Burn Severity, Triage, and Burn Center Referral Practice Questions

25 multiple-choice questions on Burn severity, triage, and burn center referral for paramedic and EMT students, from Chapter 33 (Burns). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The three factors most strongly linked to death after a burn are:

   1. A. Age, TBSA, and burn location
   2. B. TBSA, sex, and body weight
   3. C. Age, TBSA, and inhalation injury
   4. D. Pain score, heart rate, and SpO2
   Show answer

   Answer: C. Age, TBSA, and inhalation injury

   Older age, larger burns, and inhalation injury each raise mortality sharply. Location matters for function and referral but predicts death less than these three, and sex and body weight are not core predictors in the revised Baux score.

2. The revised Baux score estimates burn mortality by adding:

   1. A. Age, %TBSA, and 17 for inhalation
   2. B. Weight, %TBSA, and heart rate
   3. C. Age, pain score, and GCS
   4. D. %TBSA, depth, and 10 for electrical
   Show answer

   Answer: A. Age, %TBSA, and 17 for inhalation

   A higher Baux score means higher predicted mortality; inhalation injury adds 17 points. Burn depth is not a separate term in the formula.

3. Under current American Burn Association referral guidelines, a full-thickness burn warrants burn center consultation when it is:

   1. A. Over 10% TBSA
   2. B. Over 20% TBSA
   3. C. Any size
   4. D. On the trunk only
   Show answer

   Answer: C. Any size

   The 2022 ABA guidelines recommend consultation for full-thickness burns of all sizes. The older 5% and 10% cutoffs are no longer used for full-thickness injury.

4. Under the 2022 ABA referral guidelines, partial-thickness burns call for immediate burn center consultation, with consideration for transfer, when they cover at least:

   1. A. 5% TBSA
   2. B. 10% TBSA
   3. C. 20% TBSA
   4. D. 30% TBSA
   Show answer

   Answer: B. 10% TBSA

   The 2022 ABA guidelines place partial-thickness burns of 10% TBSA or more, at any age, in the immediate-consultation tier; smaller partial-thickness burns still merit a consultation call but not automatic consideration of transfer. 5% is not a current ABA threshold and would over-triage many small burns. 20% and 30% are too high and would delay specialist input for patients who clearly benefit from burn center care.

5. Which burn location, when deep partial- or full-thickness, meets burn center referral criteria regardless of size?

   1. A. Upper back
   2. B. Thigh
   3. C. Abdomen
   4. D. Hands
   Show answer

   Answer: D. Hands

   Burns of the face, hands, feet, genitalia, perineum, or over major joints threaten function and cosmesis. A small thigh burn of the same depth does not meet criteria by location alone.

6. A 22-year-old man has a 2% deep partial-thickness burn across the front of his knee. The most appropriate destination is:

   1. A. A burn center, as it crosses a joint
   2. B. Any ED, since it is well under 10%
   3. C. An urgent care clinic for a dressing
   4. D. Home with outpatient clinic follow-up
   Show answer

   Answer: A. A burn center, as it crosses a joint

   Deep burns over joints can contract and limit motion, so they meet referral criteria despite small size. The 10% rule applies to partial-thickness burns in non-critical areas.

7. A 35-year-old lineman contacted a 7,200-volt distribution line. He has a small entry wound on his hand, feels fine, and has a normal ECG. Regarding burn center referral, he:

   1. A. Does not meet criteria, since TBSA is small
   2. B. Meets criteria as a high-voltage injury
   3. C. Meets criteria only if he had an arrest
   4. D. Needs referral only if there is an exit wound
   Show answer

   Answer: B. Meets criteria as a high-voltage injury

   The 2022 ABA guidelines call for immediate consultation, with consideration for transfer, for every high-voltage (1,000 V or more) electrical injury and every lightning injury, because small surface wounds hide deep muscle, nerve, and vessel damage along the current path. A small TBSA does not exclude that hidden injury. Arrest is not required: a patient who feels fine with a normal ECG can still have serious deep tissue damage. An exit wound is not always visible, and its absence does not rule out a current path. Low-voltage (under 1,000 V) injuries, such as household current, are handled differently: they warrant consultation and consideration of burn center follow-up for delayed symptoms and vision problems.

