Patients with major burns (more than 15% body surface area in adults and more that 10% in children, and sometimes less extensive burns involving face, hands and genitals) should be managed in specialist burns centres associated with plastic surgery units. There should be at least one such unit per 2-4 million population. Although plastic surgeons may be primarily responsible for the resuscitation of burned patients, there must be experienced anaesthetists or intensive care experts available, particularly for the treatment of the respiratory burn.

Due to the complex nature of the burn injury several essential supporting services are needed which should be on site. Anaesthesia, paediatrics, medicine, clinical microbiology, general and orthopaedic surgery and haematology should all be present with the appropriate laboratory facilities. Other disciplines which should be readily available to assist are specialist occupational and physiotherapy services, a dietetic service, social workers, clinical psychologists and nephrologists.

Burns centres should be in self contained units, treating adults and children, attached to a major plastic surgery centre which is itself in a large acute hospital.

Burns usually require skin grafting and patients with extensive burns are often re-admitted to hospital at a later stage after their primary treatment for reconstructive plastic surgery to rectify the effects of scarring on function and appearance. These units should have outreach services to support the patient and advise the general practitioner when he/she is discharged from the burns unit.