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Savell SC, Howard JT, VanFosson CA, Medellín KL, Staudt AM, Rizzo JA, Maddry JK, Cancio LC. A Retrospective Cohort Study of Burn Casualties Transported by the US Army Burn Flight Team and US Air Force Critical Care Air Transport Teams. Mil Med 2024; 189:813-819. [PMID: 36165680 DOI: 10.1093/milmed/usac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The US Army Burn Center, the only burn center in the Department of Defense provides comprehensive burn care. The Burn Flight Team (BFT) provides specialized burn care during transcontinental evacuation. During Operations Iraqi and Enduring Freedom, burn injuries accounted for approximately 5% of all injuries in military personnel. To augment BFT capacity, US Air Force Critical Care Air Transport Teams (CCATTs) mobilized to transport burn patients. The purpose of this study was to describe critically ill, burn injured patients transported to the US Army Burn Center by BFT or CCATT, to compare and contrast characteristics, evacuation procedures, in-flight treatments, patient injuries/illnesses, and outcomes between the two groups. MATERIALS AND METHODS We conducted a retrospective cohort study of CCATT and BFT patients, admitted to the burn ICU between January 1, 2001 and September 30, 2018. Patients with total body surface area burned (TBSA) >30% were evacuated by BFT, while CCATT evacuated patients with ≤ 30% TBSA. RESULTS Ninety-seven patients met inclusion criteria for this study. Of these, 40 (41%) were transported by the BFT and 57 (59%) were transported by CCATTs. Compared with patients transported by CCATTs, patients transferred by the BFT had higher median TBSA and full-thickness burn size, higher prevalence of chest, back and groin burns, and higher prevalence of inhalation injury. BFT patients had increased hospital days (62 vs. 37; P = .08), ICU days (29 vs. 12; P = .003) and ventilator days (14 vs. 6; P < .001). TBSA was the only variable significantly associated with ARDS (aOR = 1.04; 95% CI: 1.01, 1.08; P = 0.04), renal failure (aOR = 1.07; 95% CI: 1.03, 1.11; P = .002), and mortality (aOR = 1.08; 95% CI: 1.03, 1.13; P = .001). CONCLUSIONS Evacuation by the BFT was associated with increased ICU and ventilator days, increased mortality, and a greater risk for developing renal failure. The severity of injury/TBSA likely accounted for most of these differences.
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Affiliation(s)
- Shelia C Savell
- United States Air Force En route Care Research Center/59th MDW/ST, Fort Sam Houston, TX 78234, USA
| | - Jeff T Howard
- United States Air Force En route Care Research Center/59th MDW/ST, Fort Sam Houston, TX 78234, USA
- Oak Ridge Institute of Science and Education, Oakridge, TN 37830, USA
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Christopher A VanFosson
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
| | - Kimberly L Medellín
- United States Air Force En route Care Research Center/59th MDW/ST, Fort Sam Houston, TX 78234, USA
| | | | - Julie A Rizzo
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
- Uniformed Services University, Bethesda, MD 20814, USA
| | - Joseph K Maddry
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
- Uniformed Services University, Bethesda, MD 20814, USA
- US Army Institute of Surgical Research, Fort Sam Houston, TX, 78234, USA
| | - Leopoldo C Cancio
- Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
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Staudt AM, Savell SC, Biever KA, Trevino JD, Valdez-Delgado KK, Suresh M, Gurney JM, Shackelford SA, Maddry JK, Mann-Salinas EA. En Route Critical Care Transfer From a Role 2 to a Role 3 Medical Treatment Facility in Afghanistan. Crit Care Nurse 2018; 38:e7-e15. [PMID: 29606685 DOI: 10.4037/ccn2018532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND En route care is the transfer of patients requiring combat casualty care within the US military evacuation system. No reports have been published about en route care of patients during transfer from a forward surgical facility (role 2) to a combat support hospital (role 3) for comprehensive care. OBJECTIVE To describe patients transferred from a role 2 to a role 3 US military treatment facility in Afghanistan. METHODS A retrospective review of data from the Joint Trauma System Role 2 Database was conducted. Patient characteristics were described by en route care medical attendants. RESULTS More than one-fourth of patients were intubated at transfer (26.9%), although at transfer fewer than 10% of patients had a base deficit of more than 5 (3.5%), a pH of less than 7.3 (5.2%), an international normalized ratio of more than 2 (0.8%), or temporary abdominal or chest closure (7.4%). The en route care medical attendant was most often a nurse (35.5%), followed by technicians (14.1%) and physicians (10.0%). Most patients (75.3%) were transported by medical evacuation (on rotary-wing aircraft). CONCLUSION This is the first comprehensive review of patients transported from a forward surgical facility to a more robust combat support hospital in Afghanistan. Understanding the epidemiology of these patients will inform provider training and the appropriate skill mix for the transfer of postsurgical patients within a combat setting.
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Affiliation(s)
- Amanda M Staudt
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Shelia C Savell
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Kimberly A Biever
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Jennifer D Trevino
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Krystal K Valdez-Delgado
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Mithun Suresh
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Jennifer M Gurney
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Stacy A Shackelford
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Joseph K Maddry
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas.,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas.,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky.,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas.,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas.,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas
| | - Elizabeth A Mann-Salinas
- Amanda M. Staudt serves as an epidemiologist, Jennifer D. Trevino is a program manager, Krystal K. Valdez-Delgado is a research nurse coordinator, and COL Elizabeth A. Mann-Salinas is the Task Area Manager for the Systems of Care for Complex Patients Task Area at the US Army Institute of Surgical Research in San Antonio, Texas. .,Shelia C. Savell serves as the Senior Scientist for the USAF En Route Care Research Center at the 59th MDW/ST, Chief Scientists Office in San Antonio, Texas. .,COL Kimberly A. Biever is a critical care clinical nurse specialist and serves as a consultant to the Surgeon General for En Route Critical Care Nursing, Human Resources Command, Fort Knox, Kentucky. .,Mithun Suresh is a physician working in the Epidemiology/Biostatistics Division of the Research Directorate at the US Army Institute of Surgical Research in San Antonio, Texas. .,COL Jennifer M. Gurney serves as the Chief of Trauma Systems Development and Col Stacy A. Shackelford serves as the Chief of Education and Performance Improvement for the Joint Trauma System in San Antonio, Texas. .,Maj Joseph K. Maddry serves as the Director for the USAF En Route Care Research Center at the 59th MDW/ST and is Director of the Clinical Resuscitation, Emergency Sciences, and Toxicology Research Program, Chief Scientists Office in San Antonio, Texas.
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Bradley M, Nealeigh M, Oh JS, Rothberg P, Elster EA, Rich NM. Combat casualty care and lessons learned from the past 100 years of war. Curr Probl Surg 2017; 54:315-351. [PMID: 28595716 DOI: 10.1067/j.cpsurg.2017.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Matthew Bradley
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Matthew Nealeigh
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - John S Oh
- Division of Global Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Philip Rothberg
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Norman M Rich
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Division of Global Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
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