Burns Associated with Wars and Disasters

  • Leopoldo C. Cancio
  • Jonathan B. Lundy


Military operations and civilian mass casualty fire disasters provide an ultimate test of the ability of individuals, hospitals, and health care systems to respond to large numbers of critically injured burn patients. Armed conflict in the modern era has featured thermal injury in 5–20% of casualties. In recent conflicts, improvised explosive devices have become the predominant mechanism of injury for combat casualties. Mishaps involving fuels or explosives are a common cause of accidental injury on the battlefield. Civilian mass casualty disasters commonly feature 25–50 casualties each, but on occasion have produced many more. The era of large-scale terrorist attacks has now blurred the lines between military conflict and civilian mass casualty events. Recognizing that burn expertise is a scarce resource and that burn care is manpower- and resource-intensive, successful management of both types of events requires commitment, planning, and practice.


Military personnel Disasters Burns Fire Iraq war Afghanistan 


  1. 1.
    Cancio LC, Horvath EE, Barillo DJ, Kopchinski BJ, Charter KR, Montalvo AE, et al. Burn support for Operation Iraqi Freedom and related operations, 2003 to 2004. J Burn Care Rehabil. 2005;26(2):151–61.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Champion HR, Bellamy RF, Roberts CP, Leppaniemi A. A profile of combat injury. J Trauma. 2003;54(5 Suppl):S13–9.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Kauvar DS, Wolf SE, Wade CE, Cancio LC, Renz EM, Holcomb JB. Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/OEF explosion burns). Burns. 2006;32(7):853–7.CrossRefGoogle Scholar
  4. 4.
    Kauvar DS, Cancio LC, Wolf SE, Wade CE, Holcomb JB. Comparison of combat and non-combat burns from ongoing U.S. military operations. J Surg Res. 2006;132(2):195–200.CrossRefGoogle Scholar
  5. 5.
    Barillo DJ, Wolf S. Planning for burn disasters: lessons learned from one hundred years of history. J Burn Care Res. 2006;27(5):622–34.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Allen BD, Whitson TC, Henjyoji EY. Treatment of 1,963 burned patients at 106th general hospital, Yokohama, Japan. J Trauma. 1970;10(5):386–92.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Eldad A, Torem M. Burns in the Lebanon War 1982: “the blow and the cure”. Mil Med. 1990;155(3):130–2.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Voisine JJ, Albano JP. Reduction and mitigation of thermal injuries; what can be done (Report No. USAARL-96-03.). Fort Rucker, AL: U.S. Army Aeromedical Research Laboratory; 1996.Google Scholar
  9. 9.
    Chung KK, Blackbourne LH, Wolf SE, White CE, Renz EM, Cancio LC, et al. Evolution of burn resuscitation in Operation Iraqi freedom. J Burn Care Res. 2006;27(5):606–11.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Ennis JL, Chung KK, Renz EM, Barillo DJ, Albrecht MC, Jones JA, et al. Joint Theater Trauma System implementation of burn resuscitation guidelines improves outcomes in severely burned military casualties. J Trauma. 2008;64(2 Suppl):S146–51.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Markell KW, Renz EM, White CE, Albrecht ME, Blackbourne LH, Park MS, et al. Abdominal complications after severe burns. J Am Coll Surg. 2009;208(5):940–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Alvarado R, Chung KK, Cancio LC, Wolf SE. Burn resuscitation. Burns. 2009;35(1):4–14.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Barillo DJ, Cancio LC, Hutton BG, Mittelsteadt PJ, Gueller GE, Holcomb JB. Combat burn life support: a military burn-education program. J Burn Care Rehabil. 2005;26(2):162–5.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Anonymous. Joint Trauma System Clinical Practice Guideline (CPG). Burn Care (CPG ID: 12). 11 May 2016. (CPGs)/Burn_Care_11_May_2016_ID12.pdf. Accessed 30 Mar 2018.
  15. 15.