8. A 50-year-old woman has a 4% partial-thickness burn on her forearm from a drain cleaner splash. According to ABA criteria she:

   1. A. Does not meet criteria, since it is under 10%
   2. B. Meets criteria only if her eyes were involved
   3. C. Needs referral only for acid burns
   4. D. Meets criteria as a chemical injury
   Show answer

   Answer: D. Meets criteria as a chemical injury

   Chemical injuries meet referral criteria at any size because they can keep damaging tissue and may cause systemic toxicity. Alkali burns are often worse than acid burns, not exempt.

9. A 40-year-old man has a 6% partial-thickness burn of his arm and was trapped in a smoky room. He is hoarse and has soot in his mouth. He should be referred to a burn center because:

   1. A. The burn exceeds 5% TBSA
   2. B. Soot in the mouth means a facial burn
   3. C. He has an inhalation injury
   4. D. He needs formal fluid resuscitation
   Show answer

   Answer: C. He has an inhalation injury

   Suspected inhalation injury is a referral criterion by itself and greatly increases mortality. The 6% skin burn alone would not meet criteria or require formal fluid resuscitation, and soot in the mouth points to the airway, not to a facial skin burn.

10. A 30-year-old motorcyclist has 25% TBSA partial-thickness burns from a fuel fire after a crash, plus a femur fracture and signs of shock. The best initial destination is:

    1. A. A burn center that has no trauma service
    2. B. The closest community hospital
    3. C. Any hospital, since burns are the priority
    4. D. A trauma center, then burn center transfer
    Show answer

    Answer: D. A trauma center, then burn center transfer

    When trauma poses the greater immediate risk, ABA guidelines direct the patient to a trauma center first for stabilization. The burns can be managed later at a burn center.

11. A 72-year-old man with heart failure and diabetes has an 8% partial-thickness scald of his leg. He warrants burn center consultation mainly because:

    1. A. His medical conditions add risk
    2. B. Leg burns always meet criteria
    3. C. Scalds are deeper than flame burns
    4. D. His burn exceeds 5% TBSA
    Show answer

    Answer: A. His medical conditions add risk

    The 2022 ABA guidelines place burns in patients with comorbidities in the immediate-consultation tier. Heart failure limits his tolerance of resuscitation fluid, and diabetes slows healing and raises infection risk. Without them, an 8% partial-thickness leg burn would still merit a consultation call but not immediate transfer consideration. Leg burns are not a critical location unless deep and over a joint or the foot. Scalds are not deeper than flame burns; usually the reverse. 5% is not an ABA threshold.

12. A 3-year-old has a 5% partial-thickness scald, and the caregiver's story does not match the injury pattern. Besides the burn itself, the most important reason to involve the burn center is that:

    1. A. Scalds in children always become full-thickness
    2. B. Suspected abuse needs a full team evaluation
    3. C. Children have no ability to thermoregulate
    4. D. A 5% scald needs formal fluid resuscitation
    Show answer

    Answer: B. Suspected abuse needs a full team evaluation

    The 2022 ABA guidelines say any burned child (14 or younger, or under 30 kg) may benefit from burn center referral, and possible non-accidental trauma is one of the listed reasons. Burn centers have social work, child-protection, and specialist teams to evaluate the injury pattern and keep the child safe; you must also report your concern as required. Scalds do not always become full-thickness; most spill scalds are partial-thickness. Children can thermoregulate, although less efficiently than adults because of their larger surface area to mass. A 5% scald is well below the size that calls for formal resuscitation formulas.

13. Under the 2022 ABA guidelines, which burn in an otherwise healthy adult does NOT call for immediate burn center consultation?

