Retrieval and Transfer

   
Urgent arrangements for transferring and retrieving severe burns injury patients should take place as soon as is possible. This includes:
      

• all burn inhalation injuries
• burns to greater than 20% TBSA
• high-voltage electrical burns, including lightning injury.

It is important to note that exhaustive clinical workup and interventions are not always necessary or appropriate prior to transfer. Stabilisation and management of life-threatening problems, as well as taking measures to prevent deterioration en route, are essential aspects of early care. Delaying transfer to obtain laboratory results or imaging studies may simply delay access to definitive treatment. Often such studies must be repeated at the receiving facility.

Hospitals with specialist burns facilities should manage burns patients requiring critical care support. All health services are advised to avoid patient deterioration during inter-hospital transfer by the timely and proactive transfer of such patients to a MTS. Currently in Victoria, burns specialist facilities are located at The Alfred and the Royal Children’s Hospital.

In liaison with ARV clinicians, interventions to stabilise patients prior to retrieval personnel arriving should be commenced. ARV will coordinate the retrieval and will evaluate the practicality and clinical needs involved in transferring the patient from the source hospital. Once retrieval staff arrive on scene, be prepared to give a thorough handover. Retrieval staff will assess the patient prior to transfer and may make changes to care in order to ensure the patient is safe during transfer.

Adult Retrieval Victoria recommends the IRMIST-AMBO method of handover for facilitating health professional communication and ensuring clarity and completeness.

Consultation about transferring non-urgent burns patients to a specialist facility should also take place where there is:

• Burns greater than 10% TBSA.
• Burns to special areas and full-thickness burns involving the face, eyes, ears, hands, feet, major joints or genitalia.
• Full-thickness burns greater than 5% TBSA.
• Electrical burns.
• Chemical burns.
• Circumferential burns of the limbs or chest.
• Burns with associated trauma.
• Burns in the very young or older people.
• Burn injury in patients with a pre-existing illness or disability that could adversely affect patient care and outcomes.
• Suspected non-accidental injury in children.
• Small area burns in patients with social problems, including children at risk.
• Burns occurring in pregnant women.
• Burn injuries that the referring unit is concerned about or are slow to heal.

The transfer of these patients will be assessed on a case-by-case basis and an appropriate transfer timeline will be given according to need.