    Chung KK, Salinas J, Renz EM, Alvarado RA, King BT, Barillo DJ, et al. Simple derivation of the initial fluid rate for the resuscitation of severely burned adult combat casualties: in silico validation of the rule of 10. J Trauma. 2010;69(Suppl 1):S49–54.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    D’Avignon LC, Chung KK, Saffle JR, Renz EM, Cancio LC, et al. Prevention of infections associated with combat-related burn injuries. J Trauma. 2011;71(2 Suppl 2):S282–9.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Anonymous. Annual research progress reports. Fort Sam Houston, TX: U.S. Army Institute of Surgical Research. p. 1967–72.Google Scholar
  18. 18.
    Grissom TE, Farmer JC. The provision of sophisticated critical care beyond the hospital: lessons from physiology and military experiences that apply to civil disaster medical response. Crit Care Med. 2005;33(1):S13–21.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Renz EM, Cancio LC, Barillo DJ, White CE, Albrecht MC, Thompson CK, et al. Long range transport of war-related burn casualties. J Trauma. 2008;64(2 Suppl):S136–44.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Kirksey TD, Dowling JA, Pruitt BA Jr, Moncrief JA. Safe, expeditious transport of the seriously burned patient. Arch Surg. 1968;96(5):790–4.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Chapman TT, Richard RL, Hedman TL, Chisholm GB, Quick CD, Baer DG, et al. Military return to duty and civilian return to work factors following burns with focus on the hand and literature review. J Burn Care Res. 2008;29(5):756–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Wolf SE, Kauvar DS, Wade CE, Cancio LC, Renz EP, Horvath EE, et al. Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom. Ann Surg. 2006;243(6):786–92.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Chapman TT, Richard RL, Hedman TL, Renz EM, Wolf SE, Holcomb JB. Combat casualty hand burns: evaluating impairment and disability during recovery. J Hand Ther. 2008;21(2):150–8.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Anonymous. IV Geneva convention relative to the protection of civilian persons in time of war of 12 August 1949. Accessed 11 Mar 2018.
  25. 25.
    Anonymous. Employment of the Combat Support Hospital: tactics, techniques, and procedures (Field Manual 8-10-14). Washinton, DC: Headquarters, Department of the Army; 1994.Google Scholar
  26. 26.
    Levy BS, Sidel VW. Adverse health consequences of the Iraq War. Lancet. 2013;381(9870):949–58.PubMedCrossRefGoogle Scholar
  27. 27.
    Schmidt PM, Sheridan RL, Moore CL, Scuba SC, King BT, Morrissey PM, et al. From Baghdad to Boston: international transfer of burned children in time of war. J Burn Care Res. 2014;35(5):369–73.PubMedCrossRefGoogle Scholar
  28. 28.
    Smith D. Dennis Smith’s history of firefighting in America: 300 years of courage. New York: Dial Press; 1978.Google Scholar
  29. 29.
    Goodman EC. Fire! The 100 most devastating fires through the ages and the heroes who fought them. New York: Black Dog & Leventhal; 2001.Google Scholar
  30. 30.
    Follett GP. The Boston fire: a challenge to our disaster service. Am J Nurs. 1943;43:4–8.Google Scholar
  31. 31.
    Cancio LC, Pruitt BA Jr. Management of mass casualty burn disasters. Int J Disaster Med. 2004;2:114–29.CrossRefGoogle Scholar
  32. 32.
    Cowan D. Great Chicago fires: historic blazes that shaped a city. Chicago: Lake Claremont Press; 2001.Google Scholar
  33. 33.
    Moulton RS. Cocoanut grove night club fire. Boston: National Fire Protection Association. Accessed 11 Jan 1943.Google Scholar
  34. 34.
    Anonymous. Fire investigations: nursing home fire, Norfolk, VA, October 5, 1989. Quincy, MA: National Fire Protection Association; 1990.Google Scholar
  35. 35.
    Klem TJ. 25 die in food plant fire. NFPA J. 1992;86:29–35.Google Scholar
  36. 36.
    Finland M, Davidson CS, Levenson SM. Clinical and therapeutic aspects of the conflagration injuries in the respiratory tract sustained by victims of the Cocoanut Grove disaster. Med Health. 1946;25:215–83.Google Scholar
  37. 37.
    Schorow S. The Cocoanut Grove fire. Beverly, MA: Commonwealth Editions; 2005.Google Scholar
  38. 38.
