, lactate, toxicology and pregnancy test.

  5. 05

    Confirming

    Referral to a burns unit

    More than 10% adult TBSA, more than 5% paediatric, face, hands, feet, perineum, circumferential, inhalation, electrical, chemical, comorbidity or suspected NAI.

  6. 06

    Protecting

    Compartment and escharotomy

    Circumferential deep burns can compromise perfusion or ventilation. Escharotomy or fasciotomy is a surgical emergency.

  7. 07

    Protecting

    Safeguarding and tetanus

    All paediatric burns and any suspicious pattern (glove and stocking, contact, adult-shaped) trigger safeguarding review. Tetanus status is checked for every burn.

Typical timeline: resuscitation in minutes, referral in hours, rehabilitation over months.

Presentation

What burns actually look like.

Depth changes the appearance, the pain and the plan. And there are features - especially airway signs - that mean the burn is bigger than the skin suggests.

  • Pain and skin change

    Erythema, blistering or leathery white or charred skin depending on depth - the classic first sign of a burn.

  • Superficial epidermal (first degree)

    Sunburn-type erythema, dry, no blisters, painful, heals in days without scarring.

  • Superficial partial thickness (2a)

    Wet, blistered, pink, very painful, blanches - usually heals in about two weeks without grafting.

  • Deep partial thickness (2b)

    Blistered but drier, mottled, reduced sensation, slow to heal beyond three weeks and often scars.

  • Full thickness (third degree)

    Leathery, dry, white, brown or charred, insensate - almost always needs a split-thickness skin graft.

  • Fourth degree

    Extends through fascia into muscle, tendon or bone - reconstructive surgery and sometimes amputation.

  • Oedema and shock

    Extensive burns leak plasma into tissues within hours - tachycardia, hypotension and reduced urine output.

  • Red flag - inhalation injury

    Soot in nostrils, singed nasal hair, facial burns, hoarse voice or stridor - airway compromise can be rapid and lethal.

Treatment

How burns are treated in the UK.

Cooling and Parkland first, airway and dressings next, then grafting, nutrition, infection control and long-term rehabilitation in an MDT setting.

  • First aid

    Cool running water for 20 minutes within the first hour, remove clothing and jewellery, avoid hypothermia and cover loosely with cling film.

  • Fluid resuscitation

    Parkland formula Ringer's lactate over 24 hours, titrated to urine output of 0.5 mL/kg/h in adults and 1 mL/kg/h in children.

  • Airway and inhalation care

    Early intubation for airway burns, 100% oxygen for carbon monoxide, hydroxocobalamin for cyanide, hyperbaric oxygen in selected cases.

  • Wound care and dressings

    Silver dressings (Aquacel Ag, Acticoat, Mepilex Ag), Biobrane, Suprathel or collagen matrices as depth and site dictate.

  • Skin grafting

    Meshed split-thickness grafts for larger areas, full-thickness grafts for cosmetic sites, Integra or Matriderm dermal substitutes and cultured epidermal autograft for very extensive burns.

  • Escharotomy and NPWT

    Escharotomy for circumferential deep burns and selective negative pressure wound therapy to prepare the bed for grafting.

  • Nutrition, infection and pain

    High-protein, high-calorie enteral feeding, infection surveillance, multimodal analgesia including opioids, ketamine, regional blocks and gabapentinoids.

  • Long-term rehabilitation

    Pressure garments, silicone, physiotherapy, occupational therapy, laser scar revision, reconstructive surgery and psychological support.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

A burns team can see the wound in front of them and knows your medical history. If in doubt about any burn, get seen.

  • British Burn Association. National Burn Care Referral Guidance and standards.

  • NICE. Burns and scalds - primary care management scenarios (CKS).

  • Emergency Management of Severe Burns (EMSB) course manual, Australian and New Zealand Burn Association / UK.

  • MHRA and NHS England. Guidance on silver dressings, dermal substitutes and burns care pathways.

Red flags

When a burn is an emergency.

Small burns can usually be managed in primary care or an ED. These are the situations that cannot wait and belong in a burns unit or intensive care.

  • Inhalation injury

    Facial burns, singed nasal hair, soot in the airway, hoarse voice or stridor mean early laryngoscopy and a low threshold to intubate before oedema shuts the airway.

  • Carbon monoxide and cyanide poisoning

    Suspect after fires in enclosed spaces - headache, confusion, cherry-red skin or metabolic acidosis. Give 100% oxygen and consider hydroxocobalamin.

