ATP 4-02.11 Reference

BURNS: CLASSIFICATION, COOLING & FIELD TREATMENT

Source: ATP 4-02.11, Chapter 12 — Burns, 23 March 2026

Key Points

  • First priority: eliminate the burn source before treating
  • Rule of Nines estimates burn area percentage
  • 1st degree burns (superficial) = NOT counted in burn percentage
  • Burns >20% body surface area = high risk of shock AND hypothermia
  • Do NOT use ice on burns — use cool (not cold) water
  • Do NOT apply field ointments, butter, or creams to burns
  • If clothing stuck to burn: cut around it — leave stuck portion in place
  • Burn patients are especially susceptible to hypothermia
  • Facial burns in closed spaces = suspect inhalation injury

Common Mistakes

  • Applying ice directly to burns (causes vasoconstriction, tissue damage)
  • Applying butter, toothpaste, or other home remedies
  • Pulling clothing that is stuck to burned skin
  • Submerging a chemical burn casualty in water (spreads irritation, causes hypothermia)
  • Touching an electrical burn casualty without removing electrical source first
  • Not monitoring airway in facial burns (inhalation injury risk)

Rule of Nines

  • Head: 9%
  • Torso (front): 18%
  • Torso (back): 18%
  • Each arm: 9%
  • Each leg: 18%
  • Pubic area: 1%
  • Buttocks: 1%
  • Palm = approx. 1% (for estimation)

Round up to nearest 10%. 1st degree burns not counted.

Critical Principle

Burn care in TCCC is basic. Eliminating the source of the burn is the initial priority. Providing treatment prior to removing the casualty from the source of the burn will be ineffective and harmful to the casualty and responders. (ATP 4-02.11, para 12-9)

Burn Classification

Classification Also Called Depth Appearance Pain
1st Degree Superficial Epidermis only Red, dry, no blisters (like sunburn) Painful
2nd Degree Partial thickness Epidermis + part of dermis Red, blistered, moist, weeping Very painful
3rd Degree Full thickness Through all skin layers White, brown, or black; dry, leathery; no blisters Little/no pain (nerve damage)

Note: First degree (superficial) burns are NOT included in the burn percentage calculation for the Rule of Nines and are rarely of medical significance. (ATP 4-02.11, para 12-4 note)

Thermal Burn Treatment

  1. 1

    Stop the source. Remove the casualty from the heat source. Extinguish any flames (roll, smother, or use water — not CO2 extinguisher directly on person).

  2. 2

    Cut clothing around the burned area and gently lift away. If clothing is stuck to the burn, cut around it and leave the stuck portion in place — do not pull.

  3. 3

    Do not grab the burned area while moving or picking up the casualty.

  4. 4

    Cover burned areas with sterile, moist dressings (not tight). Do NOT apply any ointments, butter, or creams. Do NOT use ice — use cool (not cold) water to reduce temperature only.

  5. 5

    Prevent hypothermia — Burns >20% body surface area: use the Heat Reflective Shield (HRS) to cover burned areas. Keep off the ground on insulated surface. (ATP 4-02.11, para 12-16)

Chemical Burn Treatment

  1. 1

    Eliminate the source. For dry chemicals: carefully brush off with a clean, dry cloth — do not use water yet as water can activate some dry chemicals.

  2. 2

    Flush with copious amounts of flowing water to remove liquid chemicals. Flush from wound outward.

  3. 3

    Apply a wet barrier (water-soaked gauze, clothing, or mud) with an occlusive dressing.

  4. 4

    Advise medical personnel immediately. Do NOT submerge the casualty in water — this spreads the irritant and contributes to hypothermia.

Electrical Burn Treatment

Warning: Electrical Burns

Do NOT touch the casualty or the electrical source with bare hands — you will be injured too. High voltage electrical burns may cause temporary unconsciousness, breathing difficulties, or cardiac arrhythmias.

  1. 1

    Turn off the electricity source if possible.

  2. 2

    If source cannot be turned off, use nonconductive material (rope, clothing, dry wood) to drag the casualty away from the source.

  3. 3

    Move casualty to a safe place. Assess for breathing and cardiac status — be prepared for CPR. Monitor closely.

All Burns — General Measures

  • Monitor the casualty for life-threatening conditions
  • Check for additional injuries (blast, blunt trauma, fragmentation)
  • Treat for shock if applicable
  • Seek medical aid and MEDEVAC
  • Monitor airway closely — especially for facial burns and burns in closed spaces (inhalation injury)
  • Do NOT place NPA in a casualty with signs of inhalation burns
  • Annotate all treatment on DD Form 1380 including burn percentage (Rule of Nines)

ATP 4-02.11 Source

Chapter 12: Burns — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.

See It in Practice — ESB Tasks

These ESB Medical Lane tasks apply this doctrine directly:

M10: Fracture & Burn
Head Injury & TBI Fractures & Splinting