Burns-Referral Criteria/Guidelines

Entry criteria for Level 3 burns centre
Burns that may qualify for Level 2 care
Burns that may qualify for Level 1 care

• Partial thickness (2°) and full thickness burns (3^o) > 10% total body surface area (TBSA) in patients under 10 and over 50 years of age 
• Partial thickness (2°) and full thickness (3^o) burns >20% TBSA in other age groups 
• Full thickness (3°) burns >5% (TBSA) in any age group 
• Burns to the face, hands, feet, genitalia or major joints 
• Electrical (including lightning), Chemical or Inhalation burns 
• Patients with pre-existing medical disorders compromising outcome 
• Patients with burns and concomitant trauma 
• Patients requiring extensive social,emotional or long-term rehabilitation support 
• Paediatric burns without qualified personnel or equipment 

 Associated co-morbidity and injuries may complicate any burn and the patient needs to be carefully considered and the injuries be treated according to clinical needs. Before any transfer please consult with the receiving hospital unit. 

Entry criteria for Level 3 burns centre

These are complex burns. 

• Age under 2 and over 60 years. 
• TBSA: 
  • All partial thickness burns >15% TBSA in children. 
  • All partial thickness burns >25% TBSA in adults. 
  • All full thickness burns >15% TBSA. 
• Anatomical site: 
  • Face, Hands, Feet, Genitalia, Perineum,major joints, circumferential burns. These burns could also be dealt with at level 1 or 2 but discretion must be used. 
• Inhalational injury requiring ventilation for more than 48 hours. 
• Mechanism of injury 
  • Exposure to ionizing radiation injury
  • High pressure steam injury /High tension electrical injury (>1000 Volts) 9
  • Hydrofluoric acid injury >1% TBSA 
  • 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 

 Burns that may qualify for Level 2 care

• Partial thickness burns of up to 25% TBSA in adults and up to 15% in 
• Children older than 2 years 
• Full thickness burns less than 10-15% TBSA in both adults and children excluding critical areas. 
• Burns that require debridement, skin grafting and dressing changes. 
• Inhalational burns requiring ventilation support for less than 48 hours. 

Burns that may qualify for Level 1 care 

These are non-complex injuries. 

• 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 10 
  • Minor burns in anatomically important sites 
  • Manageable and 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 and educational programmes(e.g. EMSB Course). These programmes should also be made available to the Emergency and 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 level.