Burns in the British Middle East Forces, WWII Tactical and Technical Trends, No. 14, December 17, 1942 (Lone Sentry)

a. Causes of Burns

A report has been received which is an interesting analysis of the causes and treatment of burns in British Middle East forces. Significant is the observation that the greater number of burns are of accidental cause and could be prevented. The ratio of accidental burns to battle-casualty burns in Middle East forces is 2.3 to 1. During a period of 2 months when there was little fighting on the desert, 250 cases of burns were treated at a general hospital at Tobruk among troops of the British Eighth Army. In a series of 83 fatal cases, 15 were burned during land fighting, 15 during the bombing of ships, and 13 as a result of airplane crashes, and 40 of the fatal cases were accidentally burned - 48 percent of the total.

The cause of accidental burns is almost always ignited gasoline, and most frequently accidents occur from using the "desert stove, ' an improvised gasoline fire in which the fuel is mixed with sand in a can. When the fire burns low, more gasoline is poured on the stove with disastrous results. In bright sunlight it may be difficult to see whether the fire is still burning. In other cases, clothes become soaked with gasoline (it is common to use gasoline in washing clothes), a match is struck, and the clothing is ignited.

Accidental burns are often extensive and dangerous to life. A burn which is extensive, and also in parts deep, is a very serious injury and its treatment is one of the most difficult surgical problems in the Middle East.

Battle-casualty burns are a common form of battle injury. During recent fighting, burns constituted 27 percent of wounds in personnel admitted to hospitals. In tanks, the majority of such injuries are flash burns, caused by exploding ammunition. Ordinary clothing, even light khaki, gives a high degree of protection against flash burns. Study is at present being made to determine the suitability of special protective clothing for tank crews.

b. Treatment

The treatment of burns is a controversial subject, and many of the opinions expressed in this report as regards treatment will not meet with universal approval. The treatment administered depends greatly on the circumstances. Where facilities are available and time permits, "full" treatment is given: the wound is cleansed and prepared for the local application thought most suitable. This is carried out as a rule under general anaesthesia and may be preceded, accompanied, or followed by resuscitation treatment for shock. There are three main methods of local treatment: coagulation, dyes, and non-coagulation.

(1) Coagulants

The experience in the use of coagulants (tannic acid, and tannic acid--silver nitrate) in Middle East forces has not been too satisfactory because: (a) in superficial burns the surface is said to be dry and less pliable than when greasy substances are used; (b) in deep burns the coagulant remains adherent for long periods and delays the opportunity for skin grafting; and (c) in extensive burns, sepsis is a common sequel. Also, the relationship of the absorption of tannates to toxemia and liver damage when tannic acid is used in the coagulation treatment of burns is still a disputed question.

(2) Dyes

Observations in the use of dyes (gentian violet, brillant green, and euflavine) in the local treatment of burns in Middle East forces have shown that this method of local treatment has most of the disadvantages without some of the advantages of coagulation treatment.

(3) Sulfanilamide-Vaseline Treatment

Use of a sulfanilamide-vaseline mixture in the Middle East has shown this form of local treatment to be: (a) comfortable, especially when the injured part is immobilized with a plaster-of-Paris cast, (b) in superficial burns, healing may be complete when the plaster is removed 2 weeks later, (c) in deep burns, sloughs become separated more quickly than with the coagulation treatment, and skin grafting can be done at an earlier stage. This method of local treatment is considered at present the most suitable which is available.

c. Treatment of Shock

In the treatment of the shock associated with severe or extensive burns, morphine, body warming, and transfusion of adequate amounts of plasma or serum are advocated--with the employment of rapid transfusion when the blood pressure is very low or unrecordable. If plasma is not immediately available, blood is preferable to saline or glucosesaline solution. In the treatment of the anemia which appears in the latter half of the first week and in the second and third weeks, transfusion of blood is often disappointing. The use of liver extracts and iron have been strangely neglected in the treatment of the anemia associated with burns.

d. Transportation of Burned Men

Men with extensive burns travel badly; in fact, they are more upset by travel than men with other types of wounds. Men with large septic burns are most affected, and their condition deteriorates rapidly during long journeys by road, rail, or sea. For the purpose of transport, the burned limbs are often encased in plaster-of-Paris. This practice seems to be of recent development and has been employed mainly with the sulfanilamide-vaseline form of treatment.

e. Causes of Death in Burns

In an analysis of the cause of death in 83 fatal cases of burns, shock was found to be responsible for 23 deaths, toxemia for 22, and sepsis for 38 (46 percent).

From these figures, it is seen that the most frequent single cause of death from burns in Middle East forces is bacterial infection. The organisms found are of the usual variety: staphylococci, streptococci, B. pyocyaneus, B. proteus, and coliform bacilli, etc.

Even when burns are only superficial and of moderate extent, bacterial infection occurs in many cases, especially in those burns that involve deep or extensive areas of tissue.