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07/04/2016

Brûlés: Moins grave qu'imaginé mais toujours spécifique

One year of burns at a Role 3 Medical Treatment Facility in Afghanistan

Jeevaratnam JA et Al. J R Army Med Corps. 2014 Mar;160(1):22-6

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L'expérience UK afghane confirme dans ce type de conflits la particularité des brûlures de guerre: Finalement peu fréquentes souvent isolées (72%), relativement peu étendues portant sur la face, associée à des brûlures respiratoires/inhalation de fumées (13%) et associés à d'autres lésions traumatiques (27%)  qui peuvent être  au premier plan. 6% sont intubés. Il n'en demeure pas moins que la chaîne de prise en charge se doit d'être spécifique avec le respect de délai de prise en charge en particulier du fait des techniques d'excision-greffe nécessaire et des besoins transfusionnels souvent importants.

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OBJECTIVES:
Historically, burns have formed a significant proportion of the casualties of war. The management of burns in recent conflict has been found to be a resource-heavy undertaking, though its impact on both personnel and resources in current conflicts is unclear. A case analysis has been carried out in order to quantify the logistical impact of the management of burns on Role 3 Medical Treatment Facility (MTF) infrastructure and to examine if and how the cause and management of burns have evolved in early 21st century conflict.

METHODS:
All casualties treated for burns at a Role 3 MTF over one calendar year were identified and scanned copies of their notes obtained from the UK Joint Theatre Trauma Registry and retrospectively analysed.

RESULTS:
88 of the 1461 (6.0%) trauma patients presenting to the Role 3 MTF over the year were treated for burns of whom 52.3% were combat troops and 45.4% civilians. Half of the burns were caused by non-conflict related mechanisms; the two commonest mechanisms were flame burns in 38/88 mostly non-conflict related cases and blast in 30/88 cases most of which were conflict related.

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CONCLUSIONS:
The management of burns at war is a complex process. It is further confounded by the management of civilians with non-conflict related burns, which places a predictable strain on Role 3 MTF resources: theatre time, nursing time, dressing resources and bed space. This must be planned for in current and future deployed operations.

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