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Referrals and Transfers

Referrals to Galveston’s Shriners Hospitals for Children

  • Shriners Hospitals are operated by the Shrine of North America.  All medical care provided at Shriners Hospital is provided free of charge. 
  • Children to the age of 18 years, who have received a burn injury and live in North America, may be eligible for treatment.

Emergency Admissions

  • For emergency burn admissions, the referring physician should telephone a physician at the Shriners Hospital in Galveston and indicate the patient needs emergency care.  Information will be requested concerning the patient’s demographic information, medical history and physical assessment including a description of the burn injury.  A Referral Sheet and a Burn Diagram will be filled out.
  • Phone - (409) 770-6773

Non-emergency Admissions

  • Non-emergency admission to the Galveston Hospital is dependent on the medical needs of the patient and on the availability of beds.  Please fill out an Application form (English / Spanish) for non-emergency admission to a Shriners Hospital.
  • Appointments for current patients only - (409) 770-6998
  • All other patient questions - (888) 215-3109
  • From Mexico - 001-888-215-3109

Foreign Patient Requirements

  • The child's parent/guardian will need to accompany the patient to the hospital. This is imperative for treatments/surgical consents as well as for emotional and psychological support for the patient during their stay.  The parent/guardian will be trained in the care of the patient and will be responsible for care while the patient is an outpatient.
  • Although all medical treatment if provided free of charge, the hospital cannot be responsible for any transportation, food or lodging for the parent/guardian or for any expenses incurred while a child is an outpatient in the United States.
  • A medical history of the child must be provided (i.e. past/present diseases or conditions, previous surgeries, hospitalizations, etc.).
  • Round trip transportation between the home country and the United States, for the child and guardian must be guaranteed prior to acceptance.  Confirmation of this would be copies of airline tickets or similar documents.
  • Please provide a letter from a local physician stating that medical treatment is available for this child upon return to his/her country.

Approximate costs while at Shriners Hospital

Costs for parent lodging and meals may range from approximately $140.00 to $245.00 per week depending on the place of lodging. 

Burn Unit Referral Criteria

Burn injuries that should be referred to a burn unit include the following:

  • Partial thickness burns greater than 10% total body surface area (TBSA).
  • Burns that involve the face, hands, feet, genitalia, perineum, or major joints.
  • Third-degree burns in any age group.
  • Electrical burns, including lightning injury.
  • Chemical burns.
  • Inhalation injury.
  • Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality.
  • Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality.  In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit.  Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols.
  • Burned children that are in hospitals without qualified personnel or equipment for the care of children.
  • Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention.

Hospital Emergency Care


  • Assessment
    • Airway:  Support or provide airway and provide cervical spine protection.
    • Breathing:  Assess breathing and ventilation.  Provide assistance as necessary.  Monitor chest movement with deep burns of the trunk.  Administer oxygen at a high flow.
    • Circulation:  Assess vital signs.  Assess circulatory status of burned extremities by monitoring distal pulses.  Start IV access. 
    • Disability:  Assess orientation and neurological status, associated injuries, hypoxia.
    • Exposure:  Keep patient warm.
    • Medical History and Head to Toe Physical Exam with x-rays and laboratory assessment.


  • Assess Burn
    • Assess type of burn and circumstances of injury.
    • Percent of burn injury (% Total Body Surface Area Burn)
      • The Burn Diagram  can be used to calculate burn size.  Children are different than adults.
      • The outline of the patient’s hand and fingers is equal to 1% of the body surface area and can be used to calculate burn size.  (An area the size of 2 of the patient’s hands would be a 2% burn.)
      • Body Surface Area nomogram:  A patient’s height and weight are used to measure Total Body Surface Area in centimeters squared.
    • Burn Depth
      • 1st Degree Burn
      • 2nd Degree Burn
      • 3rd Degree Burn
      • 4th Degree Burn








1st Degree


Epidermis only

Momentary Exposure Sunburn Sharp, uniform pain Blanches red, pink. Edematous, soft, flaking, peeling ± 7 days
2nd Degree

Partial Thickness

 Epidermal and part of Dermal layer

Exposure of Limited Duration to Lower Temperature (40-55°C) Scalds, flash burn without contact, weak chemical Dull or hyperactive pain, sensitive to air/temperature changes Mottled, red blanches red/pink, blisters, edema, serous exudate, moist 14-21 days
3rd Degree

Full Thickness

 Entire epidermis, dermis and subcutaneous tissue

Long duration of exposure to high temperature Immersion, Flame, Electrical, Chemical Painless to touch and pinprick, May hurt at deep pressure No blanching, pale white, tan charred, hard, dry, leathery, Hair absent Granulates, Requires Grafting
4th Degree Underlying structures of muscle or bone Prolonged duration of exposure to extreme heat



Usually painless Charred, Skeletonized Requires Fasciectomy, Possible amputation


  • Fluid Resuscitation
    • The most important aspect of early clinical management of the burn victim is fluid resuscitation beginning within the first couple hours of burn injury. 
    • Adult resuscitation:
      • Ringers Lactate 2-4 ml / kg / %TBSA burned.
      • Give ˝ of total volume over the first 8 hours from time of burn injury.
      • Give second ˝ of total volume over the following 16 hours.
      • Example
      • Titrate to maintain blood pressure and urine output of at least 30 cc/hr.
    • Pediatric resuscitation:
      • Ringers Lactate 5000 ml / TBSA burn (m2) + 2000 ml / TBSA (m2).
      • Give ˝ of total volume over the first 8 hours from time of burn injury.
      • Give second ˝ of total volume over the following 16 hours.
      • Example
      • Titrate to maintain blood pressure and urine output of at least 1 cc/kg/hr.


  • Wound Care for Emergency care and transport
    • No ice or cold water soaks, no wet dressings or sheets.
    • Cover with clean dry cloth.
    • Keep patient warm.
    • For delayed transfer - 
      • Wash wounds and débride loose tissue.
      • Topical Antimicrobial (Silver Sulfadiazine) and gauze wrap.
      • Monitor need for escharotomies.


In this section:
Referrals & Transfers
Burn Unit Referral Criteria
Hospital Emergency Care






Referral Sheet

Burn Diagram (Preliminary)

Burn Diagram (72 Hour)

Application Form
English  /  Spanish

Acknowledgment Form
English  /  Spanish


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