A large portion of the casualties admitted to military hospitals on the battlefield in Iraq comprise 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 Institute for Burned Children (SIBC) in Boston, Massachusetts. 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 SIBC; 6) return to Iraq. Transfer and SIBC 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 the SIBC, 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 the SIBC, 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.
(C) 2014 The American Burn Association