Which patient(s) requires burn center/facility transfer?
A. 35 year old male with partial thickness burns to entire back, shoulders and buttocks
B. 23 year old female with circumferential full thickness burns to right hand and wrist
C. 55 year old male with circumferential partial thickness burns to entire right leg
D. 18 year old female after inhalation injury with multiple partial thickness burns and wheezing, with significant asthma history
E. A, B, C, and D
F. A and B
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Transfer guidelines for patients with severe burns include
- Any burn >10% of total body surface area (BSA) in patients <10 or >50 years old
- Burns involving >20% of total BSA in any patient
- Full thickness burns of hands, face, feet, genitalia, perineum or major joints
- Significant electrical injury
- Significant chemical injury
- Significant inhalation injury, concomitant mechanical trauma, pre-existing medical disorders
- Patients with special psychosocial or rehabilitative care needs
When a burn patient is being transferred to a burn center, early physician to physician contact with the burn center is essential. Prophylactic antibiotics are not indicated, and the use of antimicrobial creams on the burn wound should be postponed until admission to the burn center. Tetanus prophylaxis should be administered.
References:
- Rosen’s Emergency Medicine – Concepts and Clinical Practice. 8th edition. 2013. Chapter 63: Thermal Burns. 811-814.
- Guidelines for the Operation of Burn Centers. Resources for Optimal Care of the Injured Patient 2006, Committee on Trauma, American College of Surgeons. 80-86. full text