MANAGEMENT GUIDELINES

FOR PEOPLE WITH BURN INJURY

NSW Health Department July 1996
(Front cover: detail of burn
in the photograph above.)
This photograph illustrates
different depths of burn.
The patient was transferred to
a major burns unit and grafted

State Health Publication No: (PHD) 96-0092

ISBN 0 7310 9215 5

Copyright NSW Health Department, July 1996

This work is copyright. It may be reproduced in whole or in part, subject to the

inclusion of an acknowledgement of the source and no commercial usage or sale.

Suggested citation: Public Health Division. Management Guidelines for People

with Burn Injury. NSW Health Department, 1996.

Further copies of this publication are available from:

The Better Health Centre
162 Blues Point Road
North Sydney NSW 2060
Telephone (02) 9391 9569
Facsimile (02) 9955 5196
MEMBERS OF THE Mr Chris Basten* Psychologist, Burns Unit, Westmead Hospital
NSW BURNS Ms Jenny Cavanagh* Burns Surgical Liaison Clinical Nurse Specialist,
MANAGEMENT The New Children’s Hospital, Westmead
WORKING GROUP Ms Jan Darke* Clinical Nurse Specialist, Burns Unit,
(Current and past members)
Royal North Shore Hospital
Ms Rae Greeves* Clinical Nurse Consultant, Burns Unit,
Repatriation General Hospital, Concord
Ms Dianne Grieve Clinical Nurse Consultant, Emergency Services,
Upper North Coast Rural Critical Care Network
Mr John Hall Superintendent, Manager Quality Assurance,
NSW Ambulance Service
Ms Jill Harrington* Nursing Unit Manager, Burns Unit,
Royal North Shore Hospital
Ms Judith Jones Clinical Effectiveness Branch,
NSW Health Department
Dr Tony Joseph Representative,
Australasian College of Emergency Medicine
Dr Peter Kennedy Director, Burns Unit,
Repatriation General Hospital, Concord
Dr Cait Lonie* Clinical Effectiveness Branch,
NSW Health Department
Dr Hugh Martin Director, Burns Unit, The New Children’s Hospital
Ms Margaret Sullivan* Nursing Unit Manager, Burns Unit,
Tamworth District Hospital
Ms Cheri Templeton* Senior Physiotherapist, Burns Unit,
The New Children’s Hospital, Westmead
Ms Sue Taggart Clinical Nurse Consultant,
Repatriation General Hospital, Concord
Ms Libby Terracini* Clinical Effectiveness Branch,
NSW Health Department
Ms Carolyn Walsh* Clinical Effectiveness Branch,
NSW Health Department

Management Guidelines for People With Burn Injury was prepared by the Minor
Burns Management Group, a sub-committee of the NSW Burns Management
Working Group. Members of the sub-committee are indicated with an asterisk (*)
in the above list. Photographs appearing in the document were provided by
members of the Minor Burns Management Group.

The Board of the Australian and New Zealand Burn Association endorses these
guidelines as appropriate for clinical usage in Australia and New Zealand and
JULY 1996 encourages their wide implementation and use.
MANAGEMENT TABLE OF CONTENTS
GUIDELINES FOR
PEOPLE WITH BURN 1.0 Introduction 1
INJURY
2.0 Referral Criteria 2
2.1 Medical Retrieval

3.0 Assessment of Body Surface Area 3

4.0 First Aid 4

5.0 Tetanus Immunisation 4

6.0 Pain Management 5

7.0 Wound Care 6

7.1 Wound Assessment 6
7.2 Wound Management 6
Summary Table of Burns with Pictorial Examples and Descriptions 8
Flow Chart for Burn Wound Management 9
7.3 Depth of Burn 11
7.31 Partial Thickness Burn 11
7.311 Superficial Partial Thickness 11
7.312 Deep Partial Thickness Burn 13
7.32 Full Thickness Burn 14

8.0 Physiotherapy 15
8.1 Exercise 15
8.2 Scar Management 15

9.0 Psychosocial Care 16

10.0 Sun Protection 17

11.0 Access to Expert Opinion 17

Appendix One Contact details for specialist burns units 18

JULY 1996
MANAGEMENT 1.0 INTRODUCTION
GUIDELINES FOR NSW Health released the NSW goals
PEOPLE WITH BURN and targets for prevention and
INJURY management of injury in August 1995.
Burns are one of the priority targets
and NSW Health is responsible for
improvements in prevention and
management. As part of this
responsibility the Centre for Clinical
Policy and Practice in the Public Health
Division has been working with a
group of burn care experts to develop
guidelines for the management of
people with burn injury.
Throughout the document,
recommendations have been made
regarding when a burns unit should be
consulted. However, users of these
guidelines are encouraged to consult
specialists at the burns units for advice
and assistance at any stage, particularly
if there is some doubt about the
appropriate course of action.

Management Guidelines for People

with Burn Injury have been developed
to provide simple, practical advice for
the management of people who have
a burn injury, especially those that
don’t require transfer to a specialist
burns unit.

Separate guidelines, Transfer

Guidelines for People with Burn Injury,
(July 1996) regarding the acute
management and transfer of patients
with severe burn injuries have also
been developed. Both sets of
guidelines include criteria for the
referral of patients to specialist
burns units.

These consensus guidelines have been

compiled by a group of experts
working in major burns units.
Consensus statements are necessary
as there is little consistent or strong
evidence in the literature regarding the
management of less severe burns.
They represent the recommendations
of the expert group based on the best
knowledge available at the time of
compilation.

Reference to any brand name in this document does not imply endorsement by the NSW Health
Department, the NSW Burns Management Group, the Australian & New Zealand Burns Association
or any other person or body involved in preparing these guidelines. Brand names have been
JULY 1996 included for the benefit of users who may not be familiar with generic names. 1
MANAGEMENT 2.0 REFERRAL CRITERIA
GUIDELINES FOR
PEOPLE WITH BURN For all patients in the following
categories, hospitals should ensure that
INJURY continued
consultation with the appropriate burns
unit takes place at presentation.
Although not all patients in these
categories will require transfer to a
specialised burns unit, advice must be
sought early in their management.

• Deep burns involving:

10% or more of the body surface area in adults,
or
5% or more of the body surface area in children
• Burns to the face, hands, feet, perineum, inner joint surfaces,
and inhalation injury
• Burns and any of the following: major preexisting disease,
suspected child abuse, concomitant injury
• Electrical and chemical burns

For patients requiring transfer please refer to the Transfer Guidelines for People
with Burn Injury (NSW Health, July 1996).

2.1 Medical Retrieval

The NSW Health Guidelines for the
Retrieval of the Critical Ill must be
consulted in deciding which patients
may require retrieval. The
recommendations for retrieval include:
- any intubated patient
- facial or airway burns
- any child with burns >10%
- burns >20% in adults
On-scene expert assistance is
available statewide from medical
retrieval teams and can be requested
even before a destination bed is
confirmed. If necessary, the Medical
Retrieval Centre can facilitate a three-
way conference call with the burns
unit. Contact the Medical Retrieval
Centre on 1-800-650-004 or your local
Medical Retrieval number.
For children < 13 years old, the
nearest paediatric ICU or NETS
(1-300-362-500) may be contacted
as an alternative.

JULY 1996 2
MANAGEMENT 3.0 ASSESSMENT OF BODY SURFACE AREA
GUIDELINES FOR
PEOPLE WITH BURN • The “Rule of Nines”, or if available the Lund and Browder chart,
should be used to assess the size of the burn.
INJURY continued
• The patient’s hand (palm plus digits) represents approximately 1%
of the body surface area.

LUND AND BROWDER CHART

IGNORE SIMPLE ERYTHEMA

123456789012345
123456789012345
123456789012345
123456789012345
123456789012345 DEEP
12345678901234567
12345678901234567
12345678901234567
12345678901234567
12345678901234567 SUPERFICIAL

REGION %

HEAD
NECK

ANT.TRUNK

POST. TRUNK

RIGHT ARM
LEFT ARM

BUTTOCKS

GENITALIA
RIGHT LEG

LEFT LEG

TOTAL BURN

RELATIVE PERCENTAGE OF BODY SURFACE AREA AFFECTED BY GROWTH SURFACE

AREA AGE 0 1 5 10 15 ADULT

A=1/2 of head 9.5 8.5 6.5 5.5 4.5 3.5

B=1/2 of one thigh 2.75 3.25 4 4.5 4.5 4.75
C=1/2 of one leg 2.5 2.5 2.75 3.25 3.25 3.5
JULY 1996 3
MANAGEMENT 4.0 FIRST AID
GUIDELINES FOR
PEOPLE WITH BURN Cool tap water (NO ICE) should be run
or sponged over the burnt area for 30
INJURY continued
minutes. It will not be of value if
commenced greater than
3 hours post burn.

