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Understanding Burn Care


Fire Fighter Burn Injuries

Ask Yourself:

  • Do you know where your closest burn centers are?
  • Which patients should be transported to a burn center, and why?
  • What is your department's plan for when a fire fighter is burned?
  • Are you prepared to support a burn injured fire fighter and their family?
  • TRAUMA CENTER vs. BURN CENTER: Is there a difference?
  • Where can I find information on available resources for supporting a burn survivor?
  • What types of specialized care are available to our patients at a burn center?
  • How can we improve the quality of life for our burn patients?

Because occupational injury or workers' compensation claims can result when fire fighters receive on-the-job burn injuries – proper care, treatment and documentation are essential. Establish return-to-work environment protocols, since exposure to heat, trauma or additional burn injury can be detrimental to recovery.

Given the nature of their work environment, it is imperative that fire departments have established protocols for all fire fighter burns, regardless of size or severity. Protocols include the process for consulting with a burn center to determine if a fire fighter requires outpatient wound care versus hospitalization, and determining return-to-work plans. Encourage fire fighters not to “self-treat,” especially with outdated or inappropriate burn topical agents or remedies, as this can lead to longer healing times and an increased risk of complications such as infection.

Establish return-to-work protocols.

Due to the nature of their profession, fire fighters are at higher risk for burns. Burns to fire fighters occur in predictable patterns, generally the head, ears, neck, knees, wrists and hands are the most common sites. Fire fighter burn injuries can occur when personal protective equipment (PPE) is not worn, not worn correctly or when it fails. However the injury occurs, it is vitally important that immediate and proper care be started at the scene and continues until the patient reaches definitive care, ideally at a verified burn center. Proper care follows American Burn Association (ABA) recommendations for triage, treatment and transport to a proper hospital facility.

Some of this decline in the number of injuries and fatalities has been attributed to advances in PPE. Although the quality of PPE is improving, there is evidence that injuries do still occur, primarily because gear is not always used properly. The other causes of reported fire fighter injuries are: falling, exhaustion, blunt force trauma and heart attacks.


In an analysis of 189 fire fighter fatality reports from the National Institute of Occupational Safety and Health (NIOSH), improper use of PPE was cited in 23 (12.2%) of the post-incident recommendations for corrective action. Some fire fighters do not consistently wear their full PPE for a variety of reasons, including:


  • Perceived interference with work performance
  • Delaying a rescue
  • Cultural factors unique to this profession
  • Lack of knowledge regarding PPE usage


Improper use of PPE leads to injury; therefore, increasing education and awareness of proper PPE use among fire fighters is critical for their safety.

Awareness of proper PPE use is critical for safety.

Fire Fighter Injury and Death Prevention

Thousands of fire fighters place themselves in harm's way every day. In the past, injury was perceived as part of the job or something that only happens to others, but each year, fire fighters continue to sustain burn injuries that are predictable and preventable. As knowledge, training and equipment advances, burn injuries seem to have reached a plateau rather than declined.


Without exception, burns are life-altering and can range from a few weeks of missed duty to months spent in a burn unit and rehabilitation center or to the end of a career. Burns take a toll on the body and can have psychological repercussions for not only the injured fire fighter, but for fellow fire fighters and families as well.


The best defense against burn injuries begins with training along with the complete and proper use of Personal Protective Equipment (PPE). Properly using PPE, every time, on every incident, is something that can become routine through constant, ongoing training, making it second nature for everyone on the team.


Treating Burns

Knowing what to do to avoid a burn is the first and most important step. However, having a plan in place for how to properly treat burns is just as important. Both of these steps occur with awareness and education.


Fire Fighter Burn Injury Prevention and Education Programs

Fire fighter safety should be a top priority for fire fighters. When a fire fighter becomes injured on the scene, the focus of the operations changes dramatically from firefighting and rescue, to now include rescuing and treating injured fire fighters. Limited resources are then stretched even further, impacting the safety of everyone on the scene.

