Burns are one of the most difficult types of injury for which to care, and about 5–20 percent of combat-related casualties during Operation Iraqi Freedom and Operation Enduring Freedom included severe burns. Blast-related burn injuries are associated with infection, disability, and mortality. To identify areas that are understudied, RAND researchers conducted a literature review and synthesis of the evidence surrounding blast-related burn injury.

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The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience

A Review of the Scientific Literature

by Charles C. Engel, Ryan K. McBain, Samantha McBirney, Sara E. Heins, Molly M. Simmons, Emily Hoch, Mimi Shen, Nicholas Broten, Gulrez Shah Azhar, Tepring Piquado

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Research Questions

  1. What are the most promising preventive interventions and surgical restoration and reconstruction advances for patients with blast-related burn injuries?
  2. What skills, capabilities, and equipment will be needed in the future for prolonged field care for blast-related burns?
  3. What are the most promising rehabilitative innovations for patients with long-term effects of blast-related burn injuries?
  4. What are the most important research, technological, and policy opportunities, and what gaps must be addressed regarding blast-related burn injuries?

Burns, a leading cause of fatality among military service members, are one of the most difficult injuries for which to care. Additionally, blast-related burn injuries are associated with infection, disability, mental illness, discharge from the military, and mortality. To identify areas that are understudied, RAND researchers conducted a comprehensive literature review and synthesis of the evidence surrounding blast-related burn injury.

The authors found sufficient information regarding treatment; however, there remains a need for additional research concerning prevention of blast-related burn injury. They also observed a lack of studies addressing prolonged field care for burns. Because U.S. military forces have expanded their scope and mission into more remote and rugged terrain, it is not always possible to immediately evacuate injured soldiers—and personnel exposed to burn injuries are at heightened risk of infection and complications. In this type of situation, burn injuries might need to be treated and managed in the field for an extended period of time. Therefore, strategic thinking and specific planning are necessary to develop, practice, and refine potential strategies to care for burns in prolonged field settings.

Key Findings

Several burn-prevention technologies and strategies, as well as advances in surgical reconstruction, have shown promise

  • Fabrics for soldiers' clothing should balance protection with comfort, mobility, and weight, and polyester might not be safe.
  • Innovation in fire-resistant fuel and silicone rubber fire-safety cables could improve safety.
  • Educational strategies, such as burn-prevention media campaigns and informational interventions, have been found to improve outcomes.
  • Skin grafting and flap surgery improve wound healing and subsequent quality of life of patients with severe burns.

Various technologies show promise for prolonged field care

  • Biobrane™ and similar wound devices could be useful in a prolonged field care setting.
  • Appropriate bandaging is critical; silver-nylon dressing has been found to be uniquely portable and easy to use and has key antimicrobial properties.
  • Platform wound devices and negative-pressure wound therapy have shown promise.

There was a lack of research in certain key areas, including prevention

  • Few studies have addressed prolonged field care.
  • More research is needed on long-term needs of patients with blast-related burns, as well as long-term effects of treatment.
  • Studies measuring the relative value of investments in prevention versus treatment could generate cost savings.
  • Further research is needed on triage algorithms for civilian burn patients receiving care at military facilities.
  • Existing methods for measuring total body surface area produce highly variable results, and the impact on clinical outcomes is unclear.

Recommendations

  • Invest in research areas where the epidemiology indicates a greater need for improvement in clinical care and service delivery.
  • Review how guidelines are developed, how often they are updated, and how the guidelines integrate new evidence.
  • Expand training on, and test new models of, prolonged field care for blast-related burn injuries.
  • Develop enhanced care coordination and triage strategies for civilian burn patients receiving care in military treatment facilities.

Table of Contents

  • Chapter One

    Background and Purpose

  • Chapter Two

    Review Methodology

  • Chapter Three

    Foundational and Etiological Research Results

  • Chapter Four

    Epidemiology Results

  • Chapter Five

    Prevention, Screening, and Diagnostic Research Results

  • Chapter Six

    Treatment and Follow-Up Care Results

  • Chapter Seven

    Military Policy and Health Services Research Results

  • Chapter Eight

    Discussion and Preliminary Recommendations

  • Appendix A

    Planning Committee Members

  • Appendix B

    Search Terms and Results

Research conducted by

This research was sponsored by the U.S. Army Medical Research and Development Command and the DoD Blast Injury Research Coordinating Office and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division.

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