Referral Criteria for Adult Burn Unit

The suggested minimum threshold for referral into specialised burn care services can be summarised as:

Size:

• All burns ≥3% in adults (Over 16 yrs)

Depth:

•  All full thickness burns

Site: 

• All burns to hands, feet, face, neck, perineum or genitalia
• All circumferential burns

Mechanism: 

• Any chemical or electrical burn
• Any cold injury
• Any burn where there is a suspicion of non-accidental injury or neglect

Co-morbidities:

• Any burn with concomitant medical illness, which may influence healing e.g. diabetes, paraplegia
• Any burn with concomitant trauma e.g. inhalation
• Any burn with concomitant psychiatric illness

Time: 

• Any burn not healed in 2 weeks

Other factors:

• Any unwell/febrile patient with a burn
• If burn wound changes in appearance / signs of infection or there are concerns regarding healing
• Any other burn that the referring department is not happy about or confident to manage

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.

For Telemedicine for burns referral

Telemedicine for Burns Referral is available to all referring clinicians. For referral criteria see: Southwest Burn Care Network.

Burn Referral / Discussion Guideline How to refer to Bristol Adult Burns Unit MDSAS Telemedicine

Step one - assess the wound:

History

• Allergies.                
• Medications.                        
• Past medical History.          
• Last meal (time)        .
• Events/Environment related to injury.

Wound

• Inspect wound.
• First aid: cool running water for at least 20 minutes but keep patient warm.
• Use cling film as a temporary covering.

Burn injury

• Date and Time.
• Cause.
• Affected areas.
• Size.
• Depth.
• First aid measures.
• Other injuries.

Psychosocial

• Social concerns
• Safeguarding concerns
• Psychiatric history
• Substance Misuse History
• Next of Kin

Step two – Photograph

• Open webpage MDSAS NHS webpage and follow instructions.
• Remove all dressings.
• Download the Secure Image Data (SID) App from the App store or Android Store to take photos using a smart phone or tablet.
• Scan the QR code from the computer using the SID App on the phone.
• Follow the simple instructions to upload photos.
• Click to send referral and photo.

Step three – Referral discussion

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

Telemedicine for Burns Referral is available to all referring clinicians.

For referral criteria see: Southwest Burn Care Network

Adult Burn Guidelines -  Management of the Burn Wound – First Aid

Aim:

• Stop the Burning Process
• Cool the Burn Wound

Stop the Burning Process:

• Remove patient from the source of injury.
• If on fire STOP, DROP, COVER face & ROLL
• Remove hot, scalding or charred clothing.
• Avoid self harm during above steps.

Cool the Burn Wound

• Cool burn with cold running tap water for at least 20 minutes
• Ideal water temperature for cooling is 15°C, range 8°C to 25°C
• Cooling is effective up to 3 hrs after injury
• Keep the remaining areas dry and warm to avoid hypothermia. If patient’s body temperature falls below 35°C - stop cooling.

NB

• Ice should not be used as it causes vasoconstriction and hypothermia. Ice can also cause burning when placed directly against the skin.
• Duration of running water should be at least 20 minutes unless other factors prevent this (eg. large burn causing rapid heat loss, hypothermia, and multiple traumas).
• Wet towels / pads are not efficient at cooling the burn as they do not cool the wound adequately. They should not be used unless there is no water readily available i.e. in transit to medical care. If required use 2 moistened towels/pads and alternate at 30 second intervals.
• Remove any jewellery or constrictive clothing as soon as possible.

Seek Medical Advice

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:

• Adult burns unit, Gate 33a, level 2 telephone: 0117 4143100 or 0117 4143102.
• Acute Burns Clinic telephone: 0117 4144005.
• Karen Highway Adult Burns Specialist Nurse Bleep 1380.
• Burns SHO on-call via switchboard.

Transfers

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).

Chemical Burns

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.

Electrical burns

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.

Facial Burns

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.

Blisters (Burns only)

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.

Wound Care

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.

After Wound Assessment

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.

Tetanus

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.

The death must be registered within 5 days.

In order to do this you will need the medical cause of death certificate issued by bereavement services and, if available, the deceased’s medical card.

