US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

International State-of-the-Science Meeting on Mitigating The Impact of Blast-Related Burn Injuries: From Prolonged Field Care to Rehabilitation and Resilience

3-5 March 2020 - Arlington, VA

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Blast-related burns experienced by U.S. Service members in combat can be devastating, are often more severe than burns occurring in civilian settings, and can be the most complex types of injuries to treat. Deployed Service members have twice the risk of suffering a burn injury compared to civilians. Approximately 5-20 percent of combat casualties during Operation Iraqi Freedom and Operation Enduring Freedom sustained severe burns, with improvised explosive devices (IEDs) accounting for as much as 87 percent of all burns. IED-related burns are often at elevated risk of infection because they are contaminated with dirt and debris. Infection control is essential for burn management, especially because the pathogens that Service members are exposed to are increasingly resistant to antibiotics (read more about wound infection after blast injury here). Skin is an essential organ which, once burned, can no longer perform needed barrier and thermoregulatory functions appropriately. Burns cause a severe inflammatory and hypermetabolic state that can lead to multiple organ failure. Immediate evacuation may not always be possible, meaning burn care has to take place in a prolonged field care environment, which presents challenges unique to the military.

Foundational components of each State-of-the-Science Meeting include a comprehensive background literature review to inform the meeting, panel discussions, presentations by researchers in the field, and working groups chaired by expert panelists that assess the state of the science and make recommendations regarding policy and strategy guidance and future research directions.

During this State-of-the-Science meeting, the expert panel identified critical needs for advanced training of medics, accessible and useable data, and improved communication across the burn treatment community. Meeting proceedings, including key findings and recommendations are available from RAND Corporation. Literature reviews and proceedings from previous State-of-the-Science meetings are available through the meeting links on the left sidebar.

Meeting Objectives

  1. Characterize the epidemiology and relevant outcomes associated with blast-related burn injuries.
  2. Identify the most effective preventive and acute management strategies for blast-related burn injuries.
  3. Examine what is known and important knowledge gaps pertaining to prolonged field care for blast-related burn injuries.
  4. Review the most promising advances and areas of new research into chronic care of blast-related burn injuries (e.g., reconstructive surgery, physical medicine, and rehabilitation).
  5. Prioritize key research and policy gaps related to blast-related burn injuries and identify potential projects and initiatives to address them.

Questions for Discussion

  1. How big is the problem of blast-related burn injury? What research is needed to better characterize the magnitude of this problem?
  2. What skills, capabilities and equipment will be needed for prolonged field care for blast-related burns?
  3. What are the most promising preventive interventions and surgical restoration and reconstruction advances for patients with blast-related burn injuries? What research is needed to understand their effectiveness and limitations? What outcomes should be studied?
  4. What are the most promising rehabilitative innovations for patients with long-term consequences of blast-related burn injuries? What research is needed to understand their effectiveness and limitations? What outcomes are most important to assess?
  5. What are the most important research, technological, and policy opportunities and gaps pertaining to blast-related burn injuries?

Summaries of the Working Group discussions based on these questions are included in the meeting proceedings report published by the RAND Corporation.

Key Recommendations

The Expert Panel synthesized findings from the literature review, meeting presentations, and Working Group discussions into four key recommendations for research to advance prevention, mitigation, and treatment of blast-related burn injuries:

  1. Revisit injury classification and data collection methods to develop agreed-upon definitions for blast-related burn injuries that can be broadly disseminated.
  2. Development of improved training and guidance to support burn injury management in prolonged field care settings.
  3. Strengthen rehabilitation practices to enhance continuity of care and emphasize a return to full function.
  4. Conduct additional research on burn management in theater.
Last modified: 23-Mar-2022