Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter III: Burn Injury

Triage

United States Department of Defense

Triage is an important aspect of military burn care to ensure that available medical care resources are matched to the severity of burn injury and the number of burn casualties. In civilian practice, with optimum resources available, every burn patient receives emergency care. Thereafter, care at a facility with optimum resources, i.e., a burn unit or burn center, is recommended for adults with second-degree burns of more than 25% of the body surface, for all patients with third-degree burns of 10% or more of the total body surface, and for all patients with significant burns involving the hands, face, feet, and perineum. Similarly, all burn patients with significant inhalation injury, significant high-voltage electrical burns, and with associated fractures or other major trauma, should be cared for in a facility with special expertise. Those patients with moderate, uncomplicated burn injury (that is, those with second-degree burns of 15-25% of the total body surface area and with third-degree burns of less than 10% of the total body surface area without the associated complications or associated injury, as noted above) should be cared for in a general hospital. Patients with less extensive uncomplicated burn injuries can commonly be cared for on an outpatient basis.

In the combat setting, the tactical situation, logistical limitations, or limited availability of health care personnel may necessitate reduction in the upper limits of these categories. In the best of circumstances, optimum treatment results in salvage of approximately 50% of patients whose burns involve 60-70% of the total body surface. With limited resources, burn care resources should be applied to that group of patients in which greatest benefit will be realized, with less attention given to those with lesser burns or those with more extensive burns. In a situation with resource restrictions or large numbers of casualties, hospital care can be delayed for those patients with burns of 20% or less of the total body surface. Similarly, expectant care should be applied to those patients with burns which exceed 70% of the total body surface and the available care facilities and resources applied to those with burns of from 20-70% of the total body surface. With even greater restriction of health care availability, the upper limit of the maximum treatment group should be reduced by stepwise decrements of 10% until the surgical workload matches available resources. Triage modifiers include significant coexisting inhalation injury and associated mechanical injury, each of which lowers the upper limit of the maximum treatment group by 10%. Conversely, burns of the hands, face, feet, and perineum, occurring in patients with lesser total body surface burns, will increase the medical care necessary for such patients.

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Operational Medicine 2001

Health Care in Military Settings

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