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EBJ
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Burn Injuries Associated with Wars and Disasters
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Burn Injuries Associated with Wars and Disasters

A special issue of European Burn Journal (ISSN 2673-1991).

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 23032

Special Issue Editor

Dr. Leopoldo C. Cancio

E-Mail Website
Guest Editor
US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, TX 78234, USA
Interests: resuscitation; ICU rehabilitation; burn critical care; performance improvement; combat casualty care; acute respiratory distress syndrome

Special Issue Information

Dear Colleagues,

Over the last century, the advances in burn care owe much to the experience gained during wars and mass-casualty disasters, specifically, how these events sparked collaboration between military and civilian burn communities. Examples abound. Frank P. Underhill developed a theory of burn shock following the Rialto Theater fire of 1921 [1] based on his observations on the pathophysiology of war gases during WWI [2]. The attack on Pearl Harbor in 1941, which caused hundreds of thermal injuries, spurred research and training in burns at Boston hospitals by the time of the Cocoanut Grove Night Club fire of 1942 [3]. The threat of nuclear war with the Soviet Union led to the founding of the second burn center in the US in 1949 at Fort Sam Houston, TX, from which stemmed numerous improvements in care for civilian and military patients [4]. This Special Issue of the European Burn Journal covers topics in burn care from a military and disaster perspective, focusing on the potential challenges of large-scale combat operations. It is not clear that the world is safer today than during the above-mentioned events. However, certainly, future conflicts and mass-casualty events will again evoke the best efforts of multidisciplinary burn teams. 

  1. Underhill, F.P. The significance of anhydremia in extensive superficial burns. JAMA 1930, 95, 852–857.
  2. Underhill, F.P. The physiology and experimental treatment of poisoning with the lethal war gases. Archives of Internal Medicine 1919, 23, 753–770.
  3. Aub, J.C.; Beecher, H.K.; Cannon, B.; Cobb, S.; Cope, O.; Faxon, N.W.; Lyons, C.; Mallory, T.; Schatzki, R. Management of the Cocoanut Grove Burns at the Massachusetts General Hospital; J.B. Lippincott: Philadelphia, PA, USA, 1943.
  4. Pruitt, B.A., Jr. Combat casualty care and surgical progress. Annals of Surgery 2006, 243, 715–729.

Dr. Leopoldo C. Cancio
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. European Burn Journal is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 971 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • burns
  • military personnel
  • disaster medicine

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Published Papers (11 papers)

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Editorial

Jump to: Research, Review, Other

5 pages, 170 KiB  
Editorial
Introduction to the Special Issue on Wars and Disasters: Advancing Care during Times of Crisis
by Leopoldo C. Cancio
Eur. Burn J. 2024, 5(3), 283-287; https://doi.org/10.3390/ebj5030026 - 2 Sep 2024
Viewed by 640
Abstract
Civilian mass-casualty disasters and armed conflict share many features, including the fact that both maximally challenge multidisciplinary burn teams. Rigorous training is required to build teams and systems that can respond effectively. One of the critical but potentially overlooked components of readiness for [...] Read more.
Civilian mass-casualty disasters and armed conflict share many features, including the fact that both maximally challenge multidisciplinary burn teams. Rigorous training is required to build teams and systems that can respond effectively. One of the critical but potentially overlooked components of readiness for crisis care is a robust clinical research program. Rather than stalling progress, disasters and conflict over the last 100 years consistently energized advances in care. This was made possible by the hard work of our predecessors to learn from the crisis in the midst of the crisis, and resulted in significant reductions in postburn mortality. Now, further work is needed not only to maintain these improvements in mortality, but also to understand the long-term functional outcomes and to improve the quality of life of burn survivors. Clinical research programs to address these issues must be established now, so that we are optimally prepared for the next conflict or disaster. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)

