Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom.

Historically, burns have comprised 8% to 10% of casualties sustained in post World War II conflicts,1–3 and vary based on the predominant type of weapon employed. Wartime injuries, including burns, in the current conflict in southwest Asia, known as Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), are evaluated and treated within an echelon-based evacuation system, with initial first-aid rendered on site by embedded military medics (level I) who start intravenous resuscitation, control hemorrhage, and immobilize fractures. Injured military personnel are then transported to Forward Surgical Teams (level II), which include a surgeon and anesthetist who provide initial surgical stabilization prior to evacuation to Combat Support Hospitals (level III). The level III facilities contain surgical subspecialists, intensive care unit capability, and other advanced capabilities for further stabilization and treatment. From there, casualties are triaged for evacuation to military hospitals in the continental United States if further care will be required, transiting through Landstuhl Regional Medical Center in Germany (level IV), and finally for burn casualties, to Brooke Army Medical Center in San Antonio, TX, the home of the U.S. Army Institute of Surgical Research (USAISR) Burn Center (level V). The USAISR serves as the sole referral center for all significantly burned active duty military personnel. The USAISRis notified of casualties by phone from the theater of operations, and depending on severity, can launch a Burn Flight Team of specialized burn care practitioners consisting of a physician, critical care nurse, licensed vocational nurse, respiratory therapist, and a noncommissioned officer to assist with evacuation. Otherwise, injured patients with less severe burns are evacuated using U.S. Air Force Critical Care Air Transport Teams (CCATT). The USAISR Burn Flight Team pioneered the aeromedical transport of seriously ill patients and has been flying missions around the world since 1951.4,5 For the current conflict, severely burned patients are met at Landstuhl Regional Medical Center close to Frankfurt, Germany, where the patient is further stabilized and flown to the burn center in San Antonio, TX. All further care for burned military personnel, including rehabilitation and reconstruction, take place at the USAISR. The USAISR also functions as the civilian regional burn center in south Texas, serving an area of 80,000 square miles with 6,800,000 people. Patients are brought directly to the USAISR by Emergency Medical Services if burned locally, or if burned outside the immediate metropolitan area, are referred through a centralised referral system for medical emergencies in south Texas. Patients are transported to the USAISR where they receive all of their primary burn care. Patients also receive rehabilitation and reconstruction at the USAISR or are referred to practitioners closer to home if requested by the patient. Since the USAISR serves as a burn care center for 2 distinct populations, we sought to compare them, with the initial hypothesis that outcomes would be poorer for the active duty military group because of the distance of evacuation, other associated injuries, and extended time to definitive care. We also sought to determine whether clinical outcomes for wartime burns were similar to those sustained in civilians. To address these aims, we compared demographics, burn characteristics, associated injuries, mortality, and clinical outcomes between the 2 populations.