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Burn service leaders should actively engage in local and regional surge in demand planning.

Each burn service should prepare to provide mutual aid to other burn services who may be overwhelmed.

Early communication between service leads is vital.⁷⁰

Agreed local clinical guidelines should be in use that have been produced by an appropriately constituted multiprofessional team, comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants or autonomously practising anaesthetist and managers. These guidelines should cover at least the following:

• assessment and management of pain and pruritus, including the recording of pain and itch scores^13...

Elective plastic surgery operating lists should be separated from those for plastic surgery trauma to allow efficient planning in advance for elective cases, to prevent cancellation of elective cases and to allow a flexible response to emergencies.⁶³

Information from the patient’s preoperative assessment should be readily available, ideally as part of an electronic patient record so that information is easy to transfer between locations and to enable data collection for later analysis.¹²

Hospitals should provide scheduled local anaesthesia lists, using a dedicated area for initiating and assessing local nerve blocks. Organising cases in this way fosters the development and maintenance of expertise in the anaesthetists and support staff and minimises delay between cases.

For planned burn and plastic surgery, there should be a preoperative assessment clinic organised as described in GPAS Chapter 2: Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent Care Patients.²

There should be specific guidelines for assessing a suspected difficult airway, for example in patients with head and neck malignancy and in reconstructive burn surgery.⁷⁶

Where major elective reconstructive surgery requiring postoperative critical care provision is undertaken, the funding for and provision of these beds should be planned to meet the demands of the service so that cancellations can be minimised.