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.

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

A Review of the Scientific Literature

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

ResearchPublished Sep 21, 2020

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.

Topics

Document Details

Citation

Chicago Manual of Style

Engel, Charles C., Ryan K. McBain, Samantha McBirney, Sara E. Heins, Molly M. Simmons, Emily Hoch, Mimi Shen, Nicholas Broten, Gulrez Shah Azhar, and Tepring Piquado, The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature. Santa Monica, CA: RAND Corporation, 2020. https://www.rand.org/pubs/research_reports/RRA807-1.html.
BibTeX RIS

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.

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.