Introduction

Modern care

In the last 20 years large changes in burn care and in the background and logistics around the care for the burn injured has occurred which has implications for how burn care now should be administered and practically performed. Firstly the incidence of burn injuries has decreased in the Western world and a decrease of about 30% is evident from e. g., since the eighties [1–2]. In parallel, length of stay in the burn care facilities for the injured has been reduced to about 40% of what it was at that time [3–4]. Thirdly, the outcome of burns has been significantly improved over the same time period. This may be exemplified by the 50% survival chance that was present for a 45% total burn surface area burn (TBSA %) in a 21 year old in the late 70-ties, which is to be compared to the corresponding 50% survival chance for 80–90% TBSA % burn in the same age patient today [5–6]. Fourth, patients, with smaller burns, today are to a significant extent treated as outpatients and smaller injuries may have their surgery done as outpatients as well [7–9]. At the same time an increasing proportion of the patients are in the elderly age groups where the injury poses a larger treat as compared to in younger patients [10–11]. In this age group care is to a large extent influenced by co-morbidities [12].

Marc G. Jeschke et al. (eds.), Handbook of Burns

Based on these changes the approach to burn care has been to centralize this type of care to larger burn units and centers. A process, that is ongoing in most countries, however with a variable intensity. The multidisciplinary approach to the care and the need to keep the care process unified for this patient group has lead to that the centralization process has been pursued and is most often successful. The latter exemplified by lower mortality rates and shorter lengths of stay [6, 13–14]. At the same time such organizational changes bring about important care implications for the general medical practitioners and medical organizations [13–14]. The decreased incidence and the centralized care reduce the magnitude of medical staff that have experience of these cases and that treats them on a regular basis. This then calls for good teaching programs and a good organized care. Especially the early management and stabilization of the patients needs to be well functioning at any level of care as this care is often provided at a non-burn center by personal with limited experience of burns. Importantly, as the outcome has been improved significantly in later times, the care to be provided needs to be optimized and the tolerance for any less successful results is low. It is relevant to note that there is an inherent risk in “over”- centralizing care even of small injuries that should be cared for at the local hospital [15]. Therefore continuous teaching programs are important. This early part of the treatment has therefore been

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