Research

Jump to: Editorial, Review, Other

10 pages, 221 KiB  
Article
Resource Requirements in a Burn Mass Casualty Event
by Wei Lun Wong, Kristina Carlsson, Marie Lindblad, Olivia Sjökvist and Fredrik Huss
Eur. Burn J. 2024, 5(3), 228-237; https://doi.org/10.3390/ebj5030022 - 2 Jul 2024
Viewed by 1141
Abstract
Burn mass casualty event occurrences are rare but will place significant burdens on any burn unit or healthcare system. Effective disaster preparedness plays a significant role in mitigating the aftermath of a burn mass casualty. The aim of this study was to assess [...] Read more.
Burn mass casualty event occurrences are rare but will place significant burdens on any burn unit or healthcare system. Effective disaster preparedness plays a significant role in mitigating the aftermath of a burn mass casualty. The aim of this study was to assess the resource requirements during the initial two weeks of a burn mass casualty event. Eight patients in a burn mass casualty event were simulated using the Emergo Train System®. These simulated patients were matched with real historical patients treated in our burn centre, and their resource requirements were analysed. An average of eight staff is required to care for a patient per day along with almost 75 h of operating time (excluding anaesthesia and turnover time). A substantial quantity of consumables was used in the first two weeks. This study has demonstrated the substantial material consumption and staff requirements in the first two weeks of management in a burn mass casualty event. Such findings will offer valuable insight for disaster preparedness planning and resource management strategies. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)

