Burn Injuries from a military perspective

Purpose of Review In the combat environment, there are unique considerations in the management of thermal injuries. The purpose of this review is to describe the unique considerations and challenges for burn care in the deployed environment. Burn injuries have occurred in 5-15% of combat casualties during the recent conflicts; when considering the "future operating environment" with the potential for large scale military operations, burn injury may be much more common. Recent Findings Burn injuries require specialized wound care and surgical interventions. Advances in the management in burn injuries realized from the recent conflicts include early evacuation from the combat environment using specialized and advanced critical care teams, the use of renal replacement therapy (including during the en route transport environment), aggressive surgical care of concomitant soft tissue injury to facilitate limb prosthetic placement if necessary, advanced ventilator strategies, pulmonary support with ECMO in patients who fail ventilator management, aggressive nutritional support, and consultation/communication along the battlefield continuum of care with 24/7 telehealth support. The battlefield continuum of care requires frequent casualty movement which presents a unique challenge in regard to the resuscitation of burn casualties. Optimal care requires a concerted effort on the part of all providers along this continuum of care. This review will focus on the management of burn casualties in the deployed environment and will highlight specific principles in the management of burn causalities in the military trauma system.