Burn care: before the burn center
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EDITORIAL
Open Access
Burn care: before the burn center David J. Dries1,2,3 Many burn care papers and textbooks begin with presentation of the patient to the Emergency Department. Maudet and coworkers from Switzerland depart in an important way from this pattern by providing a 10 year review of pre-hospital Helicopter Emergency Medical Service (HEMS) management of burn patients in a homogeneous practice serving one of two Burn Centers in Switzerland [1]. Notably, in this with system, every EMS service automatically refers to the Burn Center. Thus, these authors have a good sample of the pattern for initial hospital management and prehospital care. Sophisticated pain protocols utilize fentanyl and ketamine. There is remarkable consistency in evaluation of burn size. Resuscitation complications are not identified. Consideration of this elegant work begins an important conversation in which I will present a North American perspective. My observations reflect experience with the extensive area of the North Central United States served by a network of small safety net hospitals providing care for a wide variety of problems and having inconsistent burn experience. Burn injuries may be challenging to manage, and many hospitals scattered over a wide area do not have the personnel, resources, and expertise to care for these individuals. Consequently, the American Burn Association, in conjunction with the American College of Surgeons Committee on Trauma has developed referral criteria to help providers determine that patients should be transferred to a Burn Center (below) [2]. Many of these criteria relate to location, mechanism, or severity of the burn. In addition, there are criteria that recommend the transfer of specific groups of patients, such as children or patients with significant comorbidities or rehabilitation needs. Correspondence: [email protected] See the original article by Ludovic Maudet, Mathieu Pasquier, Olivier Pantet https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00771-4 1 Department of Surgery, HealthPartners Medical Group, St. Paul, USA 2 Department of Surgery, University of Minnesota, Mpls, USA Full list of author information is available at the end of the article
Burn Center Referral Criteria - Partial thickness burns > 10% TBSA - Burns to face, hands, feet, perineum, joints - Third-degree burns - Electrocution including lightning - Inhalation injury - Chemical burns - Pediatric burns - Burns with comorbid medical conditions or coincident trauma Modified: Resources for Optimal Care of the Injured Patient, 2014 [2].
Transfer Air transport is heavily used in rural areas or by hospitals that are far from Burn Centers. Although this mode of transportation is safe for patients, it should be used judiciously. Air transport is expensive and available resources may support only a portion of transportation costs [3]. Moreover, some patients who are brought to the Burn Center by air are discharged within 24 h if their injuries are discovered to be minor [4]. The need for air tr
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