Partial-thickness burns (second-degree) show reddened skin with blisters and signal how to care for them in the field

Outline for the article

• Hook: a quick field scene where a medic faces a burn injury and needs to classify depth quickly.

• What second-degree (partial-thickness) means: layers of skin involved (epidermis plus part of dermis), symptoms (reddened skin, swelling, blistering), and how it differs from first- and third-degree burns.

• Why blisters matter: they signal deeper injury, protection/risks, and what to do about them.

• Recognizing the signs in the field: redness, swelling, blister formation, pain levels, and how these compare to other burn levels.

• Tactical Care basics (Tier 3 relevance): scene safety, cooling, dressing, keeping blisters intact, pain control, tetanus, and when to evacuate.

• Practical steps you can take now: a concise, prioritized checklist.

• Common myths to avoid.

• Takeaways: quick recap and reminders.

What characterizes a partial-thickness or second-degree burn? Let’s break it down

Imagine you’re on a training exercise or a real mission. A burn happens, and quick, reliable assessment matters. A partial-thickness burn, also called a second-degree burn, involves more than the outermost skin layer. Specifically, it damages the epidermis (the skin’s tough, protective outer layer) and a portion of the dermis (the next layer down). That extra depth is what makes this kind of burn different from a simple red patch that hurts a little.

Here’s the thing: a first-degree burn affects only the epidermis. It stings, turns red, and often heals without blistering. A second-degree burn crosses into the dermis. You’ll usually see redness, swelling, and most tellingly, blisters. The pain tends to be more intense than with a first-degree burn because nerves in the dermal layer are involved. If a burn is third-degree, that’s a different story entirely — the damage runs through the full thickness of the skin, often leaving charring, numbness, or a leathery texture. With partial-thickness burns, the blistering is a hallmark sign that the injury isn’t superficial, and that deeper skin layers have taken a hit.

Blisters aren’t just pretty annoying little bubbles. They’re signals that the skin has been broken into, and fluid has rushed to the damaged area to provide a cushion for healing. They can protect underlying tissue, but they’re also fragile and prone to infection if not cared for correctly. So the presence of blisters helps distinguish second-degree burns from minor redness or from deeper, more catastrophic damage.

Recognizing second-degree burns in the field

What should you look for when you’re assessing someone with a burn? A few dependable clues:

• Reddened skin that looks more than just a sunburn. It’s often a bright or vivid red, and the area may be warm to the touch.

• Blisters. Expect fluid-filled pockets that may be intact or ruptured. Blisters are a sign that the injury goes beyond the epidermis.

• Swelling around the burn. Inflammation is common as the body responds to tissue damage.

• Pain that’s usually significant. The nerves in the affected dermal layer can cause noticeable discomfort, though in larger burns, nerves may also be damaged, which can dull sensation in some spots.

• The burn extends beyond a small patch. Partial-thickness injuries tend to cover a larger area than a tiny sunburn-only patch.

How this kind of burn is treated in Tactical Combat Casualty Care (TCCC) terms

In Tier 3 or higher-level field care, the goal is to stabilize, protect, and prepare for evacuation if needed. For a partial-thickness burn, the priorities are to calm pain, prevent infection, and keep the wound from getting worse, while avoiding anything that could complicate healing.

Key steps you’d typically take in the field include:

• Scene safety and initial assessment: Make sure the area is safe for you and the patient. Quick airway, breathing, and circulation checks help identify more critical injuries that might be present.

• Cool the burn: If available and not causing shivering or hypothermia, gently cool the area with clean running water for about 10 minutes. This helps reduce pain and limits tissue damage. Avoid applying ice directly on the skin; it can worsen tissue injury.

• Remove jewelry and constrictive items: If you can do so safely, remove rings, bracelets, or tight gear from the affected limb before swelling worsens.

• Do not break blisters: Intact blisters reduce infection risk and preserve a natural protective barrier. If a blister is fragile or ruptured, clean the area with water and apply a sterile dressing.

• Dressings: Use a sterile non-stick dressing or a clean, dry dressing to cover the burn. Avoid fibrous materials that shed bits into the wound.

