title: Operational demands on pre-hospital emergency care for burn injuries in a middle-income setting: a study in the Western Cape, South Africa.
abstract: BACKGROUND
  Burns occur disproportionately within low-socioeconomic populations. The Western Cape Province of South Africa represents a middle-income setting with a high rate of burns, few specialists and few burn centres, yet a well-developed pre-hospital system. This paper describes the burn cases from a viewpoint of operational factors important to pre-hospital emergency medical services.
  
  
  METHODS
  A retrospective, cross-sectional study of administrative and patient records was conducted. Data were captured for all pre-hospital burn patients treated by public Emergency Medical Services over a continuous 12-month period. Data were captured separately at each site using a standardised data collection tool. Described categories included location (rural or urban), transport decision (transported or remained on scene), age (child or adult) and urgency (triage colour).
  
  
  RESULTS
  EMS treated 1198 patients with confirmed burns representing 0.6% of the total EMS caseload; an additional 819 potential burn cases could not be confirmed. Of the confirmed cases, 625 (52.2%) were located outside the City of Cape Town and 1058 (88.3%) were transported to a medical facility. Patients from urban areas had longer mission times. Children accounted for 37.5% (n = 449) of all burns. The majority of transported patients that were triaged were yellow (n = 238, 41.6% rural and n = 182, 37.4% urban).
  
  
  CONCLUSIONS
  Burns make up a small portion of the EMS caseload. More burns occurred in areas far from urban hospitals and burn centres. The majority of burn cases met the burn centre referral criteria.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. rachel.allgaier@gmail.com.|Division of Emergency Medicine, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, South Africa. rachel.allgaier@gmail.com.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Allgaier
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|University of South Africa, Pretoria, South Africa.
authors.forename: Lucie
authors.initials: L
authors.lastname: Laflamme
authors.affiliation: Division of Emergency Medicine, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
keywords: Burns; Healthcare systems; Pre-hospital emergency care