C O R P O R A T I O N EMILY HOCH, SAMANTHA MCBIRNEY, CHARLES C. ENGEL, TEPRING PIQUADO Mitigating the Effects of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience Proceedings and Expert Findings from a U.S. Department of Defense International State-of-the-Science Meeting For more information on this publication, visit www.rand.org/t/CFA807-2 Library of Congress Cataloging-in-Publication Data is available for this publication. ISBN: 978-1-9774-0618-7 Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2020 RAND Corporation R® is a registered trademark. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Preface This document represents the complete proceedings of the Ninth Department of Defense Inter- national State-of-the-Science Meeting (SoSM) on Blast Injury Research, held from March 3 to March 5, 2020, at the Arlington, Virginia, office of the RAND Corporation. The topic of the ninth SoSM was “Mitigating the Effects of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience.” The SoSM aims to identify knowledge gaps in blast-injury research; ensure that the U.S. Department of Defense (DoD) medical research programs address existing gaps; foster collaboration; promote information-sharing on the latest research; and identify short-term, intermediate, and long-term actions to prevent, mitigate, and treat blast injuries. Participants and presenters consisted of scientists, clinicians, and policy- makers from DoD, including the Departments of the Army, Navy, and Air Force; the Marine Corps; the National Institutes of Health; and the U.S. Department of Veterans Affairs; as well as representatives from academia and industry and scholars from several different countries. This research should be of interest to senior military and medical leaders. The Human Subjects Protection Committee (HSPC) is RAND’s institutional review board to review research involving human subjects, as required by federal regulations. RAND’s Federalwide Assurance for the Protection of Human Subjects (FWA00003425, effective until June 22, 2023) serves as the organization’s assurance of compliance with the regulations of 17 federal departments and agencies. According to this assurance, the HSPC is responsible for review of all research, regardless of the source of funding. The views of sources used in this study are solely their own and do not represent the official policy or position of DoD or the U.S. government. This research was sponsored by the U.S. Army Medical Research and Development Command and the DoD Blast Injury Research Coordinating Office and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD), which operates the National Defense Research Institute (NDRI), a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense intelligence enterprise. For more information on the RAND Forces and Resources Policy Center, see www.rand.org/nsrd/frp or contact the director (contact information is provided on the webpage). iii Contents Preface ........................................................................................................... iii Figures and Tables .............................................................................................vii Acknowledgments ............................................................................................. ix Abbreviations ................................................................................................... xi CHAPTER ONE State-of-the-Science Meeting Content Summary ......................................................... 1 Background on Burn Injury .................................................................................... 2 Working Group Questions, Answers, and Recommendations ............................................. 2 Expert Panel Discussion of Research Questions and Recommendations ................................. 5 CHAPTER TWO Literature Review Summary .................................................................................. 9 Results of the Literature Review ................................................................................ 9 Future Research Directions from the Literature Review and Synthesis of the Evidence ...............10 CHAPTER THREE Keynote Address ...............................................................................................13 CHAPTER FOUR Invited Speaker Presentation Summaries .................................................................15 Blast-Related Burns: A Modern History .....................................................................15 Overview of DoD Burn Research .............................................................................15 Military Health System Burn Injury Prevention Standard: Example of Dermal Burn Science .......16 Civilian Burn Mass Casualty Events and Preparedness Research .........................................16 Prehospital Burn Care: Prolonged Field Care ...............................................................17 Acute Assessment and Management of Burn Injury ........................................................18 Impact of Acute Care on Long Term Outcomes ............................................................18 Surgical Advances: Reconstruction and Restoration ........................................................18 Psychosocial Aspects of Resilience and Functioning ....................................................... 20 CHAPTER FIVE Scientific Presentation Summaries .........................................................................21 Burn Injuries in U.S. Service Members: 2001–2018 ........................................................21 U.S. Army Burn Center Registry and Burn Injury Model System ....................................... 22 TBI, Burns and Blast: Is PTSD All About the Blast? ...................................................... 23 v vi Mitigating the Effects of Blast-Related Burn Injuries National Trauma Research Action Plan: A Burn Research Agenda ..................................... 23 A Warrior Avatar for Model Based Blast and Burn Injury ................................................ 24 In Vivo Terahertz Spectral Imaging for Burn Depth Diagnosis.......................................... 24 Creating an Automated, Enhanced Lund Browder Diagram to Calculate TBSA ......................25 Blood mRNA Integrity Is a Marker of Radiation Exposure ...............................................25 Burn Resuscitation: Can We Be Better? ......................................................................25 Nanofiber Dressings for Infection Prevention and Pain Relief ........................................... 27 CHAPTER SIX Accepted Poster Abstracts ....................................................................................29 Poster Presentation by Travis McQuiston ................................................................... 30 Poster Presentation by Jerry Heneghan .......................................................................31 Poster Presentation by Chandan K. Sen ......................................................................32 Poster Presentation by Laveta Stewart ........................................................................33 Poster Presentation by George Tetz ...........................................................................35 Poster Presentation by Randall McCoy ..................................................................... 36 Poster Presentation by Richard A. Clark .....................................................................37 Poster Presentation by Martin J. Mangino .................................................................. 38 Poster Presentation by Kaitlin A. Pruskowski .............................................................. 38 Poster Presentation by M. A. Hassan Talukder ..............................................................39 Poster Presentation by Zachary Collier ...................................................................... 40 Poster Presentation by John C. Elfar ..........................................................................41 Poster Presentation by Gary S. Rogers ....................................................................... 42 Poster Presentation by Subhra Mandal .....................................................................