Review

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13 pages, 3660 KiB  
Review
Diagnosis and Treatment of Infections in the Burn Patient
by David G. Greenhalgh and John L. Kiley
Eur. Burn J. 2024, 5(3), 296-308; https://doi.org/10.3390/ebj5030028 - 4 Sep 2024
Viewed by 1075
Abstract
Infection is very common in burn patients because they lose the primary barrier from microorganism invasion, the skin. While there are attempts to prevent infections, topical antimicrobials and systemic prophylaxis tend to lead to more resistant organisms. After the initial resuscitation, the most [...] Read more.
Infection is very common in burn patients because they lose the primary barrier from microorganism invasion, the skin. While there are attempts to prevent infections, topical antimicrobials and systemic prophylaxis tend to lead to more resistant organisms. After the initial resuscitation, the most common cause of death is from sepsis and multiple organ dysfunction syndrome. The diagnosis is difficult in the burn population because the constant exposure from the open wound leads to an inflammatory response that leads to persistent hypermetabolism. This paper reviews the current understanding and treatment of infection and sepsis in burns. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
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11 pages, 270 KiB  
Review
Extracorporeal Organ Support for Burn-Injured Patients
by Garrett W. Britton, Amanda R. Keith, Barret J. Halgas, Joshua M. Boster, Nicholas S. Niazi, Kevin K. Chung and Leopoldo C. Cancio
Eur. Burn J. 2024, 5(2), 66-76; https://doi.org/10.3390/ebj5020006 - 25 Mar 2024
Viewed by 1791
Abstract
As mortality relating to severe acute burn injury improves, patients are surviving longer into the critical care phase, which is commonly complicated by multisystem organ failure. Extracorporeal organ support (ECOS) represents a set of potential therapeutic technologies for managing patients with organ-specific complications. [...] Read more.
As mortality relating to severe acute burn injury improves, patients are surviving longer into the critical care phase, which is commonly complicated by multisystem organ failure. Extracorporeal organ support (ECOS) represents a set of potential therapeutic technologies for managing patients with organ-specific complications. This article provides a comprehensive review of the existing literature, focusing on the use of continuous kidney replacement therapy, extracorporeal membrane oxygenation, extracorporeal carbon dioxide removal, and extracorporeal blood purification. Though promising, many of these technologies are in the early phases of implementation and are restricted to well-resourced medical systems, limiting their use in large scale casualty and austere scenarios. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
17 pages, 263 KiB  
Review
Burn Wound Care Strategies for the Battlefield and Austere Settings
by Sarah Shingleton, Jared Folwell, Ian Jones, Michael Gleason and Alicia Williams
Eur. Burn J. 2024, 5(1), 49-65; https://doi.org/10.3390/ebj5010005 - 23 Feb 2024
Cited by 1 | Viewed by 2336
Abstract
Burns are commonly encountered in the battlefield environment; however, the availability of burn expertise and specialized supplies is variable. Initial burn care should remain focused on cooling the burn, preventing hypothermia, basic wound cleansing, and evacuation. Key ongoing burn wound management principles include [...] Read more.
Burns are commonly encountered in the battlefield environment; however, the availability of burn expertise and specialized supplies is variable. Initial burn care should remain focused on cooling the burn, preventing hypothermia, basic wound cleansing, and evacuation. Key ongoing burn wound management principles include wound debridement, accurate burn size and depth estimation, wound care, ongoing wound evaluation, and treatment of suspected Gram-negative wound infection. Operative management should be limited to urgent procedures, and definitive burn management should be performed only after evacuation to a higher level of care. Flexibility, creativity, and the ability to adapt care to the tactical environment are key to the successful management of burn injuries in battlefield and austere settings. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
15 pages, 1824 KiB  
Review
Enteral Resuscitation: A Field-Expedient Treatment Strategy for Burn Shock during Wartime and in Other Austere Settings
by Ian F. Jones, Kiran Nakarmi, Hannah B. Wild, Kwesi Nsaful, Kajal Mehta, Raslina Shrestha, Daniel Roubik and Barclay T. Stewart
Eur. Burn J. 2024, 5(1), 23-37; https://doi.org/10.3390/ebj5010003 - 18 Jan 2024
Cited by 1 | Viewed by 1672
Abstract
Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This [...] Read more.
Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
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26 pages, 1822 KiB  
Review
War at Sea: Burn Care Challenges—Past, Present and Future
by Matthew D. Tadlock, Theodore D. Edson, Jill M. Cancio, Dana M. Flieger, Aaron S. Wickard, Bailey Grimsley, Corey G. Gustafson, Jay A. Yelon, James C. Jeng and Jennifer M. Gurney
Eur. Burn J. 2023, 4(4), 605-630; https://doi.org/10.3390/ebj4040041 - 11 Dec 2023
Cited by 2 | Viewed by 2929
Abstract
Throughout history, seafarers have been exposed to potential thermal injuries during naval warfare; however, injury prevention, including advances in personal protective equipment, has saved lives. Thankfully, burn injuries have decreased over time, which has resulted in a significant clinical skills gap. Ships with [...] Read more.
Throughout history, seafarers have been exposed to potential thermal injuries during naval warfare; however, injury prevention, including advances in personal protective equipment, has saved lives. Thankfully, burn injuries have decreased over time, which has resulted in a significant clinical skills gap. Ships with only Role 1 (no surgical capability) assets have worse outcomes after burn injury compared to those with Role 2 (surgical capability) assets. To prepare for future burn care challenges during a war at sea, Military Medicine must re-learn the lessons of World War I and World War II. Burn injuries do not occur in isolation during war and are associated with concomitant traumatic injuries. To care for burn casualties at sea, there is an urgent need to increase the availability of whole blood and dried plasma, resuscitation fluids that were ubiquitous throughout the naval force during World War II for both hemorrhagic and burn shock resuscitation. Furthermore, those providing trauma care at sea require formal burn care training and skills sustainment experiences in the clinical management of Burn, Trauma, and Critical Care patients. While burn education, training, and experience must be improved, modern high-energy weapons systems and anti-ship ballistic missiles necessitate concurrent investments in prevention, countermeasures, and personal protective equipment to decrease the likelihood of burn injury and damage resulting from these attacks. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
