Burn Management in EMS: Assessment, Rule of Nines, and the Parkland Formula
Prehospital burn care: how to estimate TBSA with the Rule of Nines, when to activate a burn center, and how to apply the Parkland formula on scene.
August 4, 2026 · 7 min read
Burns are one of the most under-triaged trauma calls in EMS. The immediate injury is visible, but the fluid loss, airway edema, and infection risk unfold over hours. Getting the estimate and the fluid resuscitation right in the first 30 minutes changes outcomes.
Rule of Nines for adults
- Head: 9% (front 4.5, back 4.5)
- Each arm: 9%
- Anterior torso: 18%
- Posterior torso: 18%
- Each leg: 18%
- Genitals/perineum: 1%
Rule of Nines for children
The pediatric head is proportionally larger: 18% instead of 9%. Each leg is 14% (not 18%). Trunk and arms stay the same.
Parkland formula
4 mL × weight (kg) × %TBSA of second- and third-degree burns. Give half in the first 8 hours from time of injury, the other half over the next 16. Prehospital, you're delivering the first slice — usually LR.
Burn center criteria
- Partial-thickness > 10% TBSA
- Any full-thickness burn
- Burns to face, hands, feet, genitalia, or major joints
- Inhalation injury, electrical, or chemical burns
- Burns with associated trauma or in patients with comorbidities
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