• 

  Mr Paul Baker

  Plastic & Burn Surgeon: Clinical Leader for Burn Service

• 

  Dr Lindsay Damkat Thomas

  Plastic & Burn Surgeon

• 

  Mr Richard Wong She

  Plastic & Burn Surgeon

Depending on how serious the burn is (in depth, size and location) burns may be treated as either an inpatient (admitted into hospital) or as an outpatient. In both instances, multiple health professionals (surgeons, nurses, physiotherapists and occupational therapists) will be involved. As required, a social worker or psychiatric liaison staff may be involved. 

Referrals into the system can come from your family doctor or via an emergency department.

Some outpatient clinics are staffed by all members of the burn team, others by the Burn Clinical Nurse Specialists alone. Referrals to these clinics can be made by your family doctor or following discharge from hospital.

Referral Criteria for National Burn Centre

• Buns greater than 30% total body surface area (TBSA)
• Full thickness burns to face, hands, genitalia or perineum
• Burn injury with significant inhalation injury
• Electrical burns - high voltage with underlying tissue damage
• Significant chemical burns

Referral form:

http://www.nationalburnservice.co.nz/assets/Documents/Policies-and-guidelines/094a4cb523/referralform.pdf

 

On-call Burn Coordinator National Burn Centre Contact Details are:

• Phone: 09 250 3800
• Email:  

Referral Criteria for Regional Burn Unit

• Burns greater than 10% total body surface area (TBSA) for adult or 5% in a child
• Burns to special areas, e.g. face, hands, feet, perineum or over major joints
• Full thickness burns greater than 5% TBSA
• Electrical burns (including lightning injury)
• Chemical burns
• Burn injury with inhalation injury
• Circumferential burns of the limbs or chest
• Burn injury in patients at the extremes ages i.e. young children and the elderly
• Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recover or affect mortality
• Any burn patient with burns and concomitant trauma (e.g. fractures) in which the burn injury poses the greater immediate risk of morbidity or mortality
• Any burn suspected with abuse

RBU Referral Form:

http://www.nationalburnservice.co.nz/assets/Documents/Policies-and-guidelines/c84fe59f65/RegionalBurnUnitReferralForm.pdf

 

Regional Burn Centre Contacts

Phone the on-call plastic surgery registrars:

• Middlemore Hospital - (09) 276 0000 or 021 784 057
• Waikato Hospital - (07) 839 8899
• Hutt Hospital - (04) 570 9999
• Christchurch Hospital - (03) 634 0640

There are no charges for services to public patients if you are lawfully in New Zealand and meet one of the Eligibility Directions specified criteria set by the Ministry of Health.   If you do not meet the criteria, you will be required to pay for the full costs of any medical treatment you receive during your stay.

To check whether you meet the specified eligibility criteria, visit the Ministry of Health website www.moh.govt.nz/eligibility  

For any applicable charges, please phone the Accounts Receivable Office on (09) 276 0060.

Epidermal Burns (First Degree)

These only affect the outer layer of skin (epidermis). The burn area is red, dry and painful but no blisters are present. Mild sunburn is a typical first degree burn.

These only affect the outer layer of skin (epidermis). The burn area is red, dry and painful but no blisters are present. Mild sunburn is a typical first degree burn.

Superficial Dermal, Mid-Dermal and Deep-Dermal Burns (Second Degree)

Superficial Dermal burns affect the epidermis and part of the second deeper layer of skin (dermis). The development of blisters is the hallmark of a dermal burn. The burn area may appear very red or, if blisters burst, wet and shiny. The area may also be swollen and very painful. Treatment may include antibiotic ointment and frequent dressing and cleaning of the wound. A superficial dermal burn should heal spontaneously with the proper care. Mid-Dermal and Deep-Dermal burns affect progressively more of the underlying dermis and will take longer to heal with corresponding greater risk of scarring. Deep dermal burns require the same treatment as a full-thickness burn.

