The suggested minimum threshold for referral into specialised burn care services can be summarised as:
If the above criteria/threshold is not met then continue with local care and dressings as required. Burn injuries >25% TBSA + inhalation injury or >40% TBSA without will be referred and transferred to the local burn centre (Swansea).
If your referral needs immediate attention (e.g., life or limb threatening injuries), please call switchboard 0117 950 5050 - ask to speak to the Burns Consultant on call.
For non urgent referrals please submit MDSAS referral and then contact, SHO on-call via switchboard switchboard 0117 950 5050
Leave your contact number so the Burns service can advise you on the referral.
Telemedicine for Burns Referral is available to all referring clinicians. For referral criteria see: Southwest Burn Care Network.
If your referral needs immediate attention (e.g., life or limb threatening injuries), please call switchboard 0117 950 5050 - ask to speak to the Burns Consultant on call.
For non urgent referrals please submit MDSAS referral and then contact, SHO on-call via switchboard switchboard 0117 950 5050
For the SHO on-call, phone 0117 414 0978 to take non urgent referral calls.
Leave your contact number so the Burns service can advise you on the referral.
Telemedicine for Burns Referral is available to all referring clinicians.
For referral criteria see: Southwest Burn Care Network
For urgent referrals or if there is any doubt please discuss the case with a senior member of the burns medical team via Southmead Hospital Switchboard: 0117 9505050
For all burn wound injury and wound management advice please contact:
For transfers to the Burns Unit, remove all jewellery cover burn injury with cling film or clean dry sheet if evacuation is to occur quickly. Do not apply any creams or ointments. Be aware not too wrap the cling film too tight as this can cause a tourniquet effect if applied circumferentially and additionally restrict limb movement. Only if transfer is to be significantly delayed then the burn wound should be washed with chlorhexidine solution 0.1% or normal saline then more formal dressings should be applied. This should only be after liaison with the receiving burn service. If applicable, then simple application of non-adherent film, tulle/jelonet/gauze dressings to the burn wounds and wrap secondary dressings of gauze and crepes bandages loosely too allow for potential excess swelling. Elevate limbs if applicable. Keep patient warm (blanket, space blanket).
Remove contaminated clothing (store in a protective container for disposal later) and dry chemicals. Copious irrigation is required with tepid running water or saline as appropriate. Continued prolonged irrigation is required for all chemical burns for one hour or more until the patient’s chemical burning sensation has ceased/neutralised even if pH test strip is normal. Neutral = 7 or until transfer if appropriate. Bitumen and alkali burns require irrigation with water for an even longer period than other chemical burns. Hydrofluoric acid burns require neutralisation with calcium gluconate. Please discuss management with on-call burns team. Chemical eye injuries require copious water irrigation. Diphoterine is very helpful. Refer to ophthalmologist. Please bring chemical agent if available or provide details of the chemical agent. Contact the National Poisons Help line for advice.
Relevant history may include loss of consciousness or cardiac symptoms such as chest pain or palpitations. A twelve-lead ECG should be undertaken. Cardiac monitoring is required within the first 24 hours period for significant injuries. Please discuss any episode further with the on-call burns team. Please note that all significant electrical injuries should be admitted to a burns service for definitive treatment.
Clean with saline and apply soft paraffin to raw areas Apply soft paraffin to lips, clean eyes with saline, refer to ophthalmologist if required and apply eye drops or ointment as appropriate e.g. chloramphenicol ointment. Exclude injury-using fluorescein. Consider airway assessment and monitor for airway swelling, anaesthetic review if any concerns and discuss with on-call burns team.
Small ones of 1 cm or less may be left intact, however, large ones and blister over joints will need to be de-roofed and dead skin trimmed away. Redress with non-adhesive dressings such as Mepitel, Adaptic Touch or hydrocolloid to small superficial wounds only. Do not wrap hydrocolloid dressings circumferentially around fingers but place in longitudinal strips.
Clean with saline, tepid tap water or shower patient (if applicable and stable). If wounds are contaminated with dirt particles or infection suspected then warmed diluted 0.1% chlorhexidine solution (Savlon) should be used.
Apply suitable low adherent dressing e.g. paraffin gauze (if daily dressings) or hydrocolloid dressing (if wound is superficial with low exudate). If paraffin gauze is used, a secondary dressing of gauze and bandage is required. Hydrocolloids can be used without a secondary dressing where there is little exudate (can be useful for fingers to facilitate movement). If transferring a hand burn this can be temporarily placed in plastic bags to facilitate movement and comfort, depending on the extent of the burn. If delayed transfer or not transferring to the burns unit then hand burns and individual fingers will need to be redressed with a non-adhesive dressing such as Metipel or Adaptic Touch No ointment is used in bag. Do not use Flamazine or Flammercerium until seen by the burns surgeon, as these should not be used if the depth of the burn is unclear, as it will mask the appearance of the depth.
All patient’s tetanus status should be checked and revised protocol applied.
Please consult the Adult Burns Unit for additional Burns wound advice telephone: 0117 4143100 or 0117 4143102.
Burns Clinic
Gate 33A, Level 2
Brunel building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB
Acute Burns Clinic (ABC)
Gate 33A, Level 2
Brunel building
Telephone: 0117 4144005
Monday 8am–3:30pm, Tuesday-Friday 8am-2.30pm, Saturday 8am-1pm
Burns Outpatients
Gate 24, Sub Wait Area Rooms 1 to 20, Level 1
Brunel building
Telephone: 0117 4148717
Scar Management
Gate 24, Sub Wait Area Rooms 1 to 20, Level 1
Brunel building
Telephone: 0117 4143114
If you require any further information about your injury please contact the 24 hour Burns Unit helpline on 0117 4143100 or 0117 4143102