Though not all children who are burned should be referred to Shriners, ED physicians should know that the American Burn Association has determined specific criteria that a hospital should meet before it can be certified a specialty Burn Center, says Ron Hitzler, administrator of Shriners Burn Institute of Cincinnati.
"The verification process they are involved with actually goes out and looks at hospitals that volunteer to be looked at and verifies whether it is a true burn unit or not," he says. "What that says is that general hospitals shouldn’t be keeping kids that are [severely] burned."
The American Burn Association lists 11 types of injuries that require referral to a specialized burn unit:
• Second- and third-degree burns greater than 10% total body surface area (TBSA) in patients under 10 or over 50 years of age
• Third-degree burns greater than 20% TBSA in other age groups
• Second- and third-degree burns that involve the face, hands, feet, genitalia, perineum, and major joints
• Third-degree burns greater than 5% TBSA in any age group
• Electrical burns, including lightning injury
• Chemical burns
• Inhalation injury
• Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality
• Any patient with burns and concomitant trauma (such as fractures, etc.) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be treated initially in a trauma center until stable before being transferred to a burn center. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols.
• Hospitals without qualified personnel or equipment for the care of children should transfer children with burns to a burn center with these capabilities.
• Burn injury in patients who will require special social/emotional or long-term rehabilitative support, including cases involving suspected child abuse, substance abuse, etc.
Criteria for admission to Shriners
The only standard admission requirement Shriners has is that the referring phone call be made by the burn patient’s attending physician and not parents or family, says Hitzler.
The hospital considers the admission appropriate if the facility can deliver a standard of care that the child would not get if he or she remained in the general hospital.
"If we can provide a level of care for kids that they can’t get where they come from, that’s our admission criterion," he says. "That’s pretty much it."
Although Shriners of Cincinnati has a designated region, it can take children from all over the country, as can the other burn institutes in Boston and Galveston, Hitzler says.
If the patient is within driving distance, about 200 miles, Shriners will lease an ambulance and send their transfer crew to the hospital. If the distance exceeds 200 miles, the hospital will lease an aircraft and send the team, Hitzler says.
"We have a team specially trained for this and we pick up the tab for everyone, he says. "It doesn’t cost anybody a nickel."
Once a patient is accepted for admission, the Shriners staff handles all transportation and transfer arrangements, Hitzler says.
To arrange a referral of a pediatric burn patient to Shriners Burn Institute of Cincinnati, attending physicians can call (513) 872-6000, 24 hours a day, 365 days a year. For more information about patient referrals, contact Teresa Merck, BSN, Transport Team Coordinator, at the same number.
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