  • High-voltage electrical burn

    Small entry and exit wounds can hide massive deep injury. Arrhythmia, rhabdomyolysis and compartment syndrome all need cardiac monitoring and urgent transfer.

  • Chemical burn

    Alkali burns go deeper than acid. Copious water irrigation for at least 20 minutes and specialist advice - hydrofluoric acid needs calcium gluconate.

  • Circumferential deep burn

    A tourniquet-like eschar on a limb, chest or neck can compromise perfusion or ventilation - escharotomy is a surgical emergency.

  • Late acute respiratory distress

    ARDS can develop 24 to 72 hours after inhalation injury - a rising oxygen requirement and diffuse infiltrates need critical care.

  • Burn sepsis

    Loss of the skin barrier plus immunosuppression - fever, tachycardia, confusion or rising lactate warrants urgent antibiotics and source control.

  • Suspected non-accidental injury

    Glove and stocking scald patterns, contact burns matching household objects, or an adult-shaped hand print - safeguard and involve paediatrics or adult safeguarding.

  • Pregnancy or major comorbidity

    Pregnant patients and those with cardiac, respiratory or renal disease decompensate quickly - lower the threshold for early transfer.

Rehabilitation

Recovery is a long-term project.

Four things that make the biggest difference in the year after a significant burn - scar management, movement, sun protection and support.

A quiet reminder

Scars keep changing for a year or more.

Judge the final result at 12 to 18 months, not 12 weeks. Consistent silicone, pressure, physio and sun protection quietly do most of the work.

  1. 01 Scars

    Silicone and pressure

    Silicone gel or sheeting and, for larger burns, custom pressure garments worn for months help hypertrophic scars flatten and soften.

  2. 02 Movement

    Physio and OT matter

    Early physiotherapy and occupational therapy preserve range of movement across joints and prevent contractures that would need surgery later.

  3. 03 Skin

    Sun protection for a year

    New scar tissue burns and pigments more easily - high-factor sunscreen and covering up for at least a year reduce discolouration.

  4. 04 Support

    You are not alone

    Katie Piper Foundation, Changing Faces, Dan's Fund for Burns and Camp Burn offer practical and emotional support alongside NHS burns rehabilitation.

Frequently asked

Everything we get asked about burns.

Quick answers on types, depth, Parkland fluids, when to refer, first aid and scarring.

  • What are the different types of burn?

    Thermal burns (flame, scald, contact, steam and friction) account for about 85%. Chemical burns from acids or alkalis can be deceptively deep, particularly alkali. Electrical burns include low and high voltage, arc and lightning, and can cause arrhythmia and rhabdomyolysis. Radiation burns cover sunburn, radiotherapy and rare nuclear exposure. Inhalation injury is a separate emergency in its own right.

  • How is burn depth described?

    Superficial epidermal (first degree) is a red, dry, painful burn like sunburn that heals in days. Superficial partial thickness (2a) is wet, blistered and very painful and usually heals in about two weeks. Deep partial thickness (2b) is drier with reduced sensation, heals slowly and often scars. Full thickness (third degree) is leathery, white or charred and insensate and needs grafting. Fourth degree extends into muscle or bone.

  • What is the Parkland formula?

    Parkland gives an estimate of the fluid a burns patient needs in the first 24 hours - 4 mL of Ringer's lactate x weight in kg x percentage TBSA. Half is given in the first 8 hours from the time of the burn, the rest over the next 16 hours, then titrated to a urine output of 0.5 mL/kg/h in adults or 1 mL/kg/h in children.

  • When should a burn be sent to a specialist unit?

    The UK criteria include more than 10% TBSA in adults or 5% in children, any partial or full thickness burn to the face, hands, feet, perineum or over a joint, circumferential burns, inhalation injury, all electrical and significant chemical burns, comorbid patients and any suspicion of non-accidental injury.

  • What first aid should I give?

    Cool the burn under running water for 20 minutes within the first hour, remove any jewellery or non-adherent clothing, and cover loosely with cling film or a clean non-fluffy dressing. Keep the rest of the person warm to avoid hypothermia. Do not apply ice, butter, toothpaste or ointments. Seek urgent medical review for anything more than a small superficial burn.

  • Will a burn scar?

    Superficial burns usually heal without scarring. Deep partial thickness and full thickness burns almost always scar. Modern care - early grafting, silicone, pressure garments, laser scar revision, steroid injections and reconstructive surgery - can significantly improve function and appearance, but takes months to years.

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