Understanding Burn Severity And Treatment: Unveiling The Rule Of Nines

Understanding Burn Severity And Treatment Unveiling The Rule Of NinesIn the realm of burn severity, depth of burning and the extent of the burn itself are crucial measures. However, quantifying the size of a burn poses a challenge due to the inherent diversity in human size, shape, and weight. Attempting to establish a universally significant burn size is a futile endeavor, as the impact of a square foot of burned surface area varies greatly depending on an individual’s weight. What may be considered severe to a person weighing 130 pounds could be comparatively less distressing to someone weighing 200 pounds.

To address these disparities in size and body shape, the estimation of burned surface area involves calculating a percentage relative to the total body area. Although the precise measurement of square inches of skin for each individual remains elusive, we can make approximate assessments based on the amount of skin typically required to cover specific body parts such as the arms and legs.

The Rule of Nines

To approximate the percentage of burned surface area, the body has been divided into eleven sections:

  • Head
  • Right arm
  • Left arm
  • Chest
  • Abdomen
  • Upper back
  • Lower back
  • Right thigh
  • Left thigh
  • Right leg (below the knee)
  • Left leg (below the knee)

The body is divided into sections, each representing approximately nine percent of the total skin surface area, adding up to 99 percent. The remaining one percent is attributed to the genital region.

When applying the rule of nines, the areas of the body affected by second or third-degree burns, which cause blisters or worse, are added together. For instance, if the entire left arm and the blistered chest are affected, it would account for 18 percent. Partial areas are approximated, such as considering the face as the front half of the head, representing approximately 4.5 percent.

Due to the significant anatomical differences between children and adults, adjustments are made to the rule of nines for different age groups. However, discussing all these variations here would be impractical.

The primary purpose of the rule of nines is to provide a quick assessment in the field to determine whether patients should be transferred to a specialized burn center. Once at the burn center, more advanced techniques will be utilized to accurately determine the exact extent of the burned surface area.

It is important to note that the total burned surface area is not the sole determining factor in classifying a burn as critical or not. The degree of the burn is also crucial in evaluating its severity.

Treatment Approaches for Varying Degrees of Burns

The seriousness or severity of a burn is typically determined by two important factors: the depth of the burn, indicating how far the damage extends into the layers of the skin, and the extent of the burn, which refers to the total body surface area it covers.

In this article, we will explore methods for assessing the severity of a burn, provide guidance on treating non-serious burns at home, and advise when it is necessary to seek emergency medical care.

Burn Degrees

The severity of a burn is determined by its depth, which is classified into degrees. First-degree burns are superficial, affecting only the surface of the skin. On the other hand, second- and third-degree burns penetrate deeper into the layers of the skin.

First-Degree Burns

A first-degree burn pertains to a burn injury where the skin’s surface is harmed while the epidermis, the outer layer of the skin, remains unbroken.

This enables the skin to continue its vital functions of temperature regulation and safeguarding the body against infections or injuries. Typically, first-degree burns can be managed at home without the need for emergency treatment or hospitalization.

Second-Degree Burns

Second-degree burns, also known as partial-thickness burns, extend beyond the epidermis and into the dermis, which is the second layer of the skin where hair follicles and sweat glands are located.

Blisters serve as the initial indication of a second-degree burn. As the epidermis gets damaged, it detaches from the underlying dermis, causing the formation of blisters. Over time, these blisters may merge, leading to the thinning and separation of the epidermis, revealing the raw dermis beneath.

Once the epidermis has separated from the exposed dermis, the individual begins to experience fluid loss, heat loss, and a diminished ability to protect against infections. Moreover, the exposed nerve cells in the dermis make second-degree burns exceptionally painful.

Third-Degree Burns

Third-degree burns, known as full-thickness burns, extend through both the epidermis and dermis layers of the skin. Individuals with third-degree burns face similar challenges related to fluid loss, heat loss, and infection as those with second-degree burns.

Furthermore, third-degree burns result in the death of nerves, causing a loss of sensation in the burned area.

Distinguishing between a deep second-degree burn and a third-degree burn is not easily done with a quick observation.