The Registrar will ask for the following:

• Date and place of death.
• Full name and surname (and maiden surname if the deceased was a woman who has married).
• Date and place of birth (including town or village).
• Occupation (and if the deceased was a married woman or a widow the name and occupation of her husband).
• Deceased’s last known address.
• Whether the deceased was in receipt of a pension or public funds.
• If the deceased was married, the date of birth of the surviving widow or widower.

The Registrar will give you the following:

• Certificate of registration for the Department of Social Security.
• Green certificate for funeral director.

There will be a fee for each further copies of the registrations for banks, insurance etc., so you may need to take cash or a personal cheque.

Deaths occurring at Southmead Hospital Bristol must be registered by appointment at either of the following offices:

• The Regsitry Office, Southmead Hospital
  Monday – Friday 9.30am – 4pm
  Telephone:  0117 922 2800
   
• The Registry Office, The Old Council House, Corn Street, Bristol, BS1 1JG
  Monday, Tuesday, Thursday and Friday 9am – 4pm, Wednesday 10am – 4pm and 5pm – 7pm
  Telephone: 0117 922 2800

The OT team consists of a mix of 14 qualified and unqualified OT staff.

The service is based at Southmead Hospital Bristol and provides early Occupational Therapy assessment and interventions to patients both pre-surgery and post surgery.

Our aim is to enable patient’s post elective orthopaedic surgery and vascular surgery to maximise physical, psychological and social ability by using specifically selected therapy interventions which meet a person’s individual needs.

We aim to facilitate a timely length of hospital stay, enabling patients to be discharged at the earliest opportunity having reached a safe level of independence in activities of daily living, or following liaison with colleagues, support at home may be arranged.

Pre-surgery assessment may include provision of verbal and written information and advice to both patients and carers, including demonstrations of how to cope with basic activities following surgery.

Post-surgery intervention may include teaching new methods of managing tasks and sometimes the provision of assistive equipment to enable independence. Patients who have had hand surgery may be referred to the Occupational Therapist for a splint to be made and for functional assessment.

Patients may require an environmental or home assessment to highlight any possible difficulties about a patient coping after surgery, for example if returning home in a wheelchair. The Occupational Therapist will ask for consent to refer to another agency if a need is identified that cannot be met by the NHS, for example structural adaptations to property.

Staff members regularly attend events provided by the national College of Occupational Therapy Specialist Section for OT in trauma and orthopaedics and therefore are working with up-to-date knowledge and skills.

From 1 April 2025, a new sexual health service has launched across Bristol, North Somerset and South Gloucestershire.

The new service includes a clinically supported website providing advice, contraception, STI testing and treatment, including Pre-Exposure Prophylaxis (PrEP).

For sexual health services, visit: https://yunosexualhealth.co.uk/

For the pregnancy advisory service (abortion care), visit: www.uhbristol.nhs.uk/pregnancyadvisoryservice
 

In a life-threatening emergency go to the Emergency Department or call 999.

Pharmacists can help with many minor illnesses or ailments and you may well find your health complaint is resolved quicker than if you visit your GP or come to hospital.

Your local pharmacy can offer free expert advice on a wide range of health issues, support for self-care and medicines to treat common complaints such as:

• Cough and cold
• Flu
• Sore throat
• Earache
• Backache
• Stomach upsets
• Minor cuts and grazes

Opening hours: Many are open longer hours including early morning, late evenings and Saturdays.

Location: Find a Pharmacy near you

Contact: Contact your pharmacy directly or call NHS 111

In a life-threatening emergency go to the Emergency Department or call 999.

Dental care is available to you in an emergency or necessary, regardless of whether or not you have a dentist.

Only go to the Emergency Department if you:

• are in severe pain that is not helped by painkillers
• are bleeding a lot and it won't stop
• have suffered trauma of the face, mouth or teeth after a recent accident or injury.

Contact: If your problem is urgent and you are registered with a dentist, please contact your dental practice. They should have an answerphone message with information and advice on how to access out-of-hours and emergency dental services.

If you do not have a dentist and you require emergency or out-of-hours dental services call NHS 111.

For more information on accessing a dentist visit www.nhs.uk

In a life-threatening emergency go to the Emergency Department or call 999.

The NHS 111 service is available to anyone visiting or living in England.

You should use 111 services if you need:

• Medical help fast but it’s not a 999 life threatening emergency
• You think you need to go to the Emergency Department or need another NHS urgent care service but are unsure
• You don’t know who to call or you don’t have a GP
• You need health information or reassurance about what to do.