5.0 TETANUS IMMUNISATION

Tetanus status must be assessed for
every person. Check the table below
for follow-up1.

IMMUNISATION STATUS ACTION

▲
More than 10 years since the last If the burn occurred within the last

▲
Tetanus Toxoid booster 24 hours give Tetanus Immunoglobulin
(TIG) 250 IU IMI ☞
or
Person has never had Tetanus If the burn occurred more than

▲
immunisation 24 hours ago give TIG 500 IU IMI ☞
or
There is doubt as to their Tetanus ☞ NOTE:*ADT/DPT/Tetanus Toxoid
immunisation status should be given at the same time
in the opposite arm with a separate
syringe, and arrangements should be
made to complete the full course
of tetanus toxoid vaccinations.

Person has had 3 doses but it is

5 or more years since last Give ADT or DPT or Tetanus Toxoid
▲

Tetanus Toxoid booster

Person has had 3 doses and it is

less than 5 years since last No Tetanus Toxoid required
▲

Tetanus Toxoid booster

✓ Give the same dose of TIG for adults and children.

✓ For adults and children>8yrs, ADT is preferred to Tetanus Toxoid.
✓ For children, DPT (Triple Antigen) is preferred to Tetanus Toxoid.
✓ Use CDT if there has been a previous serious reaction to DPT.

1
National Health and Medical Research Council (1994) The Australian Immunisation Procedures
JULY 1996 Handbook (Fifth Edition). Commonwealth Department of Human Services and Health pp 29-30. 4
MANAGEMENT 6.0 PAIN MANAGEMENT
GUIDELINES FOR
PEOPLE WITH BURN i Even minor burns are painful
INJURY continued and need analgesia.
ii Aggressive pain management
should be used in the first
instance (eg IMI pethidine or
morphine, however NO drugs
to be given IM for people with
burns to greater than 10% of
body surface area). Monitor
pain level over next 4 hours.
If pain cannot then be controlled
with aggressive oral analgesia or
the social situation does not allow
for pain to be controlled
successfully then hospitalisation
may be necessary.
iii Analgesia should be administered –
1
/2 to 1 hour before dressing
change.
• For ADULTS oral analgesia
may range from paracetamol
(eg Panadol) to paracetamol
+ codeine phosphate (eg
Panadeine Forte).
• For CHILDREN oral analgesia
may be combined with
antihistamine to help reduce
itching in minor burns.
iv In a hospital situation pain
relief may be enhanced by
appropriate relief of anxiety.
However, agents such as
diazepam (eg Valium),
chlorpromazine, or midazolam
must not be combined with
narcotic analgesics unless a person
with anaesthetic skill is available
to deal with the respiratory
depression or hypotension which
can occur as a result of synergism.
v Nitrous oxide mixtures are
useful if trained staff are
available to administer. Nitrous
oxide must not be used with
narcotics and sedatives as the
effect of the three types of drugs
together is essentially a general
anaesthetic.
vi Patients should still be able to
mobilise and participate in
normal daily activities whilst
taking medication.

COMMON DRUGS USED IN PAEDIATRIC BURNS

TYPE OF DRUG DOSAGE HOW GIVEN

Analgesics
Paracetamol 10-20 mg/kg/dose Given orally or rectally
(eg Panadol, Dymadon) No more than
80 mg/kg/day

Narcotic analgesics
Codeine Phosphate 0.5-1mg/kg/dose Given orally 1 hour prior
to dressing

Sedatives
Midazolam (Hypnovel) 0.3-0.5mg/kg/dose Given orally 10 minutes
prior to dressing

Antihistamines
Trimeprazine Tartrate 0.1-0.5mg/kg/day Given orally
(Vallergan) Up to1.5mg/kg/day
(Antihistamine dose)
2-4mg/kg/dose Given orally 2 hours
(Premed dose) prior to dressing

JULY 1996 5
MANAGEMENT 7.0 WOUND CARE
GUIDELINES FOR
PEOPLE WITH BURN 7.1 Wound Assessment
INJURY continued i Wound care is dependent upon a
thorough history of the event being
taken including the source of the burn,
the mechanism for injury and the first
aid given.
ii The medical history also needs to
be considered to determine if there are
other underlying problems that will
affect healing eg diabetes, cardio-
respiratory problems. Social
assessment is also important.
iii The size, location and depth of the
burn need to be assessed.
7.2 Wound management
Wound management will vary
according to the depth of the burn.
The depth of a burn is often difficult to
assess soon after the injury, and is
usually underestimated. The true depth
of the burn will become more obvious
with time and therefore the wound
must be reassessed on a regular basis
to ensure that management is
appropriate. Wound management is
thus described according to whether
the burn initially appears to be partial
or full thickness. Photographic
examples are provided to assist with
assessing changes in burn depth over
the course of treatment.
Antibiotics are not to be used
prophylactically and are only
appropriate when demonstrated
infection is present.

