<h5>Current RMA Instruments</h5><table border="1" cellpadding="1" cellspacing="1"><tbody><tr><td><address><a href="http://www.rma.gov.au/assets/SOP/2024/7a8646280f/001.pdf&quot; target="_blank">Reasonable Hypothesis SOP</a></address></td><td>1 of 2024 as amended</td></tr><tr><td><address><a href="http://www.rma.gov.au/assets/SOP/2024/23171ced81/002.pdf&quot; target="_blank">Balance of Probabilities SOP</a></address></td><td>2 of 2024 as amended</td></tr></tbody></table><h5>Changes from previous Instruments</h5><p><drupal-media data-entity-type="media" data-entity-uuid="e0436c51-b841-47b9-930d-00bcfc2f592c" data-view-mode="wysiwyg"></drupal-media></p><h5><strong>ICD coding</strong></h5><p>ICD-10-AM codes: T20 to T25, T29, T26.0-2. </p><p><strong>Brief description</strong></p><p>A heat-induced burn involves injury to the skin and tissues due to external contact with flame or heat. Such injury can sometimes be more severe to also include the deep tissues and organs (multiple burn injury). Heat-induced burns may result in a systemic response involving systemic inflammation and vascular shock. </p><p>Flame and heat-induced burns can include the effects of incendiary devices such as white phsophorus grenades and rockets. </p><h5><strong>Confirming the diagnosis</strong></h5><p>This is a clinical diagnosis based on the history and findings on examination.</p><p>The relevant medical specialist is an emergency physician, dermatologist or plastic surgeon.</p><h5><strong>Additional diagnoses covered by these SOPs</strong></h5><ul><li>Burns due to hot substances</li><li>Diathermy or ultrasound burn</li><li>Sunburn</li><li>Welding burn (to the cornea)</li></ul><h5><strong>Conditions not covered by these SOPs  </strong></h5><ul><li>Chemical burns * chemical burn SOP </li><li>Electrical contact or electrical flash burns * - electrical injury SOP</li><li>Freezing cold injuries (frostbite)* Frostbite SOP</li><li>Friction "burns" (abrasion) * - cut, stab, abrasion and laceration SOP</li><li>Internal burns including to the respiratory tract and gastrointestinal tract and genitourinary tract ^#<span> </span></li><li>Isolated burns to the retina of the eye <span>* -</span> retinal burn SOP</li><li>Lightning burn * - electrical injury SOP</li><li>Photocontact dermatitis * Photocontact dermatitis SOP</li><li>Radiation burns due to ionising radiation * Radiation burns SOP</li></ul><p>* another SOP applies</p><p>^# non-SOP condition</p><h5><strong>Clinical onset</strong></h5><p>This is instantaneous with the application of the agent. In this SOP the RMA has added a time delay in some of the factors which represents the time to recognise the injury, but the injury occurred within minutes of the application of the burning agent.</p><h5><strong>Clinical worsening</strong></h5><p>An external burn is an injury.  Any subsequent burn is a new injury that requires the SOP to be invoked again.</p><p>The natural history of a burn depends on the severity (depth) of the burn and the extent of the body surface that is affected.  Superficial burns can heal without scaring.  Severe extensive burns can be fatal or cause severe scarring.</p><p>Inability to obtain appropriate clinical management for a burn that is more than superficial is likley to result in a clinical worsening. </p><p> </p>