Aeromedical crew is the vital link for saving burn patients
Stars and Stripes August 2, 2009
The badly burned patient had already died and been brought back to life by a shot of adrenalin and CPR before he was carried by stretcher onto a C-17 medical evacuation flight from Balad, Iraq, to Ramstein, Germany, last month.
His face, smothered in lotion, was the only part of him visible under a clutter of bandages, plastic tubes, wires and electronic monitors displaying his vital signs.
For the next five hours, a skilled team of medical personnel would work tirelessly to keep him alive.
Burns are relatively rare among personnel serving in Iraq these days, but in eight years of war in Iraq and Afghanistan, the U.S. military’s primary burn center at Brooke Army Medical Center in San Antonio has treated more than 800 patients from downrange, including about 120 with severe burns.
On this day, the 23-year-old patient on the flight out of Iraq — a civilian whose identity was withheld due to military privacy rules — suffered his burns in a helicopter crash.
Keeping a severely burned patient alive is a complex process that involves administering an array of medications and fluids at levels that need to be constantly altered to take into account the patient’s changing condition.
As the transport plane taxied down the runway, the patient breathed heavily through a ventilator. The emergency physician watching over him was U.S. Air Force Capt. Dan Brown, a 33-year-old from Vacaville, Calif., who leads one of three Critical Care Aeromedical Transport Teams that escort critically wounded patients on flights out of Iraq.
The man whose life was in Brown’s hands had burns covering 70 percent of his body. In such cases, even with the best medical care, victims have only a 10 percent chance of survival, Brown said, as he checked vital signs.
Despite their patient’s grave condition, the critical care team members maintained a positive attitude, smiling and bantering as they performed their duties.
“When you are just sitting there and watching them it’s hard, knowing how injured they are,” Brown said.
“Sometimes that can affect you. ... Emergency physicians and nurses get so used to doing their jobs and trying to save the patient. You don’t have time to think about what is happening with them or their family.”
The military has at least one general surgeon sub-specialized in burn care in Iraq and Afghanistan at any one time. That person provides initial treatment to serious burn victims that includes washing and bandaging burns, isolating the patients to prevent infection and keeping them warm, since their skin is no longer regulating temperature, Brown said.
Surgeons may place incisions in burn victims’ skin, which loses its elasticity, to stop it cutting blood flow to their arms and legs or restricting their breathing as injured tissue swells, he said.
The cream that covered the burned aviator’s face is called sulfamylon — an antiseptic invented by the Army to replace the natural barrier lost when skin is burned, Brown said.
The cream prevents infection, hydrates remaining skin and stops heat loss.
The team also used a portable laboratory to test the patient’s blood each hour for a variety of factors and adjusted his medication and fluid intake accordingly.
Working alongside Brown, critical care nurse Lt. Col. Belinda Warren, 45, tucked a blanket around the patient and inserted some of the plastic tubes in pumps taking vital fluids to his body.
“You have to make sure they (burn victims) don’t get cold, replace all the fluid that they are leaking out while they are oozing from the burn and make sure they don’t go into hypothermia or get their (blood) clotting factors out of whack,” she said.
The Air Force Reserve officer, who works as a civilian intensive care nurse in Sugar Hill, Ga., said her goal was to make the patient comfortable and ensure that he wasn’t aware of what was happening.
As Warren worked, the patient’s heart rate monitor hit 150 beats a minute — a rate that kept steady for the entire five-hour flight.
“He had just had a big burn. His body was in shock,” Warren said of her patient’s heart rate. “His heart was trying to circulate more blood. People can’t maintain it for a long time, but he was a young guy, and if he was an athlete, he could go longer,” she said.
Muscle damage caused by severe burns also can result in damage to kidneys and heart arrhythmias. To stop that happening during the flight, the medics monitored pumps that moved fluids into the patient to push out the proteins released by muscle damage and administered calcium, insulin, sugar and bicarbonate along with painkillers.
The patient was also suffering from inhalational burn injuries. A respiratory therapist, Tech. Sgt. Larry Combs, kept a close watch on the ventilator.
The treatment that the patient got on the aircraft is normally done in a hospital burn center for patients with burns covering more than 20 percent of their body or in critical areas such as hands, feet or face, Brown said. That’s why personnel who receive serious burns downrange are evacuated as quickly as possible, he said. Infection is the biggest risk.
At Landstuhl, severe burn patients can expect to return to the operating room for more washout of wounds before they are flown to the U.S. for prolonged care.
In an e-mail from Iraq in late July, Brown said this patient “has about a 20 percent chance of surviving,” which is higher than the usual odds.
Brown was back in Germany on Saturday and followed up on the patient’s status. He was told that the patient is doing better than expected, given the severe injuries he has.