Project Purpose Over one million burn injuries occur in the United States each year. Although not all of these are life threatening, nearly 75% result in emergency department visits and 20% in hospital admissions. Approximately 4,500 deaths annually are caused by burns, making burns the fourth leading cause of death from unintentional injury . In fact, out of all the industrialized nations in the world, the United States has the highest per capita burn death rate. Burns are consistently listed as one of the top ten causes of injury and death for children less than 5 years and adults older than 34 years. Rural communities have at least double the burn death rate than urban areas. Also on a national basis, Native American children are 2.8 times more likely to die as a result of fire than white children. Access to state of the art medical care is limited in many areas of the country by time and distance. The Intermountain West is a prime example of this where population is sparsely distributed and distances are vast. There are significant geographic barriers with a rugged topography that requires some people in the region to travel over 100 miles for health care. Accurate evaluation of burn injuries is difficult for many physicians, resulting in over- and under-triage. Inappropriate referrals are extremely costly, inconvenient and, in some situations, pose a threat to patient welfare. One impetus for this proposal came from a recent study we conducted of patients referred to our burn center from within our region. We reviewed 225 air transports of burn patients to our center during the years 2000-01; these transports comprised almost half the referrals to our facility, from a mean distance (one-way) of 246 air miles. This fact alone underscores the vastness of our region, our status as a regional resource, and the remoteness of many patient referrals. We documented a significant number of problems with the evaluation of patients by these facilities. Almost 40% of patients were judged by us to have burns sufficiently minor that either ground transport (21%) or even family transport (18%) would have been feasible, distance and logistics permitting. For the entire group of referred patients, mean burn size estimation by referring physicians was 29 percent total body surface area (%TBSA), compared to 19% TBSA by Burn Center physicians. In 92 cases, over/under-estimation of burn size by referring physicians of as much as 560% of the total burn size, or overly-aggressive performance of endotracheal intubation, suggested that telemedicine evaluation of patients prior to transport might have significantly altered transport decisions or care. In addition, in 21 cases air transport charges exceeded total hospitalization charges, strongly suggesting that more resource-efficient methods of patient evaluation could have resulted in substantial savings for these patients. In fact, the cost of one unnecessary air transport (often in excess of $15,000) could buy a reasonably good telemedicine "studio" for a referring hospital. In addition, the events of 9/11 underscore the resource-intensive nature of burn care and the limited resources currently available . Burns are one of the most likely injuries to occur with mass casualty or terrorist events, and the ability to triage and treat large numbers of patients is extremely limited. The interdiction of air traffic that can occur after such events can further compound the ability to treat large numbers of patients. All of these facts underscore the need for an immediate system of acute burn evaluation and treatment. University of Utah Health Sciences Center 50 North Medical Drive, Salt Lake City, Utah 84132 HSC Webmaster Disclaimer