Transferring When The Heat Is On

In the following steps, we discuss the important considerations when transferring a patient with burns. Firstly, we’ll look at the factors that determine severity of burns and later we’ll consider the strategies for managing these patients on a transfer…

Criteria for referring critically-ill burns patients to a burns centre is dependent on 5 key features:

1. Burn Mechanism

• Any inhalational injury
• Thermal injury fulfilling criteria below
• Chemical injury covering >5% TBSA (or 1% TBSA with hydrofluoric acid burns)
• High-pressure steam or high-tension electrical injury
• Associated trauma
• Exposure to ionising radiation

2. Total Body Surface Area (TBSA)

• Adult burns covering >3% or paediatric burns >2% require admission to the local burns facility.
• Burns 10-40% or with inhalation injury often require specialist support from a burns unit.
• Burns >40% of TBSA require HDU/ICU level support, with critical care transfer to a burns centre.
• Document the TBSA% – use a Lund and Browder chart or Rule of 9

3. Burns Depth

• Epidermal burns are superficial, requiring local hospital support.
• Dermal burns are significant and need specialist burns care early on.

4. Concerning Location

• Face, hands, feet, genitals, scalp and circumferential burns may indicate a more critical patient

5. Burns Complicated By…

• Necrotising fasciitis
• Toxic shock/scalded skin syndrome
• Haemodynamic instability
• Extremes of age.