The US Army burn center: professional service during 10 years of war.

S ince 1952, the US Army Institute of Surgical Research (USAISR) Burn Center has provided comprehensive care for patients who have sustained severe thermal trauma, inhalation injury, and other diseases related to burn trauma. The Army Burn Center serves the entire population encompassed by the military health care system as well as veterans and civilian emergency patients requiring burn center care within the 26,000-sq mi trauma service area surrounding San Antonio, Texas. US military engagement following the events of 9/11 markedly changed the number and type of patients with burn injury treated at our center and the system used to care for them. We report our experience and summarize the most noteworthy changes in practice implemented during these 10 years of war. As the number of patients admitted to our center rose during the decade of combat operations, the mix of military versus civilian patients varied considerably (Fig. 1). The first military casualty from overseas contingency operations, initially referred to as the Global War on Terrorism, arrived at our burn center in March 2003; between the start of Operation Enduring Freedom in October 2001 and March 2003, there were no combat-related injuries warranting burn center care (Table 1). The mechanism of thermal injury among those evacuated from Iraq and Afghanistan was predominantly from fire and flame injury related to effects of explosives; however, other noncombat-related injuries predominated during the early part of the engagement. Explosions represent the single largest mechanism of injury for combat-related burn casualties (Fig. 2).