Burns are diagnosed as first-degree, second-degree, or third degree, depending on how deep they penetrate into the layers of the skin. First-degree burns can be treated at home, but second- and third-degree burns require treatment by a healthcare provider. Third-degree burns, especially, can require emergency treatment.

What Does Each Degree of Burn Look Like?

In first-degree burns, the skin typically appears dry and may exhibit a raised area or welt. Blisters do not form, and the underlying layers of skin remain unexposed.

Second-degree burns often result in the formation of blisters. Along the well-defined edge of the burn, distinct layers of skin may be visible. In severe cases of second-degree burns, the affected area may have a glossy, red appearance without blisters, and droplets of liquid might form on the surface.

Third-degree burns can exhibit characteristics such as dry, leathery, and dark red skin, or they may appear white, blackened, or charred. The absence of layers of skin can reveal yellow fatty tissues. Due to the destruction of nerve endings, third-degree burns are typically not painful to the touch.

Burn Surface Area

The width of a burn is typically expressed as a percentage of the body’s surface area and is applicable only to burns that are at least second-degree in severity. Second-degree burns covering over 10% of the body’s surface area are generally regarded as highly serious.

Healthcare providers employ the Rule of Nines to calculate the total burned surface area. This rule divides the body into 11 sections, each accounting for approximately 9% of the skin’s surface. These sections include:

  • Head and neck
  • Right arm
  • Left arm
  • Chest
  • Abdomen
  • Upper back
  • Lower back
  • Right thigh
  • Left thigh
  • Right lower leg
  • Left lower leg

The genital area represents the final 1% of the body’s surface area.

To apply the rule, the areas of the body affected by burns deep enough to cause blisters are added together. If you or someone with you has sustained burns, providing this information when calling 911 can assist first responders in promptly determining whether transportation to a specialized burn unit is necessary.

Alternatively, you can estimate the burn’s size using the palm of your hand. In most individuals, the palm constitutes about 1% of the skin’s surface area. As a general guideline, if a burn covers more than three palms or 3% of the total body surface area in adults (2% for children), immediate medical attention should be sought.

Specific Types of Critical Burns

Burns affecting specific areas of the body can be classified as critical, regardless of the overall size of the burn. Even if it is the only affected area, a burn to any of the following body parts is considered critical:

  • Burns that completely encircle a hand or foot
  • Face
  • Genitals

However, it’s important to note that for a burn to be considered critical, it must still be of at least second-degree severity or worse.

How Burns Are Treated

The fundamental principles of burn treatment remain consistent regardless of the severity of the burn, although additional steps are necessary for more severe cases.

Treating First-Degree Burns

The initial step following a burn should be to gently run cool water over the affected area or apply cold compresses for a minimum of 10 minutes. It’s important to avoid using excessively cold substances, such as ice, as they can potentially harm the skin tissues. Once the burn has been cooled, you can cleanse it with mild soap.

To provide relief and cool the burn, you can use petroleum jelly or aloe vera. It is acceptable to use topical antibiotic ointments if you are certain that the person is not allergic to them. However, avoid using creams, lotions, or oils. Disregard any misconceptions about using butter or toothpaste, as they do not offer any benefits and can trap heat within the skin, leading to an increased risk of infection.

After cleansing the burn, apply a sterile bandage that won’t adhere to the wound. Over-the-counter (OTC) pain relievers can be used to alleviate discomfort.

Summary of First-Degree Burn Treatment

Use cool running water or a cold compress.

Apply petroleum jelly, aloe vera, or an antibiotic ointment.

Cover with a nonstick bandage.

Take OTC pain relievers, if needed.

Treating Second-Degree Burns

To manage second-degree burns, it is essential to follow similar steps as with first-degree burns, being cautious not to rupture any blisters. Remember that blisters are a natural part of the healing process, and breaking them can increase the risk of infection.

If you suspect the burn may require emergency treatment, take measures to cool the affected area while awaiting medical assistance. Using a cool compress during transportation to the hospital can help minimize further damage.

