Which burn patient can be safely managed outside a level I trauma center, such as a patient with 30% first-degree burns?

Safe Management of Burn Patients Outside Level I Trauma Centers

The patient with 30% first-degree burns (Option D) can be safely managed outside a level I trauma center, as superficial burns without complicating factors do not require specialized burn center care. 1

Analysis of Each Patient Option

Option A: Patient with Diabetes and Second-Degree Leg Burn - REQUIRES BURN CENTER

• Patients with partial-thickness burns and complicating factors such as diabetes must be referred to a burn center for specialized care. 1
• Diabetes significantly increases the risk of complications and infection in burn patients, warranting early burn center referral. 2
• The combination of partial-thickness injury with metabolic comorbidity elevates both morbidity risk and need for specialized wound management. 1

Option B: Patient with Inhalation Injury - REQUIRES BURN CENTER

• Inhalation injury requires immediate specialized burn center care according to CDC guidelines. 1
• Inhalation injury is one of the three major risk factors for mortality in severe burns (along with age and total body surface area). 3
• These patients require specialized airway management, bronchoscopy capabilities, and intensive monitoring that only burn centers can provide. 4, 5

Option C: Patient with 15% Third-Degree Burns - REQUIRES BURN CENTER

• Patients with full-thickness burns of any significant extent should be automatically referred to a burn center for early surgical excision and skin grafting. 1
• Third-degree burns involve the entire dermal layer and require specialized surgical intervention that cannot be provided outside burn centers. 2
• Early tangential excision and grafting, routinely performed in burn centers, significantly reduce morbidity, mortality, and hospital length of stay. 3

Option D: Patient with 30% First-Degree Burns - CAN BE MANAGED OUTSIDE BURN CENTER

• Field triage guidelines do not mandate burn center transfer for superficial burns without other trauma mechanisms or complicating factors. 1
• First-degree (superficial) burns involve only the epidermal layer and require only simple first-aid techniques with over-the-counter pain relievers. 2
• These burns can be managed with cooling, pain control (acetaminophen or NSAIDs), and application of petrolatum-based ointments or aloe vera. 6, 2

Key Clinical Pitfalls to Avoid

• Do not underestimate burns with comorbidities: Any partial-thickness burn in a patient with diabetes requires burn center referral, regardless of size or location. 1, 2
• Do not delay transfer for inhalation injury: These patients deteriorate rapidly and require immediate specialized care with bronchoscopy and advanced airway management capabilities. 1, 3
• Do not attempt outpatient management of full-thickness burns: All third-degree burns require surgical excision and grafting available only at burn centers. 1, 2
• Recognize that direct admission to burn centers improves survival: Sequential transfers increase morbidity and mortality compared to direct admission. 1, 3