• Pain management: Administer appropriate analgesia per your protocol. Acetaminophen or NSAIDs might be used if allowed by your team’s guidelines, and consider local anesthesia for larger, clearly defined areas if protocols permit.

• Tetanus and infection prevention: Check vaccination status and provide a booster if needed according to your medical guidelines. Antimicrobial ointments may be used in some protocols, but many field treatments prefer dry dressings to keep the wound clean.

• Fluid management and systemic concerns: For most small to moderate burns, you won’t need IV fluids for a skin-deep burn alone, but monitor for signs of dehydration or shock if multiple injuries are present.

• Evacuation decisions: Partial-thickness burns that are extensive, involve critical areas (face, hands, feet, genitals, joints), or cover a significant total body surface area (TBSA) require urgent evac to a higher level of care. A burn-injury that shows signs of infection, increased swelling, or deteriorating pain may also prompt moving to a more capable facility.

Here’s a practical, bite-sized checklist you can keep in mind

• Quick identification: Is the skin red with blisters? If yes, think partial-thickness burn.

• Cool, not cold: Run cool water over the area for about 10 minutes if feasible.

• Gentle coverage: Don’t pop the blisters. Cover with a sterile, non-stick dressing.

• Avoid irritants: Don’t put greasy ointments, ice, or rough materials on the wound.

• Pain and exposure: Manage pain per protocol and keep the patient comfortable.

• Monitor for spread: Keep an eye on swelling, redness extending beyond the initial burn, or fever.

• Evacuation threshold: If the burn is large, on the face or joints, or shows signs of infection, arrange for higher care sooner rather than later.

Common myths worth debunking

• Myth: You should always pop blisters to relieve pain. Reality: Intact blisters protect tissue and reduce infection risk. Only rupture under medical guidance if necessary.

• Myth: Cold water is bad for burns. Reality: Cool, clean water helps limit tissue damage when used in short, controlled exposure.

• Myth: A bigger burn means you’ll need a longer hold at the site before evacuation. Reality: Size matters, but location and depth matter more for decisions about moving to higher care.

A few notes on nuance and nuance in practice

• Depth matters, but so does location. A second-degree burn on a finger might require a different approach than a similar burn on the torso or face. In field practice, exposure, mobility, and risk of infection all influence care decisions.

• Pain isn’t just a nuisance; it’s a vital sign. Severe pain can mask other injuries. Treat pain to improve assessment accuracy and comfort.

• Hydration and overall condition matter. A burn patient’s fluids should be watched, especially in a high-stress field environment where other injuries may be present.

• Tetanus timing can be the quiet variable. In austere environments, even small burns deserve attention to vaccination status and booster needs as part of overall care.

Why this distinction matters in real-world settings

Understanding that a second-degree burn involves reddened skin with blisters helps clinicians and first responders tailor care. The blistering signals that deeper layers are involved, which guides both immediate management and decisions about evacuation. In tactical environments, the differences between superficial and deeper burns can influence how you allocate resources, how you protect the wound in the field, and when you call for additional medical support.

A quick, friendly recap

• Partial-thickness (second-degree) burns reach the epidermis and part of the dermis.

• The hallmark: reddened skin with blisters, often accompanied by swelling and more intense pain.

• In the field, treat by cooling, protecting, and preventing infection; keep blisters intact when possible.

• Use dressings that protect without sticking; remove restrictive items; manage pain per protocol.

• Monitor for signs that call for evacuation to higher care, especially if the burn is large, involves joints or the face, or shows infection.

Final thoughts

Burns are tricky because the surface can look deceptively simple while the damage runs deeper. The presence of blisters in a reddened area is a telltale clue of a partial-thickness burn. On the ground, the right care is a blend of science and practical judgment: cool the area, protect it, and get the patient to a facility that can manage healing and prevent complications. It’s the kind of knowledge that becomes second nature when you’ve seen it in action, talked it through, and practiced the steps until they feel almost automatic.

If you ever find yourself in a situation with a burn, remember that the goal is to support the body’s healing process while keeping the risk of infection low and ensuring the patient is ready for the next step in care. Stay calm, follow the basics, and use the tools you’ve trained with. In the end, those small, deliberate actions can make a big difference in recovery—and that’s what TCCC is all about: clear, practical moves that save lives in high-stakes moments.