For large wilderness burns, what is the recommended course of action?

• A. Apply ointments and simulate healing on site.
• B. Keep the burn dry; apply ice.
• C. Elevate and wrap loosely with cloth, no evacuation.
• D. Keep the patient warm, evacuate, and monitor for infection.

Answer: (D)

The important idea here is that large wilderness burns require rapid actions focused on preventing hypothermia, getting professional care, and watching for infection. In the field, keeping the person warm is essential because extensive burns disrupt the skin’s protective barrier and cause fluid and heat loss. Cold conditions plus a large burn can lead to hypothermia and shock, which worsens outcomes, so cover the patient with a clean, dry blanket or clothing and shield the wound from the wind.

Evacuation is crucial because large burns need definitive care that isn’t available in most field settings—fluid management, wound cleaning, analgesia, tetanus prophylaxis, and potential surgical intervention. Delays increase the risk of complications, so arrange transport to a facility as soon as possible and continue monitoring during the transfer.

Monitoring for infection is a key ongoing task. Burn injuries are highly susceptible to infection as the protective skin barrier is compromised. In the field, watch for fever, increasing redness or swelling, foul discharge, or worsening pain, and keep the wound protected with clean dressings while preparing for transport.

Other approaches that try to treat on-site with ointments or cooling, or that omit evacuation, don’t address the main needs of a large burn in a wilderness setting: warmth, definitive care, and infection surveillance.