An analysis of the long-distance transport of burn patients to a regional burn center.

The concentration of specialized burn care to relatively few centers within relatively large geographic regions requires an organized system of patient triage, referral, and transport. The purpose of this study was to identify systematic errors in either the initial evaluation or care of burn patients requiring transport more than 90 miles to a single regional burn center. Therefore, we undertook a descriptive analysis of patients transported more than 90 miles to a single regional burn center from 2000 to 2003. The outcomes of interest were duration of transport, errors in burn size estimation, errors in fluid management, appropriateness of intubation, and complications during transport. During the years 2000 to 2003, there were 1877 admissions to the burn center; 949 (51%) were transferred from an outside facility. Of these 949, 424 (45%) were transferred more than 90 miles from a referring facility to our burn center. The average transport time from injury to our burn center was 7.2 hours (range, 1.6-48). There were no patient deaths during transport, and the most common complications were loss of or inability to secure intravenous access and inability to secure an airway. Burn size estimates differed significantly (P < .001) between referring providers and burn center physicians. This study confirms that patients can be transported safely and efficiently over long distances to a regional burn center. Given the current geographic distribution of burn centers and concerns about declining numbers of burn surgeons, organized systems of patient triage and transport may become increasingly important.