537 Burned at Sea: Transport and Critical Care of Two Sailors Injured on the Pacific Ocean

TL;DR

This paper describes the complex care and transport of two sailors with severe burns sustained at sea, highlighting the challenges and resources required for their recovery.

Contribution

The paper provides a detailed case study of burn care coordination during a peacetime maritime incident, offering insights for future combat scenarios at sea.

Findings

Two sailors with 86% and 70% TBSA burns required 11 days of transport and 101 days of hospital care.

They underwent 14 major surgeries on average and received extensive rehabilitation.

Multinational naval coordination was essential for rescue and evacuation.

Abstract

Burns have constituted 5-10% of combat casualties from recent conflicts and are projected to become even more common during future war at sea. Advances in critical care and surgery have improved postburn mortality. Nevertheless, survivors of such massive injuries require immense efforts by an interprofessional team from point of injury through the restoration of long-term function and quality of life. Here, we documented the challenges and resources required for 2 sailors who were severely burned at sea on the Pacific Ocean and who received definitive multidisciplinary care at an American Burn Association-verified Burn Center.

In July 2022, 2 sailors from a coalition nation sustained life-threatening burns during a boiler-room fire aboard a ship at sea during the RIMPAC multinational exercise on the Pacific Ocean. Multiple naval assets including the US Coast Guard, the French Navy, and the US Navy collaborated to rescue and evacuate these patients. A Burn Flight Team transported the casualties aboard US Air Force aircraft to an American Burn Association-verified Burn Center in the United States. Both sailors returned to their home country approximately 5.5 months postburn. Unless otherwise stated, data are presented as means.

Patient 1 was 27 years old with an 86% TBSA burn; patient 2 was 29 years old with a 70% burn. Both sustained concomitant inhalation injury. Transfer from point of injury to definitive care took 11 days with 7 handoffs. Mean hospital length of stay (LOS) was 101 days, ICU LOS 50 days, and ventilator days 10.5. They underwent an average of 14 major surgical operations and were transfused 78 units of blood products. They received an average of 4.4 hours of direct rehabilitation per day during inpatient hospitalization, and as outpatients, they received an average of 63 rehabilitation treatment sessions.

The care of these 2 severely burned sailors required the coordination of naval assets from multiple countries and lengthy resource-intense definitive care at the Burn Center. These efforts took place during peacetime and were not complicated by a combat environment to include communication and air transport challenges.

Future peer and near-peer combat operations, to include war at sea, are expected to generate greater numbers of burn casualties than were seen during recent conflicts. Properly forecasting and preparing for the substantial needs of those future casualties is an essential component of readiness.