***This page is under review***
Burns may be thermal, electrical or chemical and may be associated with other injuries. The majority of cases will present to A&E and be referred directly to the burns unit at St John’s hospital. Some however may present at their General Practice where the majority of minor burns can be managed, assuming that sufficient burns care experience is available.
Burns that do require formal assessment, with or without admission to the burns unit, include all paediatric burns over 5% total body surface area (TBSA) or adults burns over 10%. All chemical burns and significant electrical burns should also be referred. Burn wounds in certain areas of the body are prone to infection and / or poor functional or cosmetic outcome if poorly managed and should therefore be assessed in the burns unit. These areas include the head, hands, perineum and feet. All but the smallest of full thickness burns should be referred for immediate assessment regarding the need for debridement and grafting.
All chemical burns should be referred urgently especially hydrofluoric acid burns.
In children and vulnerable adults, any burn where the circumstances are not clear or there is a suspicion of neglect or abuse should be referred and admitted for investigation.
What to refer:
- Acute thermal burns- urgent referral to on call plastic surgery team (SpR) via St John’s Hospital switchboard.
- Chemical burns – as above.
- Electrical burns – as above.
- Chronic burn wounds that are slow to heal – urgent referral.
- Burn scars that are symptomatic or affecting function or aesthetics (see RefHelp scar guidelines).
What not to refer:
- Minor superficial or superficial partial thickness burns wounds where sufficient experience exists in the general practice.
How to refer:
For emergency burn referrals contact the on call plastic surgeon at St John’s Hospital or the Royal Hospital for Sick Children. Routine referrals can be made via SCI gateway to the Plastic Surgery service at St John’s Hospital with details and appropriate background information.
