Current Status of US Children’s Burn Care and Opportunities for Change

Importance: The discipline of burn care has been challenged by a declining professional workforce, resulting from changes in general surgery residency training, simultaneous with a multidisciplinary but siloed approach to care. Secondary effects on children’s burn care include decreased awareness of where children receive care outside of the American Burn Association (ABA)-verified burn centers, loss of bidirectional education and communication inherent to patient and family-centered care, and good outcome measures. These factors affect disaster planning. Observations: A system of care must be capable of addressing “everyday” pediatric burn care availability before the nation can manage multiple burn victims in a disaster. Pediatric burn care is delivered by a variety of clinicians with complementary skill levels, knowledge, and resources at several types of centers, including verified burn centers caring for children and adults or only children and nonverified children’s or acute care hospitals providing pediatric burn care. The current ABA verification process is rigorous but not tiered, making it difficult for many children’s hospitals to satisfy these standards. Conclusions: The current landscape of children’s burn care has strengths and opportunities in terms of access to care, care delivery, workforce and training, education, data and quality, and research. A national pediatric burn system will: (1) improve the understanding of “everyday” and expert burn care for children, (2) define gaps in children’s burn care, including preparedness of the emergency care system where children initially receive care, and (3) anticipate action and implementation strategies to address these gaps.