    1. A. A 1% full-thickness burn of the forearm
    2. B. A 3% deep partial-thickness burn of the face
    3. C. A 2% superficial partial-thickness arm burn
    4. D. A 12% partial-thickness burn of the upper back
    Show answer

    Answer: C. A 2% superficial partial-thickness arm burn

    A partial-thickness burn under 10% TBSA in a non-critical area falls in the consultation-recommended tier; it can usually be managed locally after a call. Any full-thickness burn, any deep partial-thickness burn of the face, and partial-thickness burns of 10% TBSA or more are all in the immediate-consultation tier.

14. Which burn patient has the highest predicted mortality?

    1. A. A 25-year-old with 40% TBSA and no inhalation injury
    2. B. A 75-year-old with 10% TBSA and no inhalation injury
    3. C. A 40-year-old with 30% TBSA and a hand burn
    4. D. A 75-year-old with 40% TBSA and inhalation injury
    Show answer

    Answer: D. A 75-year-old with 40% TBSA and inhalation injury

    By the revised Baux score, 75 + 40 + 17 = 132, far higher than the others. The young adult with the same TBSA scores only 65, showing how strongly age and inhalation injury drive mortality.

15. A 26-year-old man has 40% TBSA partial- and full-thickness burns. He is alert with a patent airway, and a burn center is 25 minutes away by ground. The best action is:

    1. A. Go to the closest ED to start fluids
    2. B. Wait on scene for a helicopter
    3. C. Go directly to the burn center
    4. D. Transport to an urgent care clinic
    Show answer

    Answer: C. Go directly to the burn center

    When a burn center can be reached directly in a reasonable time and the patient is stable, direct transport avoids a delay for interfacility transfer. Stopping at a local ED is appropriate when airway or shock cannot be managed en route.

16. A patient with major burns has an airway that is swelling quickly and a burn center 90 minutes away. The closest ED is 10 minutes away, and you cannot secure the airway. You should:

    1. A. Drive directly to the burn center
    2. B. Go to the closest ED for the airway
    3. C. Wait for the burn team on scene
    4. D. Place an OPA and go to the burn center
    Show answer

    Answer: B. Go to the closest ED for the airway

    An airway you cannot control takes priority over destination. The patient can be transferred to the burn center after the airway is secured.

17. Burns in which age groups carry the highest mortality for a given TBSA?

    1. A. Infants and older adults
    2. B. Teenagers and young adults
    3. C. Middle-aged adults only
    4. D. School-age children only
    Show answer

    Answer: A. Infants and older adults

    Thin skin, limited physiologic reserve, and comorbidities raise mortality at the extremes of age. Young adults tolerate the same burn best.

18. Which finding makes an otherwise moderate burn more serious?

    1. A. Superficial redness of the back
    2. B. A small scald on the thigh
    3. C. A circumferential chest burn
    4. D. Intact blisters on the forearm
    Show answer

    Answer: C. A circumferential chest burn

    Circumferential deep burns can restrict breathing or perfusion and may need escharotomy. Superficial redness does not add to severity.

19. During a mass-casualty fire, burn patients with the best expected outcome and lowest need for immediate care are those with:

    1. A. Small partial-thickness burns, no airway issues
    2. B. Burns over 80% TBSA in patients over 80
    3. C. Inhalation injury with facial burns and stridor
    4. D. Circumferential full-thickness chest burns
    Show answer

    Answer: A. Small partial-thickness burns, no airway issues

    Patients with small burns and no airway involvement can wait. Massive burns in older adults may be expectant when resources are overwhelmed, and airway burns need urgent care.

