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Transferring When The Heat Is On
How to ensure you don't transfer out of the frying pan into the fire
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.
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