Guidelines for the operation of burn centers.

e ach year in the United States, burn injuries result in more than 500,000 hospital emergency department visits and approximately 50,000 acute admissions. Most burn injuries are relatively minor, and patients are discharged following outpatient treatment at the initial medical facility. Of the patients who require hospitalization, about 20,000 are admitted directly or by referral to hospitals with special capabilities in the treatment of burn injuries. These service capabilities, along with the setting in which they are provided, are termed burn centers. These guidelines define the burn care system, organizational structure, personnel, program, and physical facility involved in establishing the eligibility of a hospital to be identified as a burn center. (See Definition of Terms on the following page.) Many trauma centers do not have a burn center within the same hospital. In such cases, the trauma center should be able to communicate with the burn center and assess, stabilize, and arrange safe transport for seriously burned patients. Assessment follows Advanced Burn Life Support © (ABLS ©) and Advanced Trauma Life Support® (ATLS®) guidelines. The burn center should be telephoned and the patient and transfer discussed with the senior burn surgeon on call. In the absence of other injuries, the condition of burn patients usually is easily stabilized, and patients can withstand long-distance transport with resuscitation continuing in route. A trauma center that will need to refer burn patients should have in place a written transfer agreement with a referral burn center. The agreement should identify which patients will be referred, what specific stabilization will be expected, who will arrange transportation, and what needs the patient will have during transfer. It is the responsibility of the referring hospital and the burn center director to keep this transfer agreement current. If there are collaborative arrangements for the transfer of patients from another unit of the hospital, such as a trauma unit, a surgical intensive care unit, and so on, protocols should be written for such transfer and acceptance. A burn center may treat adults, children, or both. Burn injuries that should be referred to a burn center include the following: 1. Partial-thickness burns of greater than 10% of the total body surface area 2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints 3. Third-degree burns in any age group 4. Electrical burns, including lightning injury 5. Chemical burns 6. Inhalation injury 7. Burn injury in patients with …