The NHS 111 service is staffed by a team of fully trained advisers, supported by experienced nurses. They will ask you questions to assess your symptoms, then either give you the healthcare advice you need or direct you to a local service that can help you. That could be a late-opening pharmacy, community nurse, out-of-hours doctor, walk in centre, Urgent Care Centre, Minor Injury Unit (MIU) or the Emergency Department.

Opening hours: 24 hours a day, 7 days a week.

Contact: The NHS 111 number is free to call from landlines and mobile phones.
For less urgent health needs contact your GP or local pharmacist. For more information on NHS 111 visit www.nhs.uk/111

In a life-threatening emergency go to the Emergency Department or call 999.

The Yate Minor Injury Unit (MIU) offers treatment for adults and children for a wide range of minor injuries.

The unit is open from 8am until 8pm, seven days a week including bank holidays. X-ray facilities are available from 8am until 7.30pm, Monday to Friday and from 9am until 5.30pm Saturdays, Sundays and bank holidays. 

You can drop in with no appointment necessary or you can be referred in by another healthcare professional, such as your GP.

All patients are seen by an Emergency Nurse Practitioner (ENP) or an Emergency Care Practitioner (ECP).

Yate Minor Injury Unit is provided by Sirona care & health and is able to treat patients presenting with minor injuries that include:

• Cuts and grazes
• Sprains and strains
• Arm, lower leg & foot injuries – including broken bones
• Bites – human/animal/insect
• Minor burns and scalds
• Minor head injuries
• Broken nose/nosebleeds
• Minor eye problems such as scratches, foreign bodies in the eyes

The service cannot treat minor illnesses, such as:

• Sore throats
• Ear aches
• Coughs
• Colds
• Abdominal pains
• Dental pain
• Mental health problems
• Other illnesses – for example chest pain, shortness of breath, or exacerbations of chronic conditions.

They also cannot:

• Redress wounds
• Review wounds
• Remove stitches
• See any injury over two weeks old
• Administer Tetanus injections – please see your GP for this

​Opening hours

Yate MIU is open from 8am to 8pm seven days a week, including bank holidays. 

X-ray service

X-ray facilities, provided by us, are available Monday to Friday 8am to 7.30pm and 9am to 5.30pm on Saturdays, Sundays and bank holidays. 

Please be aware practitioners are not able to request X-rays of the neck, hips or back, or any imaging of the head. Chest x-ray can be requested in certain circumstances only. If you do not meet this criteria please contact your GP, call 111 or consult a pharmacist as appropriate. People booking in with any of the above conditions will be re-directed to a more appropriate service.

The x-ray facilities will stop for a period of 30 minutes each day to accommodate a staff lunch break. Very occasionally due to high volumes of people attending x-ray it may be necessary to stop accepting patients earlier than the times above. 

Information at times of significant demand

Please note, the service may need to close earlier than the times stated above if it is experiencing significant demand.

Location

Yate Minor Injury, Yate West Gate Centre, 21 West Walk, Yate, BS37 4AX.

Contact details

Telephone number: 0300 125 6800

For more information about Yate MIU visit www.sirona-cic.org.uk/services/minor-injury-unit

In a life-threatening emergency go to the Emergency Department or call 999.

All public authorities have a duty to set out arrangements for assessing and consulting on the impact that proposed policies could have on the promotion of equality. This is also a requirement of the Care Quality Commission. Equality Impact Assessments (EIAs) help us ensure that equality is placed at the centre of policy development and review as well as service delivery.

An equality impact assessment is a useful tool as it helps us to identify, in a detailed and systematic way, the potential impact of our policies, services and functions on patients, staff and visitors.

North Bristol NHS Trust is committed to eliminating individual and institutional discrimination. Valuing diversity is a key organisational principle and equality of opportunity and outcome for everyone should be promoted within all Trust business. NBT is building a culture that encourages dialogue and involves a diverse range of staff and patients/service users in evaluating and planning services.

These legal responsibilities also extend to individuals and the Trust therefore expects all staff, patients, service users, relatives, carers, visitors and contractors to act in accordance with this Policy when delivering or receiving the Trust's healthcare services

Good Communication

To ensure we provide services which are accessible to disabled people we must provide information in accessible formats.