A 25% TBSA burn in TCCC requires evacuation Category A.

True or False? A combat casualty with 25% TSA burns would be evacuation category A?

• A. True
• B. False
• C. Depends on the region
• D. Not enough information

Answer: (A)

In the context of TCCC and casualty evacuation categories, a combat casualty with burns covering 25% of the total body surface area (TSA) is categorized as a critical condition that typically warrants urgent medical attention. Specifically, burns of this extent can have serious implications for the casualty's health, including respiratory compromise, shock, and the risk of infection. Evacuation Category A is designated for patients who require immediate evacuation due to life-threatening conditions. Since 25% TSA burns pose significant risks and complications, it falls into the criteria for urgent evacuation. Therefore, the assertion that a casualty with 25% TSA burns would be evacuation category A is accurate, as they need prompt transfer to a medical facility equipped to manage severe burn injuries. In this case, other factors like the region or additional information do not alter the classification of the injury, reinforcing that such a case should indeed be treated with high priority for evacuation.

True. A 25% TBSA (Total Body Surface Area) burn in a combat casualty is a red flag that pushes the patient toward urgent evacuation, and in TCCC-level care, that often means Evacuation Category A. Here’s how that plays out in the field, and what it means for responders who want to move fast without sacrificing safety.

A quick map of Evacuation Categories in Tier 3 care

• Category A: Immediate evacuation is required due to life-threatening or rapidly deteriorating conditions. Think airway danger, major breathing compromise, signs of shock, or burns that will likely worsen quickly.

• Category B: Urgent evacuation is needed for injuries that aren’t instantly life-threatening but require rapid transport to prevent deterioration.

• Category C: Routine evacuation for injuries that are stable and can be monitored on a longer timeline.

Why a 25% TBSA burn screams “get this patient moving now”

Burn injuries don’t just sit there. They evolve. In the field, a 25% TBSA burn isn’t simply skin damage; it’s a metabolic and physiologic hammer blow. Here’s what makes it so serious:

• Respiratory risk rises quickly. Burns, especially on the face or neck or those involving inhalation, can swell the airway. The result: breathing becomes harder, faster, and less effective. In a combat setting, that can spiral into a life-threatening airway obstruction if not addressed promptly.

• Shock and fluid shifts. Large burns draw fluid out of the circulation and into the damaged tissues. Even with first aid, that shift can drop blood pressure and impair perfusion, which means organs don’t get the oxygen they need. The body’s demand for fluids and warmth climbs, and the clock is ticking.

• Infection threat. Open burn wounds are vulnerable to bacteria. In field conditions, controlling contamination while keeping the casualty warm is a delicate balance. Infection and sepsis are real threats if the burn wound is exposed or cooled inadequately.

• Complications add up fast. The bigger the burn, the greater the risk of complications like inhalation injury, carbon monoxide or cyanide exposure, and systemic inflammatory response. When you’re operating with limited resources, those risks translate into a higher likelihood you’ll need to move the patient to a higher level of care sooner rather than later.

So, the framework says, yes—the 25% burn is a Category A scenario, because the potential for rapid decline is there. The system is built to err on the side of rapid extraction and definitive care.

What field care looks like when you’re staring down a 25% burn

Let me explain the practical, on-the-ground steps that mesh with the evacuation priority. The goal is to stabilize enough to move, while giving the casualty the best odds once they’re en route to a medical facility.

• Airway and breathing first, always. Assess for obstructions, facial burns, or swelling that might tighten the airway. High-flow oxygen is standard, with humidified oxygen if possible. If there’s any sign of inhalation injury or airway compromise, be prepared for advanced airway management on arrival at the next echelon of care.

• Keep the casualty warm. Hypothermia is a silent killer in burn patients. Use blankets, warming lights, and avoid exposing the wound more than necessary. A warm body generally survives the transport better and recovers faster.

• Control pain and comfort. Analgesia matters, not as a luxury but as a vital part of stabilization. If it’s in your protocol, administer appropriate analgesia while monitoring for respiratory depression or other side effects.

• Protect the wound. Cover the burns with clean, dry dressings or sterile burn sheets. Avoid applying ice directly to the wound—cooling too aggressively can worsen tissue damage and chill the patient, which you don’t want.