GENERAL NOTES ON DRESSINGS:

• The purpose of dressings is to keep the wound clean and to protect it from
further damage.
• There are many dressings on the market. Some examples are hydrocolloids,
calcium alginates and synthetic skin substitutes. Consult your specialist
burns unit for appropriate use of these dressings.
• Always provide analgesia prior to dressing change and reassess regularly.
• All dressings need to be firmly held in place. Suggested products suitable for
keeping the dressing in place are Tubigrip, crepe bandage, Fixamul, and
Hypafix. These dressings are commonly referred to as retention dressings.
• In the event of the dressing being “stuck” then SOAK off the remainder of the
dressing (eg in the bath, shower, by irrigation etc) to ensure the wound is not
traumatised.
• It is important that the wound is kept moist during dressing changes.
• While the dressings are off the patient should exercise the affected area
through its full range of movement.
• Always check for allergies. If the person is allergic to sulphonamides
contact the specialist burns unit for advice regarding alternative treatment.

JULY 1996 6
MANAGEMENT SUMMARY TABLE AND FLOW CHART FOR BURN IDENTIFICATION
GUIDELINES FOR AND MANAGEMENT
PEOPLE WITH BURN
INJURY continued

JULY 1996 7
 Summary Table for BURNS IDENTIFICATION AND MANAGEMENT

FULL THICKNESS BURN HEALED

AREAS

PARTIALTHICKNESS BURN UNHEALED

AREA

Superficial burns with Deep partial thickness burn Different burn depths Partially healed at 3 weeks
fine blisters with large blisters post burn. Requires follow-up
for pressure and protection

DEPTH OF BURN COLOUR AND APPEARANCE SKIN TEXTURE SIGNS OF INFECTION (LOOK FOR)

Partial Superficial Pink-Red May be • increased pain

thickness ±fine blisters oedematous • offensive smell
(If wound colour • exudate
changes to white or • surrounding red areas
milky in appearance, • patient feels generally unwell
reassess depth) CONSULT BURNS UNIT

Deep Pink-White Thick • as above

± large blisters Limb may be • cellulitis around wound
oedematous • thromboses in base of wound
• swelling
CONSULT BURNS UNIT

Full thickness Dark Red or White Leathery • as above

CONSULT BURN or Brown or Black CONSULT BURNS UNIT
UNIT ASAP

Superficial partial thickness burn Burn appears to be Changed appearance

At 48 hours post burn Fully healed at day 7 superficial at presentation after 5-7 days indicates it
is a deep burn 8
 Flowchart for BURN WOUND MANAGEMENT

>10% BSA IN AN ADULT

ASSESS THE BURN CONSIDER SIZE >5% BSA IN A CHILD
☞ Consult with Specialist Burns Unit

Burns to face, hands, feet,

perineum, inner joint surfaces or
CONSIDER concomitant injury
LOCATION/TYPE
Electrical and chemical burns
☞ Consult with Specialist Burns Unit

CONSIDER DEPTH

PARTIAL THICKNESS BURN FULL THICKNESS BURN

SUPERFICIAL PARTIAL DEEP PARTIAL

THICKNESS BURN THICKNESS BURN < 48 HOURS
Dress as for partial
thickness burn
< 48 HOURS < 48 HOURS Give pain relief
Cleanse with chlorhexidine Cleanse with chlorhexidine
Apply AIVG dressing Apply Silvazine + dressing
Leave intact for 48 hours Give pain relief ☞ BEFORE DAY 4
Give pain relief Continue dressing daily Consult Specialist
Elevate limb if oedematous Burns Unit
Monitor colour, infection

DAYS 3-6 DAYS 3-6

Reassess colour, depth, infection,
pain
✓ If healing, continue with dressing,
changing 2nd to 3rd daily
☞ If the wound is infected consult
with Specialist Burns Unit
Reassess colour, depth, infection,
pain
✓ If healing, continue with
dressing of Silvazine

