Wartime burn care in Iraq: 28th Combat Support Hospital, 2003

INTRODUCTION: The U.S. Army 28th Combat Support Hospital (CSH), an echelon III facility, deployed to Iraq at the start of military operations in 2003. Shortly after arrival, it was designated as the hospital primarily responsible for burn care for the U.S. military in Iraq. This report reviews the experience of the CSH with burn care during combat operations. METHODS: An after-action review was conducted during a 2-day period after the hospital's redeployment. RESULTS: Between April 11, 2003, and August 21, 2003, the 28th CSH treated a total of 7,920 patients, of whom 103 (1.3%) had burns. Patients included U.S. and allied service members, U.S. contractors, and Iraqi prisoners of war and civilians. Although a CSH is designed to care for patients until they can be stabilized and evacuated, usually within 1 to 3 days, the length of stay for some Iraqi patients was as long as 53 days. Definitive care, including excision and grafting of the burn wound, was thus required for some Iraqi patients. The largest graft completed comprised 40% of the total body surface area. The largest burn survived involved approximately 65% of the total body surface area. Eighteen (17%) of 103 patients returned to duty after treatment at the 28th CSH. The mortality rate for burn patients at the 28th CSH was 8%. Shortages of burn-experienced personnel and burn-specific supplies were identified during the after-action review. CONCLUSIONS: The CSH provided complex definitive care to burn patients in an austere environment. Predeployment identification of military field hospitals for such specialized missions, with early assignment of experienced personnel and materiel to these units, may improve future wartime burn care.