An accurate history and detailed examination of the patient are vital in achieving the best outcome; they determine subsequent treatment and referral pathway.  Courses such as Emergency Management of Severe Burns (EMSB) or Advanced Trauma Life Support (ATLS) set out a safe framework for assessing burn-injured patients.  The EMSB course is delivered within the SWUK ODN region.

A rapid initial primary assessment (survey) using an ABCDE approach should be undertaken to identify and treat life-threatening problems. These may arise due to complications of the burn or from other non-burn injuries. Particular care should be taken in assessing neurologically obtunded or unconscious patients. 

Burn wounds should be fully exposed and assessed under good lighting by an experienced clinician and care must be taken to avoid hypothermia during examination. 

Tools for the accurate assessment and recording of size and depth of burn are available on-line:

• Lund and Browder chart for calculating the percentage of total body surface area burnt
• Rule of Nine (for use in ADULTS ONLY)
• Mersey Burns App..

Please read the SWUK Guideline_Initial Assessment and Management Burn Injury v1 (Oct 2018) for further information.

In the SWUK Burn Care ODN the need for interventional surgery for the burn wound prior to transfer of a patient to a Specialised Burn Service is very rare. However, it is possible there will be occasions when transfer to a Specialised Burn Service is delayed for logistical reasons and escharotomy of the burn wound may be necessary if transfer is to be delayed beyond 4-6 hours.

It is an absolute principle that surgery to the burn wound by non-specialised doctors is only carried out following discussion and advice from a senior member of the burn service.  Always contact your nearest Burn Care Service for advice.

Further advice on managing a patient with burn injuries on an Intensive Care Unit please read the SWUK Guidelines Burns Intensive Care - The First 48 Hours..