Table 2.

Burn care resource matrix.

Capability	Knowledge	Skills	Facilities/Equipment
Level 1 Service – Basic
Prevention	• Local epidemiology of burns • Available community support (e.g., Schools, NGOs, Local Media) • Basics of primary prevention and secondary prevention	Communication, ability to motivate local community	• Basic communication facilities, poster, banners. Etc. • Standardised paper/electronic registry form
First aid	• Stop, drop and roll • Application of clean cool water to the wounds • Awareness of dangerous/bad practices	Ability to demonstrate principles of first aid	Simple props for demonstrations, such as a bucket of water
Assessment of burn injured patient	• History taking • ABC of immediate burn care • Assessment of other injuries • Symptoms and signs of inhalation injury • Clinical assessment of depth and surface area of burn	• Appropriate history and clinical examination. Ability to prioritise airway (with c spine control), breathing and circulation • Ability to accurately assess size and depth of burn wound and presence of other injuries, including inhalation	Basic medical/nursing notes. Stethoscope, blood pressure cuff
Simple emergency procedures	Basic airway management	• Jaw thrust, chin tilt, insertion of guedal airway, use of bag and mask • Insertion of IV cannula	Guedal airway, bag and mask, IV fluids (saline or ringers lactate)
Clear communication and documentation	• Local legal requirements • Availability of local, regional burn service and contact phone numbers	• SBAR (Situation, Background, Assessment, Response) • Clear, accurate and legible documentation	Telephone
Safe transport	Local transport options, local burns services	Patient preparation for safe transport	Access to transport (taxi, rickshaw, ambulance. etc.)
Care of minor burns	• Analgesia, cleaning and dressing wounds • Correct positioning • Recognition of burn depth and the progression of changes in appearance • Signs and symptoms of infection	• Basic antisepsis, hand washing • Cleaning wound and applying a dressing. Correct positioning. Assess wound for signs of infection	• Oral and injectable analgesics • Antiseptic fluids and topical antimicrobials • Simple dressings, POP
Level 2 Service–Intermediate
Advanced emergency procedures	Advanced airway management, central venous catheterization, escharotomy and fasciotomy	Intubation, insertion of central line. Surgical decompression	• Laryngoscope, suction, bougey, selection of ETTs, oxygen supply • Central line kits, basic surgical set, access to theatre
Fluid management	Fluid resuscitation formula and maintenance fluids	Implementing and monitoring fluid balance. Insertion of urinary catheter	Urinary catheters, catheter bags, monitoring charts
In-patient care of minor and moderate burns	• Indications for excision and grafting of burns and prioritising areas • Management of infected burns and delayed presentations • Basics of nutrition and rehabilitation therapy • Psychosocial/social support • Specific requirements of children	• Tangential excision and skin grafting of small/moderate surface area burns • Debridement of infected burns • Pre- and post-operative management of burns • NG feeding and nutritional supplementation • Simple contracture release and burn reconstruction • Physio-, socio- and psychotherapies • Distraction and play therapy	• Specific ward or area of ward for patients • Watson knife, mesher • Laboratory support and blood transfusion facility • NG tubes, nutritional supplements • Specific physiotherapy area and equipment • Play area for children
Training of level 1 staff	Appropriate education material	Simple teaching skills and ability to motivate staff	Laptop computer, printed materials, flip chart
Level 3 Service–Advanced
Comprehensive management of complicated and extensive burns	• Advanced pathophysiology of burns • Inhalation injury management • Critical and intensive care • Advanced wound coverage modalities • Sophisticated nutritional supplementation • Complex reconstruction • Long term and comprehensive rehabilitation	• Critical/intensive care skills for adults and children • Advanced Plastic and Reconstructive Surgery skills (including micro surgery) • Burns specific rehabilitation skills	• Specialised physical plant • Designated critical care area • Dedicated burns operating theatre • Access to other specialities (e.g., renal, cardiology) • Post discharge rehabilitation facilities
Training of Level 2 staff	Appropriate education material	• Advanced teaching skills • Ability to motivate staff	Digital camera, projector, lecture theatre/seminar room
Research and Audit	• Principles of research methodology and use of evidence informed practice • Quality improvement framework • Importance of general and targeted audit	• Ability to design, develop and implement research projects and audit • Ability to lead quality improvement initiatives	• IT equipment (internet access, data management software) • Data collection support • Library
Policy & National Planning	• Health service structure, government and non-governmental initiatives relevant to burns • Familiarity with regional burn care resources	• Develop working relationship with health/planning ministries • Develop strategic level national framework plans • Collaboration with other burn centres in the region	• Access to data • Administrative support

N.B. The levels outlined in the table are pyramidal in nature, i.e., all that is mentioned in Level 1 is included in Level 2, with Level 3 including items listed for Levels 1 and 2.