    Kimball WY. Hartford city holocaust. NFPA Q; 1944. p. 9–21.Google Scholar
  39. 39.
    O’Nan S. The circus fire: a true story of an American tragedy. New York: Anchor; 2008.Google Scholar
  40. 40.
    Harrington DT, Biffl WL, Cioffi WG. The station nightclub fire. J Burn Care Rehabil. 2005;26(2):141–3.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Mackie DP, Koning HM. Fate of mass burn casualties: implications for disaster planning. Burns. 1990;16:203–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Gill JR, Goldfeder LB, Stajic M. The Happy Land homicides: 87 deaths due to smoke inhalation. J Forens Sci. 2003;48(1):1–3.CrossRefGoogle Scholar
  43. 43.
    Arturson G. Analysis of severe fire disasters. In: Masselis M, Gunn SWA, editors. The management of mass burn casualties and fire disasters: proceedings of the first international conference on burns and fire disasters. Dordrecht: Kluwer Academic; 1992. p. 24–33.CrossRefGoogle Scholar
  44. 44.
    Simon R, Teperman S. The World Trade Center attack: lessons for disaster management. Crit Care. 2001;5:318–20.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Asaeda F. The day that the START triage system came to a stop: observations from the World Trade Center disaster. Acad Emerg Med. 2002;9:255–6.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Bradt DA. Site management of health issues in the 2001 World Trade Center disaster. Acad Emerg Med. 2003;10:650–60.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Anonymous. Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center—New York City, September 2001. Morb Mortal Wkly Rep. 2002;51(1):1–5.Google Scholar
  48. 48.
    Anonymous. Centers for Disease Control and Prevention. Deaths in World Trade Center terrorist attacks—New York City, 2001. Morb Mortal Wkly Rep. 2002;51:16–8.Google Scholar
  49. 49.
    Yurt RW, Bessey PQ, Bauer GJ, Dembicki R, Laznick H, Alden N, et al. A regional burn center’s response to a disaster: September 11, 2001, and the days beyond. J Burn Care Rehabil. 2005;26(2):117–24.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Arturson G. The tragedy of San Juanico—the most severe LPG disaster in history. Burns. 1987;13:87–102.CrossRefGoogle Scholar
  51. 51.
    Arturson G. The Los Alfaques disaster: a boiling-liquid, expanding-vapour explosion. Burns. 1981;7(4):233–51.CrossRefGoogle Scholar
  52. 52.
    Ishida T, Ohta M, Sugimoto T. The breakdown of an emergency system following a gas explosion in Osaka and the subsequent resolution of problems. J Emerg Med. 1985;2(3):183–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Buerk CA, Batdorf JW, Cammack KV, Ravenholt O. The MGM Grand Hotel fire: lessons learned from a major disaster. Arch Surg. 1982;117(5):641–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Sharpe DT. Management of burns in major disasters. NATNEWS. 1989;26(12):9–10.PubMedGoogle Scholar
  55. 55.
    Pruitt BAJ. Aeromedical transport and field care of burn patients in disaster situations. In: Haberal MA, Bilgin N, editors. Burn and fire disaster in the middle east. Ankara: Haberal Education and Research Foundation; 2001. p. 221–43.Google Scholar
  56. 56.
    Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002;53(2):201–12.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Osler T, Glance LG, Hosmer DW. Simplified estimates of the probability of death after burn injuries: extending and updating the Baux score. J Trauma Acute Care Surg. 2010;68(3):690–7.CrossRefGoogle Scholar
  58. 58.
    Pruitt BA Jr, Wolf SE, Mason AD Jr. Epidemiological, demographic, and outcome characteristics of burn injury. In: Herndon DN, editor. Total burn care. Philadelphia: Elsevier; 2007. p. 14–32.CrossRefGoogle Scholar
  59. 59.
    Baux S. Contribution à l'étude du traitement local des brûlures thermiques étendues. Paris: AGEMP (Université de Paris [1896-1968]. Faculté de Médecine); 1961.Google Scholar
  60. 60.
    Bowen TE, Bellamy RF. Emergency war surgery: Second United States revision of the emergency war surgery NATO handbook. Washington, DC: U.S. Government Printing Office; 1988.Google Scholar
  61. 61.
