2019 MBRP Programmatic Panel Member Vignette
Title: Charting a Course Toward Resuscitation and Recovery
COL Kevin Chung, MD, FCCM, FACP; Uniformed Services University of the Health Sciences

I am an internist by training, and I sub-specialized in critical care. I was assigned to San Antonio at the U.S. Army Burn Center in 2005 and immediately started taking care of combat casualties.

Any time there’s active combat operations, about 5 to 10 percent of all casualties put together will sustain pretty significant burn injury. Generally, those patients also sustain trauma on top of their burn. And having both combined doesn’t happen very much in the civilian setting.

A lot of times in the civilian population we’re dealing with flame burns, you know, house fires, accidents. In the combat operation setting, what you’re dealing with are burns associated with explosions. So you have lots of blast concussive effects on top of the burn itself, and the constellation of burns, trauma to the body, and trauma to the brain—that’s just a bad combination.

The Military Burn Research Program Programmatic Panel consists of a diverse group of individuals, each with their own perspective. They’re all subject-matter experts in their field. And they’re comprised of a representative from the Army, from the Air Force, and the Navy with burn expertise. There’s also a civilian burn clinician that’s on the panel that provides that civilian perspective. There are two consumers who represent burn survivors who themselves have experienced significant burns during combat, and each bring a tremendous amount of insight as to what burn patients go through based on their own experience. And so that really diverse group is essential in evaluating what we should fund, what we should work on next to advance the field.

And the broad areas that are important to burn care include, initially, the acute resuscitation of the burn patient and optimizing that; the closure of the burn wounds and wound healing in general, so assisting surgical debridement of the burn wound and replacing that with normal skin, which is providing definitive coverage for the burns; and critical care is another topic area that we’ll focus on. Rehabilitation of the patients as they recover from their burn injuries and long-term functional outcomes, so getting them back to as close as possible to baseline function with minimal pain and full range of motion with minimal scars.

And from year to year, the focus shifts. And the reason we do that is we want to stagger the areas that we address so that there’s minimal overlap between the research projects that are ongoing in the burn community.

When we take a look at a proposal, we want to see that, number one, is the project feasible? Can it get done in a timely fashion with the amount that’s budgeted for that project? And if the answer is yes, we move on. The next question is: Is this militarily relevant? For example, the last cycle, we wanted to focus on interventions that could occur in the pre-hospital setting because the current and future environment does not allow for rapid evacuation of casualties. How can we best resuscitate in a resource-limited environment? How do we best cover these wounds so that they don’t get infected in that pre-hospital environment? How do we best address the wounds if they do get infected? How do we address the wounds if there’s no surgical capability, for example? How do we protect the organs from developing organ failure when you don’t have state-of-the-art medical care?

The best advice I can give a principal investigator, clinical scientist, translational scientist interested in getting funded through the Military Burn Research Program is try to find a problem that exists clinically that is unaddressed, that is a problem in the day-to-day care of burns. It doesn’t have to be specific to the military. I guarantee, if it’s a problem in the care of civilian burns, it’s going to be a problem in the care of military burns. But find a gap that exists within the scope of clinical practice and try to figure out how to solve that gap and, hopefully, that project will be aligned with the priorities that they’re focusing on for that year. And it may change every couple of years. It does. We do it deliberately and so, be patient. At some point, one of the cycles will probably ask you to prioritize a problem that you’re already working on.

The second advice I can give you is find a collaborator that has some knowledge and some experience with military burn care and burn care in the midst of combat operations, somebody that has been deployed and been in that environment taking care of burns downrange or has worked in the burn center in previous years. I think that collaboration is vital in helping shape the proposal so that it addresses that major question: Is this project militarily relevant?

Out of all the different programs that exist, both in the CDMRP as well as the NIH and other intra-agency funding programs, the Military Burn Research Program is the only program dedicated to burns. And that’s—that’s what makes it unique.