DAYS 7-10
✓ If healing, continue with
dressing, changing 3rd daily
Apply Sorbolene once healed
AFTER DAY 6
✓ If healing, dress with antibacterial
impregnated vaseline gauze (if
unavailable use vaseline gauze)
X If not healing, continue with
Silvazine dressing

DAYS 12-14
☞ If any unhealed patches >1cm
consult with appropiate burns
specialist

IF ANY BURN IS NOT HEALING CONTACT THE APPROPRIATE SPECIALIST BURN UNIT 9
MANAGEMENT 7.3 Depth of Burn
GUIDELINES FOR Burns fall into two categories, Partial Thickness Burn and Full Thickness Burn.
PEOPLE WITH BURN Partial Thickness Burn includes Superficial Partial Thickness and Deep Partial
INJURY continued
Thickness Burns.

7.31 Partial thickness burn

7.311 Superficial partial thickness burn
The wound will generally be red and may have fine blisters.

Examples of superficial burns with fine blisters

Up to 48 hours post burn

i Cleanse with chlorhexidine 0.1% or 0.2% solution (if not available use
normal saline)
ii Apply 2 layers of antibacterial impregnated vaseline gauze (AIVG)*
(example, Bactigras) + absorptive dressing + retention dressing.
*If antibacterial impregnated vaseline gauze is unavailable use vaseline gauze until
the AIVG becomes available.
iii Leave dressing intact for 48 hours.

After 48 hours
i Reassess the wound to check for healing, signs of infection and depth.
ii A normal inflammatory process will be evident.
iiia If the wound is healing the patient will report decreased pain and the wound
will be pink and dry. If the wound is healing, continue with the same
dressing, changing every 2-3 days.

JULY 1996 At 48 hours post burn Fully healed at day 7 11

MANAGEMENT iiib If the wound is infected the patient may feel generally unwell and have
GUIDELINES FOR increased pain. The wound may develop an offensive odour, exudate,
PEOPLE WITH BURN and have surrounding red areas. The patient may be febrile. People
INJURY continued particularly at risk of infection are the aged, diabetics and people who
are immunosuppressed. If there are signs of infection, CONSULT the
appropriate burns unit regarding further management.
iv If the wound is deeper than a superficial wound then the colour of the wound
will alter from pink/red to being white or having a milky appearance
(see 7.312 Deep Partial Thickness Burn and 7.32 Full Thickness Burn).

Burn at presentation Changed appearance after 5-7 days

If the wound is healing (within 7-10 days approximately)

i Continue with the same dressing until fully healed
ii Change the dressing 3rd daily
iii Inform the patient to return if there are any signs of infection
(ie feeling unwell, increased pain, smell)
iv After the wound has fully healed apply sorbolene cream 2-3 times per day
until any redness has disappeared.

JULY 1996 12
MANAGEMENT 7.312 Deep partial thickness burn
GUIDELINES FOR The wound will generally be pink or white and may have large blisters.
PEOPLE WITH BURN
INJURY continued

Deep partial thickness burn with large blisters

Up to 48 hours post burn

i Cleanse with chlorhexidine 0.1% or 0.2% solution (if not available use normal
saline)
ii Apply silver sulfadiazine (Silvazine) + absorptive dressing + retention dressing.
(When applying Silvazine, impregnate gauze with 4-6mm thick layer
of cream before applying to the wound)
iii Continue dressing daily. Remove the Silvazine at each dressing change with
dilute chlorhexidine (if not available use normal saline).
iv If the limb is oedematous then elevation will be required.
v Monitor change in colour. Check for signs of infection. If the wound is infected
there may be cellulitis around the wound or thromboses in the base. The
person may report increased pain, feeling generally unwell and swelling.
If there are signs of infection CONSULT the appropriate burns unit regarding
further management.

Days 3 - 6
i Continue with daily dressing of Silvazine
ii Continue to monitor colour and signs of infection

After day 6
i The slough starts separating
iia Healed epithelium is pink and dry. If the wound is healing then dress with
2 layers of antibacterial impregnated vaseline gauze + absorptive dressing
+ retention dressing. As the wound continues to heal adjust the dressing
according to exudate ie decrease absorptive component as healing
progresses.
iib If the wound is not healing continue to apply daily dressing of Silvazine.
If there are any patches which are greater than 1 cm in diameter that are not
healed within 12 to 14 days the burn probably requires a graft and an
APPROPRIATE BURNS SPECIALIST SHOULD BE CONSULTED.

