title: Incidence and severity of combat hand burns after All Army Activity message.
abstract: BACKGROUND
  Operations Enduring Freedom and Iraqi Freedom have resulted in severe burns to the hands. Because of the frequency and severity of hand burns, an All Army Activity (ALARACT) message was distributed emphasizing the importance of hand protection (HP). Our purpose was to assess the effectiveness of the ALARACT in reducing the incidence and severity of hand burns.
  
  
  METHODS
  A retrospective review of the US Army Institute of Surgical Research Burn Registry for active duty personnel with hand burns 17 months before and after the ALARACT was conducted. Data include percentage total body surface area (% TBSA), % full-thickness injury, depth of hand burn, and ratio of hand burn to TBSA. Statistical analysis was performed using Mann-Whitney U test.
  
  
  RESULTS
  Four hundred fifty-one military personnel were admitted during the 34-month period: 257 (56.9%) pre-ALARACT; 194 (43.1%) post-ALARACT. Two hundred thirty-nine (52.9%) sustained hand burns: 138 (53.7%) pre-ALARACT; 101 (52.1%) post-ALARACT (p = NS). Mean TBSA: 21.5% pre-ALARACT; 28.8% post- ALARACT (p = 0.01). Mean full-thickness TBSA: 14.5% pre-ALARACT; 21.9% post-ALARACT (p = 0.02). Mean hand TBSA: 3.2% pre-ALARACT; 3.2% post-ALARACT (p = NS). Mean ratio, hand burn to TBSA: 36% pre-ALARACT; 25% post-ALARACT (p < 0.001).
  
  
  CONCLUSIONS
  Post-ALARACT, the incidence of hand burns remained unchanged. Despite an increase in burn severity, ratio of hand burn to TBSA decreased, suggesting a possible relationship between increased awareness and use of HP and decreased injury. Based on the data collected, the impact of the ALARACT is unclear. The importance of HP remains a priority. The fact that the incidence of hand burns remains unchanged demands our continued awareness and increased efforts.
authors: United States Army Institute of Surgical Research, Burn Center, Fort Sam Houston, TX 78234, USA. travis.hedman@amedd.army.mil
authors: Travis L
authors: TL
authors: Hedman
authors: Evan M
authors: EM
authors: Renz
authors: Reginald L
authors: RL
authors: Richard
authors: Charles D
authors: CD
authors: Quick
authors: William S
authors: WS
authors: Dewey
authors: David J
authors: DJ
authors: Barillo
authors: Leopoldo C
authors: LC
authors: Cancio
authors: David G
authors: DG
authors: Baer
authors: Steven E
authors: SE
authors: Wolf
authors: John B
authors: JB
authors: Holcomb
mesh_terms: D002056:Burns / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D003142:Communication; D017575:Gloves, Protective / Q000706:statistics & numerical data*; D006230:Hand Injuries / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008889:Military Personnel; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014481:United States