20. Under current ABA guidelines, a 6% partial-thickness burn of the abdomen in a healthy 30-year-old with no other injuries:

    1. A. Must be transported to a burn center
    2. B. Can usually be managed locally
    3. C. Requires formal fluid resuscitation
    4. D. Requires escharotomy in the field
    Show answer

    Answer: B. Can usually be managed locally

    Under the 2022 ABA guidelines, a partial-thickness burn under 10% TBSA in a non-critical area, with no other criteria, is in the consultation-recommended tier: a call to the burn center is reasonable, but care can usually be given locally. Mandatory burn center transport is reserved for criteria such as larger burns, critical areas, inhalation, chemical, or high-voltage injury. A 6% burn is far below the size that needs formal fluid resuscitation. Escharotomy is for circumferential full-thickness burns that restrict breathing or blood flow, which this burn is not.

21. Burn centers also treat certain non-burn conditions. Which of these patients most needs burn center care?

    1. A. An adult with widespread poison ivy rash
    2. B. An adult with severe hives from penicillin
    3. C. An adult with widespread plaque psoriasis
    4. D. An adult with toxic epidermal necrolysis
    Show answer

    Answer: D. An adult with toxic epidermal necrolysis

    Toxic epidermal necrolysis and severe Stevens-Johnson syndrome strip away large areas of epidermis, producing the same fluid loss, hypothermia, and infection risk as a large partial-thickness burn, so treatment guidelines recommend a burn unit or similar critical care setting with wound expertise. (The 2022 ABA referral sheet itself covers thermal, inhalation, chemical, electrical, and pediatric injuries.) A widespread poison ivy rash leaves the epidermis intact and is managed with symptom care. Hives from a drug reaction and plaque psoriasis also leave the epidermis in place and do not cause burn-like skin loss.

22. Under the 2022 ABA referral guidelines, which statement about burned children is correct?

    1. A. Referral applies only to children under 2 years
    2. B. Only children with burns over 10% TBSA qualify
    3. C. Any burned child may benefit from referral
    4. D. Children are referred only if abuse is proven
    Show answer

    Answer: C. Any burned child may benefit from referral

    The 2022 ABA guidelines define pediatric patients as 14 years or younger, or under 30 kg, and state that all pediatric burns may benefit from burn center referral because of pain, dressing-change and rehabilitation needs, family support, or possible non-accidental trauma. The older rule, which referred children mainly when the local hospital lacked pediatric staff or equipment, has been broadened. The pediatric definition extends well past age 2. Size thresholds such as 10% TBSA do not limit pediatric referral. Abuse does not need to be proven; suspicion alone is a reason to involve the burn center, and you must also report it as required.

23. A 45-year-old woman has a deep partial-thickness burn of 1% on her perineum from a hot bath. You should:

    1. A. Treat it as minor, since it is only 1%
    2. B. Count it as 9% and start fluid resuscitation
    3. C. Transport only if she cannot urinate
    4. D. Consult a burn center for its location
    Show answer

    Answer: D. Consult a burn center for its location

    Deep burns of the genitalia or perineum meet referral criteria at any size because of infection risk and function. It is 1% by the rule of nines, not 9%.

24. Compared with a flame burn, a scald of the same size in an adult is generally:

    1. A. Less likely to be full-thickness
    2. B. More likely to be full-thickness
    3. C. Always associated with inhalation
    4. D. Treated with different fluid formulas
    Show answer

    Answer: A. Less likely to be full-thickness

    Most adult scalds from hot liquids are partial-thickness, while flame and contact burns are more often deep. Immersion scalds in children and older adults are an important exception.

25. A 34-year-old man has partial-thickness burns covering 7% of his back and 4% of his right arm, with no other injuries or conditions. Regarding burn center referral, he:

    1. A. Does not meet criteria, as no area exceeds 10%
    2. B. Meets criteria, at 11% partial-thickness
    3. C. Meets criteria only if a burn is full-thickness
    4. D. Does not meet criteria, as the back is not critical
    Show answer

    Answer: B. Meets criteria, at 11% partial-thickness

    The 10% threshold applies to the total partial-thickness TBSA, not to each area separately, so 7% plus 4% meets criteria. Judging each region alone is the tempting error.