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 > 20% TBSA (Adults) and > 10% TBSA (Paediatrics)
- High-voltage electrical burns, including lightning injury.
It is important to note that an exhaustive clinical workup and interventions are not always necessary or appropriate prior to transfer. Stabilisation and ensuring life-threatening problems are addressed, as well as taking measures to prevent deterioration enroute, are essential aspects of early care. Delaying transfer to obtain laboratory results or imaging studies may simply delay access to definitive treatment.
Hospitals with specialist burns facilities should manage burns patients requiring critical care support. 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 the patient 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 referring hospital. Once retrieval staff arrives on scene, be prepared to give a thorough handover. Retrieval staff will assess the patient prior to transfer and may update care to ensure the patient is safe during transfer.
Adult Retrieval Victoria recommends a standardised recognised handover tool such as ISBAR or IMIST-AMBO to facilitate clarity and completeness amongst health professionals and patient safety.(7)
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.
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