Burn TBSA Calculator

Burns Management at Sea

Burns aboard vessels present a uniquely dangerous clinical scenario. Engine room flash burns, galley scalds, and chemical exposures are among the most common thermal injuries at sea, and the maritime clinician faces challenges that shore-based emergency departments never encounter. There is no burns unit over the horizon. Fluid resuscitation with large volumes of crystalloid may exceed the ship's medical stores. Silver sulfadiazine supplies are typically limited to a single tube or jar. And the patient cannot be transferred to definitive care for hours or days.

The Wallace Rule of Nines provides a rapid, systematic method for estimating the percentage of total body surface area affected by burns. Developed for adult patients, it divides the body into regions each representing approximately 9% (or multiples of 9%) of total body surface area. While not as precise as the Lund-Browder chart used in specialist burns units, the Rule of Nines is designed for rapid field assessment and is the standard taught to maritime clinicians, military medics, and pre-hospital providers worldwide.

Accurate TBSA estimation drives every downstream decision: fluid resuscitation volumes, pain management strategy, wound care approach, and crucially at sea, the decision to evacuate. Overestimation leads to fluid overload and unnecessary medevac requests. Underestimation leads to inadequate resuscitation and delayed evacuation. Neither error is acceptable when you are the only clinician aboard.

When to Evacuate

Maritime medevac for burns should be considered when any of the following criteria are met:

• TBSA greater than 15% in adults (10% in patients over 50 years of age or under 10 years)
• Full-thickness burns greater than 5% TBSA at any age
• Burns involving the face, hands, feet, genitalia, perineum, or major joints
• Circumferential burns of the limbs or trunk (risk of compartment syndrome)
• Inhalation injury (suspected from singed nasal hairs, carbonaceous sputum, hoarse voice, facial burns in enclosed space fire)
• Chemical or electrical burns
• Burns in patients with significant comorbidities (diabetes, immunosuppression, cardiac disease)
• Inadequate fluid resuscitation capacity aboard the vessel

The threshold for evacuation at sea should be lower than ashore. A 20% TBSA burn managed in a well-equipped emergency department is a different clinical proposition from the same burn managed in a two-bed ship's hospital with one clinician, limited IV fluids, and no possibility of blood products. When in doubt, initiate TMAS consultation early and prepare for evacuation while continuing treatment.

Parkland Formula

The Parkland (Baxter) Formula is the standard calculation for estimating crystalloid fluid requirements in the first 24 hours following a significant burn injury:

Total 24-hour volume = 4 mL x body weight (kg) x %TBSA burned

Half of this volume is administered in the first 8 hours from the time of injury (not from the time of presentation), and the remaining half over the following 16 hours. The formula uses Ringer's Lactate (Hartmann's solution) as the preferred crystalloid. Normal saline is an acceptable alternative if Ringer's Lactate is unavailable, but carries a higher risk of hyperchloraemic acidosis with large volumes.

At sea, the Parkland Formula serves a dual purpose: it guides fluid administration, and it reveals whether you have sufficient IV fluid stores to sustain the patient. If the calculated 24-hour requirement exceeds your available crystalloid supply, this must be communicated immediately during your SBAR-M to telemedical services, as it directly affects the urgency of evacuation.

Last updated: May 2026