    Anonymous. ABA Board of Trustees; Committee on Organization and Delivery of Burn Care. Disaster management and the ABA Plan. J Burn Care Rehabil. 2005;26(2):102–6.CrossRefGoogle Scholar
  62. 62.
    Hammond JS, Ward CG. Transfers from emergency room to burn center: errors in burn size estimate. J Trauma. 1987;27:1161–5.CrossRefGoogle Scholar
  63. 63.
    Briggs SM, Brinsfield KH. Advanced disaster medical response: manual for providers. Woodbury, CT: Cine-Med; 2014.Google Scholar
  64. 64.
    Mozingo DW, Barillo DJ, Holcomb JB. The Pope Air Force Base aircraft crash and burn disaster. J Burn Care Rehabil. 2005;26(2):132–40.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Cushman JG, Pachter HL, Beaton HL. Two New York City hospitals’ surgical response to the September 11, 2001, terrorist attack in New York City. J Trauma. 2003;54(1):147–54.PubMedCrossRefGoogle Scholar
  66. 66.
    Sheridan R, Barillo D, Herndon D, Solem L, Mohr W, Kadilack P, et al. Burn specialty teams. J Burn Care Rehabil. 2005;26(2):170–3.PubMedCrossRefGoogle Scholar
  67. 67.
    Kuijper EC. The 2003 Everett Idris Evans memorial lecture: every cloud has a silver lining. J Burn Care Rehabil. 2004;25(1):45–53.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Becker WK, Waymack JP, McManus AT, Shaikhutdinov M, Pruitt BA Jr. Bashkirian train-gas pipeline disaster: the American military response. Burns. 1990;16(5):325–8.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Benmeir P, Levine I, Shostak A, Oz V, Shemer J, Sokolova T. The Ural train-gas pipeline catastrophe: the report of the IDF medical corps assistance. Burns. 1991;17(4):320–2.PubMedCrossRefGoogle Scholar
  70. 70.
    Remensnyder JP, Ackroyd FP, Astrozjnikova S, Budkevitch LG, Buletova AA, Creedon CM, et al. Burned children from the Bashkir train-gas pipeline disaster. I. Acute management at Children’s Hospital 9, Moscow. Burns. 1990;16(5):329–32.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Abolghasemi H, Radfar MH, Khatami M, Nia MS, Amid A, Briggs SM. International medical response to a natural disaster: lessons learned from the Bam earthquake experience. Prehosp Disaster Med. 2006;21(3):141–7.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Barillo DJ, Jordan MH, Jocz RJ, Nye D, Cancio LC, Holcomb JB. Tracking the daily availability of burn beds for national emergencies. J Burn Care Rehabil. 2005;26(2):174–82.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Iyer N, Barrera-Oro J, Turley D, Simon D, Selivanova O, Larsen J, et al. Next-generation burn care products and strategies draw on innovative ideas. Washington, DC: Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services; 2017. Accessed 18 Mar 2018.Google Scholar
  74. 74.
    Cairns BA, Stiffler A, Price F, Peck MD, Meyer AA. Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion. J Burn Care Rehabil. 2005;26(2):144–50.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Barillo DJ, Dimick AR, Cairns BA, Hardin WD, Acker JE III, Peck MD. The Southern Region burn disaster plan. J Burn Care Res. 2006;27(5):589–95.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Leahy NE, Yurt RW, Lazar EJ, Villacara AA, Rabbitts AC, Berger L, et al. Burn disaster response planning in New York City: updated recommendations for best practices. J Burn Care Res. 2012;33(5):587–94.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Anonymous. Mass burn event overview. Office of the Assistant Secretary for Preparedness and Response (ASPR); Technical Resources, Assistance Center, and Information Exchange (TRACIE), US Department of Health and Human Services. 21 Feb 2016. Accessed 19 Mar 2018.
  78. 78.
    Anonymous. Emergency Support Function #8—Public Health and Medical Services Annex. Jan 2008. Accessed 19 Mar 2018.
  79. 79.
    Anonymous. Trauma and Critical Care Teams. Office of the Assistant Secretary of Preparedness and Response, U.S. Department of Health and Human Services. 9 Sept 2017. Accessed 19 Mar 2018.