JULY 1996 13
MANAGEMENT 7.32 Full thickness burn
GUIDELINES FOR The wound will have an intact eschar. It may be dark red, white, brown
PEOPLE WITH BURN or black.
INJURY continued

FULL THICKNESS BURN

PARTIALTHICKNESS BURN
PARTIAL THICKNESS BURN

i Dress as for deep partial thickness burn initially.

ia CONSULT THE APPROPRIATE BURNS UNIT BEFORE DAY 4.
ib A decision will need to be made whether the management of the
wound is to be surgical or conservative.

JULY 1996 14
MANAGEMENT 8.0 PHYSIOTHERAPY
GUIDELINES FOR (please cross reference with the section
PEOPLE WITH BURN dealing with Wound Management)
INJURY continued
These recommendations are not intended
for patients who meet the criteria for
transfer to a specialist burns unit.
8.1 Exercise
i All areas affected by a burn need
to be exercised through full range
COMMENCING ON DAY ONE.
ii The joints that need exercising are
those covered by the burn or where
the burn is adjacent to the joint.
iii Assess the need for analgesia prior
to exercise.
iv Dressings should not restrict movement.
v If posture indicates that a joint
is being held stiffly then it also
needs to be exercised, even if it is
not adjacent to the burn.
vi Exercise should be 3 times per day
and for 10 repetitions at each
session, or as deemed necessary
by the therapist.
vii Exercise should always be active
unless the person is unable to comply.
viii Normal daily activities should
continue and be encouraged.
If the limb requires elevation then
ONLY elevate when resting ie slings,
crutches, and wheelchairs are
unnecessary.
ix Splinting may be required if the
person refuses to exercise or move
their joints. CONSULTATION with
the appropriate burns unit is
required in this case (refer to the
list of appropriate burns unit
contacts). For patients with small
burns around a joint, overnight
splinting may also be used to
prevent the scar tissue contracting.
JULY 1996
8.2 Scar Management
• A burn that heals within two
weeks usually leaves no
permanent scarring.
• A burn that takes longer than
three weeks to heal will scar.
The longer it takes to heal the
worse the scarring. Pressure is
required until the burn scar matures,
approximately 12-18 months.
• Hypertrophic scarring exists
when the skin over the burnt
area becomes red, raised and
hard to the touch.
i If the wound heals in less than
10-14 days then usually no
further management except
sorbolene and sun protection
are required until all redness
fades.
ii Burnt areas which take longer
than 14-21 days to heal need
protection and pressure. If no
hypertrophic scarring is present
then the application of pressure
can cease at 2-3 months post
healing. Examples of products
which can be used for this
purpose are coban, Tubigrip,
crepe bandage, Hypafix. If
hypertrophic scarring is present
after 2-3 months, pressure
garments may be required.
Burn without appropiate scar
management showing hypertrophic
scarring.
15
MANAGEMENT
GUIDELINES FOR
PEOPLE WITH BURN 8.2 Scar Management continued
INJURY continued
iiia Moisturising lotion, such as
sorbolene and glycerol 10% should
be massaged into all scars 2-3
times per day as long as the scar
is red. This should commence as
soon as the wound is healed.
iiib CONSULT with the appropriate
burns unit if assistance is needed
with management of hypertrophic
scarring and/or if pressure
garments are required (refer to the
list of appropriate burns unit
contacts).
HEALED
AREAS
UNHEALED
AREA
Three weeks post burn.
Requires follow-up for
pressure and protection.
JULY 1996
9.0 PSYCHOSOCIAL CARE
i Always assess the social situation
by taking a comprehensive social
history of the patient and their
circumstances.
ii If child abuse/neglect is suspected
then the procedure for notification
to the Department of Community
Services should be followed.
iii If the person is at risk of further
injury then additional support may
be required, for example, domestic
abuse or elderly people living in
isolated situations.
iv Specialist counselling may also
be required for the patient and/or
significant others if :
• the burn was sustained through
traumatic circumstances
(eg house fire, explosion)
• there is difficulty returning to
normal daily activities or another
loss was involved (eg a life or
house)
• the patient is concerned about
scarring or body image, or there
is obvious disfigurement
• there is suspected substance abuse
v Psychological symptoms to be alert
for include:
• Depression
• Social withdrawal
• Sleep disturbance
• Intrusive memories or visual
images
• Heightened stress levels
• Hypervigilence, increased
wariness or easily startled
• Fear or avoidance of anything
related to the accident, including
refusal to talk about incident
Contact your specialist burns unit for
advice if any of these factors are
identified.
16
MANAGEMENT 10.0 SUN PROTECTION 11.0 ACCESS TO EXPERT OPINION
GUIDELINES FOR
PEOPLE WITH BURN i Sun protection is essential for i Expert opinion is available by
INJURY continued people who have had a burn injury contacting the appropriate burns
since the burnt area is particularly unit.
susceptible to further damage from
ii Consultation with the appropriate
the sun.
burns unit is encouraged at any
ii Even when the burn is healed the stage.
burnt areas should not be exposed
to the sun between 10.30am iii The list of contacts for each burns
and 4.00pm unit are provided as Appendix
One.