Superficial Dermal burns affect the epidermis and part of the second deeper layer of skin (dermis). The development of blisters is the hallmark of a dermal burn. The burn area may appear very red or, if blisters burst, wet and shiny. The area may also be swollen and very painful. Treatment may include antibiotic ointment and frequent dressing and cleaning of the wound. A superficial dermal burn should heal spontaneously with the proper care.

Mid-Dermal and Deep-Dermal burns affect progressively more of the underlying dermis and will take longer to heal with corresponding greater risk of scarring. Deep dermal burns require the same treatment as a full-thickness burn.

Full Thickness Burns (Third Degree)

The skin may appear dry and may be charred black or white. There will be no sensation of pain in the area because the nerve endings have been destroyed. These burns will not heal on their own and treatment may include: Wound cleaning and debriding (removal of dead tissue) 
 Antibiotic ointment 
 Intravenous (IV) or oral antibiotics 
 Intravenous fluids 
 Pain medication 
 Skin grafting (a piece of undamaged skin is surgically transplanted to cover the burned area) Reconstructive Plastic Surgery

The skin may appear dry and may be charred black or white. There will be no sensation of pain in the area because the nerve endings have been destroyed. These burns will not heal on their own and treatment may include:

• Wound cleaning and debriding (removal of dead tissue) 

• Antibiotic ointment 

• Intravenous (IV) or oral antibiotics 

• Intravenous fluids 

• Pain medication 

• Skin grafting (a piece of undamaged skin is surgically transplanted to cover the burned area)
• Reconstructive Plastic Surgery

Inpatients

Patients admitted with burns are cared for in different parts of the hospital depending on how severe their burn injury is and their age. Regardless of age, severely injured and critically ill patients with burns are cared for in the Intensive Care Unit. Severely injured but stable patients, regardless of age, are cared for in the National Burns Centre. Well children are cared for in Kidz First whilst well adults will be admitted to the National Burns Centre when possible. Patients are under the care of a Consultant Plastic and Reconstructive surgeon. They are in charge of a multi-disciplinary team.

Patients admitted with burns are cared for in different parts of the hospital depending on how severe their burn injury is and their age.

Regardless of age, severely injured and critically ill patients with burns are cared for in the Intensive Care Unit.

Severely injured but stable patients, regardless of age, are cared for in the National Burns Centre.

Well children are cared for in Kidz First whilst well adults will be admitted to the National Burns Centre when possible.

Patients are under the care of a Consultant Plastic and Reconstructive surgeon. They are in charge of a multi-disciplinary team.

Inpatient Treatments - Pain Control, Wound Care and Therapy

Three main factors necessitate inpatient care for a burn injury: 1. Pain control Burns are painful, especially initially. Sometimes the hospital is the only place that is safe enough to give the required strong pain relief. With time, as analgesia requirements lessen, patients can be discharged home with medication, if still required. 2. Wound care Some burns may heal spontaneously, others require surgery. All wounds require wound care. Burn wound care in the initial phases may be very intense and require significant amounts of analgesia to be done comfortably. Furthermore, in the initial stages, expert nurses are involved in caring for the wound to ensure as much heals as possible. Children with burn injury may also require assistance from the Hospital Play Specialist who will offer support to the child and caregiver to assist them in coping with wound care procedures. Once wound care can be managed in the community, contact is made with either district nurses, visiting paediatric burn nurses or appointments are made to return to hospital for dressing changes. Occasionally burn wounds require surgery to heal. In general, if a wound takes longer than three weeks to heal, the scar that forms from prolonged healing is worse than that of a skin graft. Sometimes it is obvious from the beginning that a wound will not heal and rather than wait, surgery will be offered initially. At other times, it may take longer before a definitive decision about surgery can be made. 3. Therapy Some burns will require on-going physiotherapy and occupational therapy for the best possible scar / healing (see below) and to ensure the best possible functional outcome. Special exercises, splints and garments may be used to achieve these goals.