  80. 80.
    Anonymous. Department of Defense Directive 3025.18. Defense Support of Civil Authorities (DSCA). 29 Dec 2010. Accessed 19 Mar 2018.
  81. 81.
    Davis LE. Hurricane Katrina: lessons for army planning and operations. Santa Monica, CA: Rand Corporation; 2007.Google Scholar
  82. 82.
    Marvin DS. Bringing Comfort to New York City. 10 Sept 2016. Accessed 20 Mar 2018.
  83. 83.
    Sturkol ST. History shows strong response on 9-11 by AMC people. Air Mobility Command Public Affairs. 11 Sept 2009. Accessed 21 Mar 2018.
  84. 84.
    Moore CJ. Army Nurses and Healthcare after Hurricane Katrina. Army Nurse Corps Association. Accessed 20 Mar 2018.
  85. 85.
    Barillo DJ, Cancio LC, Stack RS, Carr SR, Broger KP, Crews DM, et al. Deployment and operation of a transportable burn intensive care unit in response to a burn multiple casualty incident. Am J Disaster Med. 2010;5(1):5–13.PubMedCrossRefGoogle Scholar
  86. 86.
    Underhill FP. The significance of anhydremia in extensive superficial burns. JAMA. 1930;95:852–7.CrossRefGoogle Scholar
  87. 87.
    Mayhew ER. The reconstruction of warriors: Archibald McIndoe, the Royal Air Force and the Guinea Pig Club. London: Greenhill Books; 2004.Google Scholar
  88. 88.
    Lockwood JS. War-time activities of the National Research Council and the Committee on Medical Research; with particular reference to team-work on studies of wounds and burns. Ann Surg. 1946;124:314–27.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Cope O, Moore FD. The redistribution of body water and the fluid therapy of the burned patient. Ann Surg. 1947;126:1010–45.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Saffle JR. The 1942 fire at Boston’s Cocoanut Grove nightclub. Am J Surg. 1993;166(6):581–91.CrossRefGoogle Scholar
  91. 91.
    Artz CP. Burns in my lifetime. J Trauma. 1969;9(10):827–33.CrossRefGoogle Scholar
  92. 92.
    Moreau AR, Westfall PH, Cancio LC, Mason AD Jr. Development and validation of an age-risk score for mortality predication after thermal injury. J Trauma. 2005;58(5):967–72.PubMedCrossRefGoogle Scholar
  93. 93.
    Pruitt BA Jr, O’Neill JA Jr, Moncrief JA, Lindberg RB. Successful control of burn-wound sepsis. JAMA. 1968;203(12):1054–6.CrossRefGoogle Scholar
  94. 94.
    Wilmore DW, Curreri PW, Spitzer KW, Spitzer ME, Pruitt BA Jr. Supranormal dietary intake in thermally injured hypermetabolic patients. Surg Gynecol Obstet. 1971;132(5):881–6.Google Scholar
  95. 95.
    Shirani KZ, Becker WK, Rue LW, Mason AD Jr, Pruitt BA Jr. Burn care during Operation Desert Storm. J US Army Med Dept. 1992;PB 8-92-1/2:37–9.Google Scholar
  96. 96.
    Salinas J, Chung KK, Mann EA, Cancio LC, Kramer GC, Serio-Melvin ML, et al. Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med. 2011;39(9):2031–8.CrossRefGoogle Scholar
  97. 97.
    Chung KK, Lundy JB, Matson JR, Renz EM, White CE, King BT, et al. Continuous venovenous hemofiltration in severely burned patients with acute kidney injury: a cohort study. Crit Care. 2009;13(3):R62.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Allan PF, Osborn EC, Bloom BB, Wanek S, Cannon JW. The introduction of extracorporeal membrane oxygenation to aeromedical evacuation. Mil Med. 2011;176(8):932–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Leopoldo C. Cancio
    • 1
  • Jonathan B. Lundy
    • 2
  1. 1.U.S. Army Institute of Surgical ResearchFort Sam HoustonUSA
  2. 2.LTC, MC, U.S. ArmyCarl R. Darnall Army Medical CenterFort HoodUSA

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