JULY 1996 17
APPENDIX ONE CONTACT DETAILS FOR SPECIALIST BURNS UNITS
Enquiries regarding children should be forwarded to the New Children’s Hospital
at Westmead.
Note: With each burns unit is a list of catchment health areas as they existed in
1995/96. These arrangements may vary in the future as health areas develop
service agreements within existing or new intra-Area, inter-Area or interstate
networks.

ROYAL NORTH SHORE HOSPITAL

Medical and Transfer Enquiries
Senior Plastic Surgery Registrar
Phone: (02) 9926 7111 (page 315) Fax: (02) 9926 7989
Sister in charge of Ward 9D
Phone: (02) 9926 8940
Enquiries regarding wound management
Phone Clinic Sister: (02) 9926 7988
Monday to Saturday: 0700 to 1530 hrs
Catchment Area 1995/1996:
Northern Sydney Area Health Service, Central Coast Area Health Service,
Hunter Area Health Service, All Health Services on the central, mid, and north coast
of NSW (Mid North Coast and Northern Rivers)

WESTMEAD HOSPITAL
Transfers and Admissions
Contact the Senior Plastics Registrar
Phone: (02) 9845 5555 then page Fax: (02) 9845 5000
The Plastics Registrar is on call after normal working hours.
Catchment Area 1995/96:
Western Sydney Area Health Service, Wentworth Area Health Service,
South Western Sydney Area Health Service, All Health Services in the central west and
far west of NSW (Mid Western, Macquarie, Far West)

REPATRIATION GENERAL HOSPITAL, CONCORD

Transfers and Admissions
Contact the Plastic Surgical Registrar
Phone: (02) 9736 7911 then page Fax: (02) 9736 7435
After hours contact the Burns Specialist on call
Phone: (02) 9736 7911 then page
Wound Management
Phone NUM or CNC, Burns Unit: (02) 9737 7775
Catchment Area 1995/1996:
Central Sydney Area Health Service, South Eastern Area Health Service, Illawarra Area
Health Service, All Health Services in the south east and south west of NSW
(Southern and Greater Murray)

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 TAMWORTH BASE HOSPITAL
Transfers and Admissions
Contact the Director, Dr J Fisher
Phone: (067) 665 688 between 0830 and 1700 hrs
Fax: (067) 666 638
After hours contact the Emergency Physician/Retrieval consultant on call.
Phone: (067) 661 722 extension 340
For enquiries regarding wound management
Contact the Nursing Unit Manager
Phone: (067) 661 722 extension 292 between 0700 and 1600 hrs
or page
Fax: (067) 666 638
Catchment Area 1995/1996:
New England Health Service

THE NEW CHILDREN’S HOSPITAL

Transfers and Admissions
Contact the Senior Surgical Registrar; Burns Ward
Phone: (02) 9845 1114 Fax: (02) 9845 0546
After hours contact the Surgical Registrar on call
Phone: (02) 9845 0000 then page
For enquiries regarding wound management
Contact the Burns Surgical Liaison CNS Fax: (02) 9845 2111
Phone: (02) 9845 0000 then page 6153
0730 to 1600 Monday to Friday
For enquiries regarding therapy
Contact the Senior Burns Physiotherapist
Phone: (02) 9845 3369
0800 to 1630 Monday to Friday
The reception desk of the Burns unit (Clubbe Ward) can be reached
on (02) 9845 1001.
Catchment Area 1995/1996: All Areas

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