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 | Burn Evaluation Sheet
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To download a Burn Evaluation Sheet in PDF format, click here.
Check the ABCs first
Name__________________________________Age_________
Date __________________ Time of Burn __________________
Mechanism of injury ______________________Weight_______
Medications_________________________________________
Allergies___________________Tetanus Immunization Status____
 Severity of Burn
 = 2 degree
 = 3 degree
_______ % burn surface area (BSA)
Rule of the palm for small burns: The patient's palm, excluding the digits, is approximately 1 percent body surface area.
Referral Criteria for Transfer to a Burn Center
- 2 and 3 degree burns >10% Burn Surface Area (BSA)
- 3 degree burns > 2% BSA
- Burns that involve the face, hands, feet, perineum and major joints
- Electrical, chemical and inhalation injuries
- Circumferential burns of an extremity or chest
- Burns involving trauma
- Patients with a burn and a complicating medical disorder
Age in Years
| |
0-1 |
1-4 |
5-9 |
10-14 |
Adult |
| A- 1/2 OF HEAD |
9 1/2 |
8 1/2 |
6 1/2 |
5 1/2 |
3 1/2 |
| B - 1/2 OF ONE THIGH |
2 3/4 |
3 1/4 |
4 |
4 1/4 |
4 3/4 |
| C - 1/2 OF ONE LEG |
2 1/2 |
2 1/2 |
2 3/4 |
3 |
3 1/2 |
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