A person with severe burns has suffered a major trauma injury and must undergo routine trauma care starting with the primary and secondary trauma survey so that immediate life threatening conditions are identified and emergency management commenced (20). In Victoria, severe burns include:
- > 20%TBSA burns
- High voltage electrical injury (>1000volts)
- Inhalation injury with/without dermal injury
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Polytrauma may co-exist, especially when there has been a blast, explosion, or road accident involved (22). Optimal resuscitation in the pre-hospital and emergency setting should be ensured, as well as early activation of the retrieval network, to ensure timely transfer to an appropriate burns facility occurs as soon as possible (23).
This section of the guidelines deals with the management of severe burns. These guidelines assume that initial assessment and interventions have been undertaken according to the Victorian State Trauma System Major Trauma Guidelines. These guidelines focus specifically on the burn specific components of these critical hours of care before arrival at the burn service. Their principles can also be applied to significant, but less severe burns between 10 – 19%.
Severe burn injury is fortunately uncommon in Australia. In Victoria there are less than 50 admissions for severe burns >20%TBSA to the designated burn centres each year, and survival and patient outcomes are good especially in young healthy male population. 50% come from regional Victoria and average transfer time is 3.6 hours (2).
Visit the Victorian State Trauma System Major Trauma Guidelines website for a comprehensive guide to the primary and secondary survey and initial management which include complete EMST principles. In particular review the Trauma Victoria Burns Guideline Education Module and review a case scenario of a severe burn in the Moderated Burns Tutorial. You will need to create a User Name and Password to access this section of the Trauma Victoria website.