Three main factors necessitate inpatient care for a burn injury:

1. Pain control

Burns are painful, especially initially. Sometimes the hospital is the only place that is safe enough to give the required strong pain relief. With time, as analgesia requirements lessen, patients can be discharged home with medication, if still required.

2. Wound care

Some burns may heal spontaneously, others require surgery. All wounds require wound care. Burn wound care in the initial phases may be very intense and require significant amounts of analgesia to be done comfortably. Furthermore, in the initial stages, expert nurses are involved in caring for the wound to ensure as much heals as possible.  Children with burn injury may also require assistance from the Hospital Play Specialist who will offer support to the child and caregiver to assist them in coping with wound care procedures. 

Once wound care can be managed in the community, contact is made with either district nurses, visiting paediatric burn nurses or appointments are made to return to hospital for dressing changes.

Occasionally burn wounds require surgery to heal. In general, if a wound takes longer than three weeks to heal, the scar that forms from prolonged healing is worse than that of a skin graft. Sometimes it is obvious from the beginning that a wound will not heal and rather than wait, surgery will be offered initially. At other times, it may take longer before a definitive decision about surgery can be made.

3. Therapy

Some burns will require on-going physiotherapy and occupational therapy for the best possible scar / healing (see below) and to ensure the best possible functional outcome. Special exercises, splints and garments may be used to achieve these goals.

Outpatients

Some patients will be assessed as being suitable for outpatient treatment after being referred in to be assessed. Others will become outpatients after being treated as inpatients. Outpatient services consist of multidisciplinary clinics staffed by doctors, nurses, physiotherapists, occupational therapists and social workers. Most clinics are run on-site at Middlemore Hospital either in Kidz First or the National Burn Centre. For select paediatric patients, a visiting burn nurse may visit the patient in their home. For other patients, a visiting district nurse service may help with dressings in the home.

Some patients will be assessed as being suitable for outpatient treatment after being referred in to be assessed. Others will become outpatients after being treated as inpatients.

Outpatient services consist of multidisciplinary clinics staffed by doctors, nurses, physiotherapists, occupational therapists and social workers.

Most clinics are run on-site at Middlemore Hospital either in Kidz First or the National Burn Centre. For select paediatric patients, a visiting burn nurse may visit the patient in their home. For other patients, a visiting district nurse service may help with dressings in the home.

Outpatient Treatments

These are a continuation of the inpatient treatments (see above).

These are a continuation of the inpatient treatments (see above).

Burns Clinics

Weekly multidisciplinary burn clinics are held for patients under the care of the Burn Team. Patients will be assessed by the surgeon, nurse, physiotherapist and occupational therapist. As required, a social worker or psychiatric liaison staff member may also be involved. Some outpatient clinics are staffed by all members of the Burn team, others only by the Burn Clinical Nurse Specialists. Paediatric/Adults Multi-Disciplinary Consultant Clinics: Mondays, 1pm - 4.30pm, National Burn Centre, Middlemore Hospital. Thursdays, 1pm - 4.30pm, National Burn Centre, Middlemore Hospital. These clinics are not run at the Manukau Surgery Centre and bookings for these clinics are not done by staff there.

Weekly multidisciplinary burn clinics are held for patients under the care of the Burn Team. Patients will be assessed by the surgeon, nurse, physiotherapist and occupational therapist. As required, a social worker or psychiatric liaison staff member may also be involved. Some outpatient clinics are staffed by all members of the Burn team, others only by the Burn Clinical Nurse Specialists.

Paediatric/Adults Multi-Disciplinary Consultant Clinics:

Mondays, 1pm - 4.30pm, National Burn Centre, Middlemore Hospital.

Thursdays, 1pm - 4.30pm, National Burn Centre, Middlemore Hospital.

These clinics are not run at the Manukau Surgery Centre and bookings for these clinics are not done by staff there.

Burn Size

The palm of the individual’s hand (including the fingers) is about 1% TBSA. Burns larger than 5% in a child or 10% in an adult should be referred for specialist treatment.

The palm of the individual’s hand (including the fingers) is about 1% TBSA. Burns larger than 5% in a child or 10% in an adult should be referred for specialist treatment.

