Title: Military Burn Injuries are Different
CAPT Zach Brown, MD; USS George H.W. Bush, Norfolk Naval Station

One of the biggest contributions, of the military burn research program is the power of the purse that we're able to bring $10 million that Congress funds annually to fund burn research and specifically military burn research. We're the only organization that does that. And the needs of military burn patients can be a little different from those of civilians.

As I say in one of my lectures, mechanism matters. And one of the common mechanisms of injuries for combat casualties are blast injuries. Blast injuries and the burns that go along with them behave a little bit differently than your garden variety house fire. They’re more complicated.

The organ systems that are affected or affected more severely than with a civilian type burn, for example, the lungs. The body naturally has a really wonderful system for dispersing heat and preventing true thermal injuries to the lungs. When you have a blast that happens in an enclosed space, the pressure goes up and the heat can get past those protective mechanisms and cause true thermal injuries to the lungs.

And actually burns to the lungs, whether it's from heat or from chemicals that equals 17% body surface area. So when we assess burns and describe them, one of the key components is what's the total body surface area that's affected by the burns. And so with combat injuries, you really have to be aware that the lungs are not just innocent bystanders, but frequently are part of that burn. And so you have to treat them a little bit more aggressively and manage them differently than than civilian burns.

We fought wars in hot environments for so long Iraq, Afghanistan, Vietnam, places where it's easy to think of heat injuries. Really, Ukraine is the first time in a while that we've been faced with what does cold do? What does a cold burn look like? How do we manage frostbite? In the past couple of years, we've been doing annual training exercises in Norway. And I had a Marine who came back from that training exercise and he had frostbite on the ends of all of his fingers. He was a motor transport mechanic and he had been working outside on vehicles and fuel leaks and liquids and whatnot had soaked his gloves, and the temperatures were just bitter cold, and he kept on working he came in and had frostbite. So he initially got stabilized, they did wound care that they thought was appropriate and came back and had to have excision and grafting on his hands. So we're starting to appreciate that this is something that we could see more and more often.

And so we're starting to see more research proposals going in to identifying if the ways that we've managed in the past are really the best or if we can do better. We had a proposal that we funded just this last cycle that is looking at TPA, which is a clot busting drug that we use for strokes. Can we use that to help with limb salvage or finger salvage or toe salvage and get a better outcome? So that's the sort of research that we grabbed on to and said, yes, please. I don't expect the answer to come in the next six months or year, but I'm hoping that that the data will point us in the right direction, maybe they stumble across something else in the process that opens up new areas for research that we can delve into.