title: Prehospital burn management in a combat zone.
abstract: OBJECTIVE
  The purpose of this article is to provide a descriptive study of the management of burns in the prehospital setting of a combat zone.
  
  
  METHODS
  A retrospective chart review was performed of U.S. casualties with >20% total-body-surface-area thermal burns, transported from the site of injury to Ibn Sina Combat Support Hospital (CSH) between January 1, 2006, and August 30, 2009.
  
  
  RESULTS
  Ibn Sina CSH received 225 burn casualties between January 2006 and August 2009. Of these, 48 met the inclusion criteria. The mean Injury Severity Score was 31.7 (range 4 to 75). Prehospital vascular access was obtained in 24 casualties (50%), and 20 of the casualties received fluid resuscitation. Out of the 48 casualties enrolled, 28 (58.3%) did not receive prehospital fluid resuscitation. Of the casualties who received fluid resuscitation, nearly all received volumes in excess of the guidelines established by the American Burn Association and those recommended by the Committee for Tactical Combat Casualty Care. With regard to pain management in the prehospital setting, 13 casualties (27.1%) received pain medication.
  
  
  CONCLUSIONS
  With regard to the prehospital fluid resuscitation of primary thermal injury in the combat zone, two extremes were noted. The first group did not receive any fluid resuscitation; the second group was resuscitated with fluid volumes higher than those expected if established guidelines were utilized. Pain management was not uniformly provided to major burn casualties, even in several with vascular access. These observations support improved education of prehospital personnel serving in a combat zone.
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA. kimberly.franzen@us.army.mil
authors.forename: Kimberly F
authors.initials: KF
authors.lastname: Lairet
authors.forename: Julio R
authors.initials: JR
authors.lastname: Lairet
authors.forename: Booker T
authors.initials: BT
authors.lastname: King
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D000328:Adult; D002056:Burns / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005440:Fluid Therapy; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel / Q000706:statistics & numerical data*; D020380:Needs Assessment; D059408:Pain Management / Q000379:methods; D012042:Registries; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult