Burns Referral Proforma Guidelines

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Paediatric Burns Referral Proforma Guidelines

Download Burns Referral Form

Refer a patient:

  • The following proforma has been developed by the Plastic Surgery department at Children's Health Ireland at Crumlin (CHI at Crumlin) to guide the referral of paediatric patients following a burn injury
  • All paediatric burn referrals must be made by telephone to the Plastics doctor on call at Children's Health Ireland at Crumlin- you can access this service by dialling the main switch line on 01 409 6100 and asking to speak to the plastics doctor on call
  • Please note, this proforma serves as an adjunct to (but does not replace) the usual referral pathway of paediatric burns to Plastic Surgery Services by phone call
  • Following on from acceptance of this referral from the plastics team in CHI at Crumlin, the referring doctor must complete the Paediatric Burns Referral Proforma in order to assist the patient in accessing the correct service in the most timely fashion
  • This proforma contains the minimum dataset required  by the Plastic Surgery service on referral of paediatric burn injuries
  • This proforma can act as well as guidance relating to intravenous fluid resuscitation when indicated by the referring doctor
  • The proforma may be used as a guide for doctors/emergency departments referring paediatric patients with burns to the Plastic Surgery service at CHI at Crumlin
  • This should be completed and transferred in hard copy with referred patients