When choosing an over-the-counter (OTC) pain reliever, opt for an anti-inflammatory variant, as second-degree burns often cause swelling. Examples of OTC anti-inflammatories include Advil (ibuprofen) and Aleve (naproxen). Additionally, elevating the burned area above heart level can aid in reducing inflammation. Your healthcare provider may also prescribe an antibiotic cream, such as silver sulfadiazine, to prevent infection as the burn heals.

Signs of Infection

If your burn shows signs of infection, it is crucial to seek immediate medical treatment. Be vigilant for the following symptoms:

Drainage or pus coming from the burned area


Heightened pain

Red streaks extending from the burn

Swollen lymph nodes

Treating Third-Degree Burns

Patients with third-degree burns often receive intravenous (IV) fluids to address dehydration, combat shock, and stabilize their condition. Depending on the severity of the burn, additional life-saving measures may be necessary. Eventually, the burned skin may be replaced by utilizing skin grafts taken from unaffected areas of the body.

Severe burns can lead to extended hospital stays, requiring multiple procedures. During this time, it is crucial to closely monitor the patient for potential complications, such as:

  • Dangerously low blood pressure
  • Excessive fluid accumulation and swelling (edema)
  • Organ failure
  • Pneumonia
  • Severe infection
  • Sepsis
  • Abnormal heart rhythms (in the case of electrical burns)

When to Get Emergency Treatment

Typically, a first-degree burn or a mild second-degree burn does not require immediate medical attention. However, there are certain circumstances that can complicate the healing process and potentially lead to future complications. It is important to seek treatment promptly if any of the following conditions apply:

  • The burn affects a large area, covering 3% or more of the body surface in adults, or 2% or more in children.
  • The burn is located on a baby, an elderly individual, or someone with diabetes or a weakened immune system.
  • The burn is situated on sensitive areas such as the face, hands, feet, or genitals.
  • The burn encircles an entire limb or extremity.
  • The burn covers a joint.
  • The burn resulted from fire, electricity, chemicals, or inhalation.

Emergency medical treatment should be sought for all third-degree burns, as well as severe second-degree burns. Some cases of second-degree burns can be addressed at an urgent care facility instead of the emergency room. If there is any uncertainty about the severity of the burn, it is advisable to go to the hospital for evaluation and appropriate care.

What Should Not Be Done to Treat Burns

The Significance of Knowing What Not to Do: Essential Guidelines for Safety. In the case of burns, here is what not to do:

  • Do notuse household products as burn treatments (e.g, butter, oil, ice, eggs).
  • Do notremove clothing that’s stuck to the burn.
  • Do notpop blisters or remove dead skin.
  • Do notuse cold water on a burn.
  • Do notblow or breathe on the burn.
  • Do notput the person’s head on a pillow if their airway has been burned from something they inhaled.
  • Do notallow the person to eat or drink if they have a severe burn.


Burns are classified into three categories: first-degree, second-degree, and third-degree burns, depending on their depth and the extent of skin affected. First-degree burns are considered minor and can be managed at home.

However, second-degree and third-degree burns are considered serious and necessitate medical intervention, come visit your nearest urgent care clinic. Third-degree burns, in particular, are regarded as a medical emergency.

Insights from TGH Urgent Care powered by Fast Track: Expert Advice on Burns

Burns can result from various causes, such as hot water, steam, fire, electricity, and specific chemicals. The optimal course of action is to focus on preventing burns altogether. The majority of burns occur within the kitchen, hence it is crucial to exercise caution when handling boiling water or igniting the stove, especially in the presence of children.

In the event that you or someone accompanying you sustains a burn, prompt action is essential to ensure proper treatment at your nearest TGH Urgent Care location.

References & Sources

TGH Urgent Care powered by Fast Track uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.


The blogs presented by TGH Urgent Care in partnership with Fast Track are not a replacement for medical care and are exclusively intended for educational purposes. The content provided here should not be construed as medical guidance. If you are encountering any symptoms, we strongly recommend that you seek an appointment with a duly qualified medical practitioner at our nearest facility.

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