Burn Depth

Burn depth is critical to determining whether a burn will spontaneously heal or not. Burn depth can change with time and treatment so reassessment is often required.

Burn depth is critical to determining whether a burn will spontaneously heal or not. Burn depth can change with time and treatment so reassessment is often required.

• National Burn Centre Referral Form (PDF, 104.3 KB)
• Referral Flowchart (PDF, 34.3 KB)
• Patient & Family Information Booklet (PDF, 240.4 KB)
  

  An informative and helpful booklet designed to answer questions that patients and families might have regarding the National Burn Centre.

• Recovering from Burn Injury - Coping and Emotional Recovery (PDF, 1.6 MB)
• Recovering from Burn Injury - National Burn Centre Transfers (PDF, 1.7 MB)

Visiting times (and restrictions on visitors) for each part of the hospital differs. Please contact the appropriate part of the hospital to confirm current visiting times and possible restrictions.

In general visiting hours are between 2pm and 8pm. Visitors are restricted to two at a time. Although children are welcome, they must be supervised by an adult at all times.  We welcome Partners in Care to our wards.  Please introduce yourself to our staff.

There is a 'No Fresh Flowers' policy on the ward as the pollen may get into wounds and cause infections. 

Restricted Visiting Policy

Whaanau who want to visit a patient need to be from the patient’s own “bubble”, and will need to request permission in advance by speaking to the Charge Nurse Manager/ Charge Midwife Manager. 

Contact details for all our sites are listed on the website. The decision will be made on a case-by-case basis, by a lead clinician in conjunction with infection prevention and control experts.

We encourage whaanau and friends to first consider “virtual” visiting options – by phone, text or video/ FaceTime – to stay connected and give support to patients who are in hospital.

Click here for more information.

 

There are some specialised services in the hospital where visiting hours may vary, for example, the Delivery Suite, or Intensive Care Unit. In these cases, signs will be in place with the relevant information. If you are not sure, please feel free to contact us at the numbers listed below:

• For Information/Visiting Hours: phone (09) 270 4799
• For Patient Enquiries: phone (09) 276 5004
• For Tiaho Mai (Acute Mental Health Unit): phone (09) 270 4742

Counties Manukau Health provides patients and visitors with a number of convenient shopping facilities. On the ground floor, by the main entrance of the hospital, you will find ‘Paataka Place’ which includes the Haumanu Pharmacy, Middlemore Florist & Gifts Ltd and a variety of food and beverage options. 

For more information, visit Counties Manukau Health website.

Parking for all other visitors is available in designated paid visitor parking spaces around the Middlemore Campus beside the new Edmund Hillary Block. Please follow the signs and to enter the visitor car park insert your ticket barcode up. Remove the ticket and the barrier will rise.

Autopay stations are located throughout the carpark and Hospital main entrance. After validating your ticket you have 15 minutes to exit the carpark otherwise extra payment is required

Daily Parking Charges:

0-15 minutes	FREE
15 minutes to 1 hour	$5.00
1-2 hours	$10.00
2-3 hours	$15.00
3-4 hours	$21.00
over 4 hours	$26.00
Lost ticket fee	$52.00
No part hours

  

 

 

 

 

 

Free parking for 30 minutes between 2pm - 8pm
Between 2pm - 8pm visitors can park for 30 minutes with no charge.  The visitor must leave within the 30 minutes otherwise normal rates apply.

Hours of operation: 24 hours per day / 7 days a week

Useful resources for families, patients and health professionals:

• Burns Support Group Charitable Trust Inc.  (email: info@burns.org.nz)
• Australian and New Zealand Burn Association
• Auckland Council - fire safety conditions and burn plan
• New Zealand First Service
• Safekids
• Burn Survivor Resource Community (American)
• American Burn Association
• Changing faces (national charity based in United Kingdom)
  
  
• National Health Emergency Plan: Multiple Complex Burn Action Plan
• Starship Clinical Guidelines - Burns