• Prevent infection and further contamination. Dressings reduce contamination, and an orderly, clean approach helps with handoffs. In the field, you won’t have all the fancy antiseptics, but simple sterile dressings make a big difference.

• Manage circulation. Monitor pulse, capillary refill, and blood pressure. If signs point to shock, follow your protocol for fluid resuscitation and rapid evacuation. Don’t delay while you search for reasons to wait.

• Document clearly for the handoff. Brief notes about burn extent (25% TBSA), location, suspected inhalation risk, accompanying injuries, and vital signs help the receiving team pick up where you left off.

What happens when other injuries ride along

You might wonder: what if there are other injuries too? Here’s the practical reality: a 25% TBSA burn still points to Evacuation Category A, because burns this extensive carry significant risk by themselves. Additional injuries can complicate the picture, but they don’t erase the urgency. In the real world, you’ll often see multiple injuries; the biggest threat—here, the burn—usually dictates the pace and priority of evacuation.

That said, you’ll still triage with a mind for the whole casualty. A gunshot wound to the leg might look dramatic, but if the burn is 25% TBSA with airway concerns, it’s the burn and the airway that drive the decision to move now. Conversely, if someone has a 25% burn but is otherwise stable and without airway signs, you still lean toward rapid evacuation due to the burn’s potential to deteriorate.

A quick, practical scenario to anchor the idea

Picture this: a field medic reaches a casualty with burns on the chest and arms covering roughly a quarter of the body surface. The person is alert but anxious, breathing is labored but not acutely failing, and there’s a shallow cherry-red tint in the lips—possible inhalation exposure. You apply high-flow oxygen, cover the wounds, keep the patient warm, and prepare for rapid transport. You call for evacuation with Category A urgency. You carry on with the plan to move as soon as possible, monitoring vitals every few minutes, reassessing the airway, and remaining ready for any sudden change.

Why this matters for your training and your future work

The takeaway is straightforward: 25% TBSA burns are a prompt call to Evacuation Category A in Tier 3 care. The field protocol isn’t about waiting for perfect data or second-guessing the severity. It’s about recognizing the red flags early, acting decisively, and getting the casualty to a burn-capable facility quickly.

If you’re digging into this topic, you’re not just memorizing a rule. You’re building a mental model for fast, reliable decisions under pressure. You’re learning to balance urgency with the practical realities of the field—the weather, the terrain, the equipment at hand, and the human mind under stress.

A few quick takeaways to keep handy

• A 25% TBSA burn is a Category A urgency in TCCC-level care due to the risk of airway compromise, shock, and infection.

• Immediate actions center on airway protection, high-flow oxygen, warmth, wound protection, and rapid evacuation.

• The presence of other injuries doesn’t remove the need for urgent evacuation; it can, however, influence how you monitor and manage the patient during transport.

• Clear, concise handoffs save lives. Document burn extent, location, airway status, accompanying injuries, and vital signs before you move.

A moment of realism

Let’s not sugarcoat it. Seeing a casualty with large burns in a field setting is intense. The stakes are high, and every minute counts. Still, there’s a steady rhythm to it if you stay focused: assess, stabilize, evacuate, reassess, and communicate. The science is solid, but the real skill lies in keeping calm when the heat, both literal and figurative, is on.

If you’re preparing to work alongside teams that handle Tier 3 care, imagine the chain of care like a relay race. You take the baton from the point of injury, you run with it using the tools and knowledge you’ve got, and you pass it smoothly to the next link—the medevac crew and the receiving hospital. In a situation with 25% TBSA burns, that relay is a sprint. Your job is to keep the pace steady, the technique clean, and the handoffs crisp.

Final thought

The bottom line is clear: yes, a casualty with 25% TBSA burns should be treated as Evacuation Category A. The justification isn’t just about the burn size—it’s about the trajectory of risk: airway threats, shock potential, infection risk, and the overall pressure on the body to adapt under stress. In field care, recognizing this scenario early and moving decisively saves lives. And that’s the core of Tier 3 readiness: translate knowledge into action when it matters most, with care, competence, and compassion.