Burns (Adult) - Patient Referral
Which level of care to refer patients to in the Western Cape
Burns that may qualify for Level 1 care (PHC clinic)
Burns that may qualify for Level 1 care (District Hospital)
Burns that may qualify for Level 2 care (Regional Hospital)
Burns that may qualify for Level 3/Tertiary care
Developed by Prof H Rhode, Dr Albie van der Merwe, Dr Stephan Fourie & Prof A Millar & released as Circular H62 of 2011
(updated 2016 by Dr S Cox, Dr R Martinez & Prof H Rhode)
Burns that may qualify for Level 1 care (PHC clinic):
- These are non-complex injuries.
- A uncomplicated minor burn is:
- Partial thickness burn < 15% TBSA in adults
- Partial thickness burn < 10% TBSA in paediatric patients
- Depending on the expertise of the available staff, additional criteria may include:
- Minor burns in anatomically important sites
- Manageable & stabilised co-morbidities
Burns that may qualify for Level 1 care (District Hospital)
- These are non-complex injuries.
- A uncomplicated minor burn is:
- Partial thickness burn < 15% TBSA
- Full thickness burn <5% TBSA
- Depending on the expertise of the available staff, additional criteria may include:
- Minor inhalational injury
- Electrical burns <400 Volts
- Minor burns in anatomically important sites
- Manageable & stabilised co-morbidities
- Surgery: debridement, skin grafting, dressing changes
The quality of care at this level can be substantially improved by the development of clinical guidelines & educational programmes (e.g. EMSB Course). These programmes should also be made available to the Emergency & Ambulance Services to standardised burn care at pre-hospital and HPC levels. There is unfortunately no published information available on the outcome of burns treated at community.
Burns that may qualify for Level 2 (Regional Hospital) care:
- Partial thickness burns:
- of up to 25% TBSA in adults,
- up to 15% in Children older than 2 years.
- Full thickness burns:
- less than 15% TBSA in adults
- less than 10% TBSA in children
- Burns that require debridement, skin grafting & dressing changes.
- Inhalational burns requiring ventilation support for less than 48 hours.
Burns that may qualify for Level 3/Tertiary burns centre:
These are complex burns.
- Age under 2 and over 60 years.
- Total body surface affected:
- All partial thickness burns >15% TBSA in children.
- All partial thickness burns >25% TBSA in adults.
- All full thickness burns >15% TBSA in adults
- All full thickness burns >10% TBSA in children depending on the anatomical site of the burn as follows:
- Face, Hands, Feet, Genitalia, Perineum, major joints, circumferential burns subjected to medium to major burns can be discussed with the referring facility to determine if referral is required. Discretion must be used, when in doubt consult.
- Inhalational injury requiring ventilation for more than 48 hours.
- Extensive burns with myoglobunuria. Refer to point 3.4 b
- Mechanism of injury
- Exposure to ionizing radiation injury
- High pressure steam injury
- High tension electrical injury (>1000 Volts)
- Hydrofluoric acid injury >1% TBSA (Severe hypocalcemia rapidly develops and needs to be treated with Calcium gluconate)
- Suspicion of non-accidental burn injury: paediatrics and adults
- Existing Co-morbidity:
- Cardiac limitation and/or MI within 5 years
- Respiratory limitation of exercise
- Uncontrolled type 1 diabetes
- Pregnancy
- Medically or disease induced immune-suppression for any reason
- Existing psychiatric or suicidal tendencies
- Suspected drug/alcohol abuse
- Severe associated injuries e.g. polytrauma and crush syndrome