significantly when 30% of TBSA is burned, and so those children should be triaged to receive care more rapidly One possible triage guideline based on a five-level emergency severity index (ESI) scale is shown in Table 104.1 Clinical Assessment Percentages After the primary survey and initial stabilization, a systematic evaluation of the surface area and depth of burns follows The rule of nines is used to estimate burn surface area in adolescents and adults Each arm is approximately 9% TBSA, each leg is 18%, the anterior and posterior torsi are each 18%, the head is 9%, and the perineum is 1% This rule cannot be applied to children because they have different body proportions In particular, young children have relatively larger heads and smaller extremities Therefore, age-adjusted methods of estimating burn surface have been developed ( Fig 104.1 ) Alternatively, a child’s palm including the fingers is approximately 1% of BSA and this can be used to estimate the extent of scattered, smaller burns