Burns are classified according to the depth of the burn wound and extent of affected burned body surface area. In deep second degree and higher grade burns the epidermis and skin appendages are destroyed so that healing can only take place with severe scarring. In these cases necrectomy and skin grafting are recommended. Extensive and deep burns should be treated at specialized centers and more precise criteria for this are laid down in the guidelines. Emergency room treatment protocols have improved the quality of admission and treatment. Concomitant injuries need to be diagnosed and treated early. In addition to the damage to the skin the subsequent burn disease with massive accumulation of interstitial fluid determines the prognosis. The circulation is stabilized and the risk of infection is controlled by intensive fluid management, early necrectomy and split thickness skin grafting. Modern sedation and ventilation management allows a more rapid convalescence.