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12 pages, 1355 KiB  
Review
Management of Casualties from Radiation Events
by Robert Alan Dent
Eur. Burn J. 2023, 4(4), 584-595; https://doi.org/10.3390/ebj4040039 - 14 Nov 2023
Cited by 4 | Viewed by 1638
Abstract
Radiation events such as nuclear war, nuclear reactor incidents, and the deployment of a radioactive dispersal device (dirty bomb) are all significant threats in today’s world. Each of these events would bring significant challenges to clinicians caring for patients with burns and traumatic [...] Read more.
Radiation events such as nuclear war, nuclear reactor incidents, and the deployment of a radioactive dispersal device (dirty bomb) are all significant threats in today’s world. Each of these events would bring significant challenges to clinicians caring for patients with burns and traumatic injuries who are also contaminated or irradiated. The result of a nuclear exchange in a densely populated area could result in thousands of patients presenting with trauma, burns, and combined injury (trauma and burn in an irradiated patient). In this review, we will discuss the three major types of ionizing radiation: alpha, beta, and gamma, and their respective health hazards and biological effects. Additionally, we will discuss the types of burn injuries in a nuclear disaster, caring for the contaminated patient, and managing the combined injury of burn trauma with acute radiation syndrome. The reader will also be left with an understanding of how to prioritize lifesaving interventions, estimate the absorbed dose of radiation, and predict the onset of acute radiation syndrome. While some animal models for morbidity and mortality exist, there is limited modern day human data for patients with combined injury and burns associated with a nuclear disaster due to the infrequent nature of these events. It is extremely important to continue multidisciplinary research on the prevention of, preparedness for, and the response to nuclear events. Furthermore, continued exploration of novel treatments for radiation induced burns and the management of combined injury is necessary. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
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11 pages, 238 KiB  
Review
Pharmacologic Considerations for Antimicrobials and Anticoagulants after Burn Injury
by Pranav Ravichandran and Kaitlin A. Pruskowski
Eur. Burn J. 2023, 4(4), 573-583; https://doi.org/10.3390/ebj4040038 - 10 Nov 2023
Cited by 1 | Viewed by 1324
Abstract
Derangements in pharmacokinetics and pharmacodynamics (PK/PD) of burn patients are poorly understood and lacking consistent data. This leads to an absence of consensus regarding pharmacologic management of burn patients, complicating their care. In order to effectively manage burn critical illness, knowledge of pharmacologic [...] Read more.
Derangements in pharmacokinetics and pharmacodynamics (PK/PD) of burn patients are poorly understood and lacking consistent data. This leads to an absence of consensus regarding pharmacologic management of burn patients, complicating their care. In order to effectively manage burn critical illness, knowledge of pharmacologic parameters and their changes is necessary. It is also imperative that the clinician understands how these changes will affect drug dosing. A common practice is to increase antibiotic dosing and/or frequency; however, this may not be necessary and doses should be adjusted to patient- and drug-specific parameters. Additionally, monitoring assays for antibiotic levels as well as coagulation factors can be useful for adjusting dosages to best treat the patient. This review focuses on alterations in PK/PD as well as other physiologic changes after burn injury, with special reference to care in military and austere settings. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
11 pages, 285 KiB  
Review
Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing
by Beth A. Shields and Asia M. Nakakura
Eur. Burn J. 2023, 4(4), 537-547; https://doi.org/10.3390/ebj4040035 - 13 Oct 2023
Cited by 1 | Viewed by 6070
Abstract
The hypermetabolic and hypercatabolic responses to severe burns put nutrition support at the forefront of treatments. When left untreated, severe weight loss, increased infection, and wound healing failure can occur. Enteral nutrition is the primary method of nutrition support in such patients. Meeting [...] Read more.
The hypermetabolic and hypercatabolic responses to severe burns put nutrition support at the forefront of treatments. When left untreated, severe weight loss, increased infection, and wound healing failure can occur. Enteral nutrition is the primary method of nutrition support in such patients. Meeting caloric needs and a positive nitrogen balance are short-term goals of nutrition support, with long-term goals of minimizing lean body mass loss and maximizing wound healing. High-carbohydrate and low-fat nutrition received evidence from randomized controlled trials of aiding in decreasing pneumonia rates and was found to promote positive nitrogen balance, which lipids do not do. We go through the macronutrient and micronutrient needs of the burn patient as well as techniques for meeting these needs in the modern intensive care unit, with some discussion of alterations in these techniques that are required in the austere environment. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)

Other

8 pages, 239 KiB  
Opinion
Hypnosis in Burn Care: Efficacy, Applications, and Implications for Austere Settings
by Deanna C. Denman
Eur. Burn J. 2024, 5(3), 207-214; https://doi.org/10.3390/ebj5030020 - 1 Jul 2024
Viewed by 771
Abstract
Burn injuries are among the most traumatic events a person can endure, often causing significant psychological dysfunction and severe pain. Hypnosis shows promise as a complementary intervention to manage pain and reduce the psychological distress associated with burn injury and treatment. This paper [...] Read more.
Burn injuries are among the most traumatic events a person can endure, often causing significant psychological dysfunction and severe pain. Hypnosis shows promise as a complementary intervention to manage pain and reduce the psychological distress associated with burn injury and treatment. This paper reviews the literature regarding hypnosis and potential applications of hypnosis in the management of burns. Hypnosis offers an effective, low-cost intervention that is widely applicable in the management of burns and can play a role in more acute and austere settings where resources are often limited. Full article
(This article belongs to the Special Issue Burn Injuries Associated with Wars and Disasters)
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