From Baghdad to Boston

Abstract

A large portion of the casualties admitted to military hospitals on the battlefield in Iraq consists of children, of whom 13% had burns. The U.S. Army Combat Support Hospital (CSH) in Baghdad, faced with an influx of such patients, successfully transferred selected burned children by commercial airlines to the Shriners Hospital for Children in Boston, Massachusetts (SHC-B). The authors aimed to document this process, from both an ethical and a procedural standpoint. Care was conducted in six phases: (1) admission to the CSH; (2) selection for transfer; (3) burn care at the CSH; (4) travel to the United States; (5) burn care at the SHC-B; (6) return to Iraq. Transfer and SHC-B care were funded by charitable organizations. A review of patient records was performed. Eight acutely burned pediatric patients participated in this program. All were successfully transferred, treated at SHC-B, and returned to Iraq. They ranged in age from 1.7 to 17 years and in burn size from 6 to 53% of the TBSA. At SHC-B, the hospital length of stay was 14 to 132 days; up to 23 visits to the operating room were performed for acute and reconstructive burn surgery. The cost of war includes the care of injured civilians, and includes burned children. For selected patients, transfer out of the combat zone is one method of fulfilling this obligation.

Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti

“…For pediatric patients with burns of larger than 40 %, in the short-term, alternative options might be considered, including potentially referring patients with large burns for treatment outside of Haiti. Along these lines, 8 Iraqi children admitted initially to military hospitals with large burns were managed in the United States with very good outcomes [14]. Such a strategy might be one reasonable ''bridging'' approach until challenges to optimized care for very large burns can be overcome locally in Haiti.…”