A safety-oriented attitude is the most important tool a fire fighter can carry.

The DC Firefighters Burn Foundation, in partnership with numerous fire fighter organizations and burn centers across the U.S., have developed a course called "It Happened In Seconds." All fire fighters and fire agencies are encouraged to view and follow this program as part of their fire fighter burn injury and prevention program.


Personal Protective Equipment (PPE)

The National Fire Protection Association (NFPA) has a series of standards that outline the requirements for PPE. These standards are generally more stringent than the Occupational Safety and Health Administration (OSHA) Standards and serve as an excellent guide for selecting, using and maintaining PPE.


NFPA 1851

NFPA 1851: Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting is one of the key standards that is used by many fire departments across the nation. It is a comprehensive document that covers the selection, care and cleaning of fire fighter protective gear.

Fire Fighter Burn Treatment

No matter the size or severity of burn injury, all fire fighters should seek treatment or consultation with a burn center to make sure they are receiving proper care and return-to-work guidance.

All fire fighters should seek treatment or consultation with a burn center.

For more information on when to transfer a burn injury to a burn center, visit the American Burn Association Referral Criteria.

Improper wound management may lead to increased risk of complications:


  • Infection - Improper wound care will result in infection. When wounds become infected, they can have tissue loss and the infection can spread to the blood stream and become life-threatening.


  • Scarring - Bad wound care can result in a worse scar. When scars occur in functionally important areas, they can result in disability. Exercise and stretching are part of the healing process and necessary to minimize or prevent loss of function and mobility.


  • Spending too much time out of work - Doctors that do not care for burns all of the time might not have the comfort level of sending you back to work when you are ready. You might spend extra time out on disability at a lower pay rate.


  • Returning to work too early - On the other hand, the less-experienced care provider might not recognize when healing skin is not ready to return to the high-heat environments common in fire fighting. New, healing skin burns more quickly and at lower temperatures than normal skin, so sometimes a skin graft with better skin can get you back to work more quickly.

When a fire fighter suffers a serious burn injury, their brother and sister fire fighters often crowd the hospital. While support is appreciated, too many people can make it hard for hospital staff to do their work. The hospital staff will communicate with the patient’s family. Help the family by designating a representative from the fire department who the family can contact with updates about the fire fighter’s condition, and can help coordinate available resources to provide assistance.  Identify likely fire department candidates before they are needed, while recognizing that individual relationships may take precedence in some situations.  Coordinating this approach with the burn center staff is beneficial to everyone involved in the care and recovery of the fire fighter with burn injuries.


Firefighters Burn Institute’sLiaison Response Team” (LRT) - The mission a this program, designed by and made up of fire fighters, is to provide assistance and emotional support to fire fighters, their families and the department following the aftermath of a burn injury. LRT members are dedicated to the well-being and recovery of their brother and sister fire fighters and understand the importance of help and emotional support during critical times. The LRT also ensures that the fire fighter’s family is taken care of through providing meals, housing or by making other special arrangements. The Firefighters Burn Institute provides resources to also assist with post recovery, including PTSD treatment, peer-support groups and funding to send the fire fighter to burn survivor support conferences.

Fire Fighters & Community Coalitions

According to many public opinion polls, fire fighters are among the most respected professionals. Fire fighters’ helpfulness, bravery and civic-mindedness position them to be valued members of burn prevention and fire safety community coalitions. Fire fighters bring value to community coalitions as credible educators and media relations spokespersons that also influence public policy. Fire fighters work closely with police departments, surrounding fire departments, local burn units, YMCAs and many other types of community organizations, providing a ready-made framework for a coalition for burn prevention. Fire fighters can take all of those relationships already built and use them to benefit the community. Fire fighter burn prevention outreach is something that everyone in the community can embrace. Fire fighters, burn professionals and community leaders are encouraged to cultivate those existing relationships. Make those calls, write that email, put that bug in someone’s ear at your next meeting,and be the local champion in your community for fire fighter burn prevention. The sky is the limit!