Study to track burn outcomes
Come here, Jones, come here!" An officer yelled to Staff Sgt. Lee Jones as Jones bolted from the burning Humvee. He started running and then dropped to the ground and rolled to try to douse the flames that engulfed his face, hands and legs. His truck had hit a roadside bomb. The three squad members in the truck with him died in the explosion.
Jones, of the 82nd Airborne, was soon evacuated to a field hospital and then to Germany. But he was in a coma—the flames had eaten away the skin from nearly half his body—and doctors didn't give him long to live.
That was in October 2005. Today—after a week at the U.S. military hospital in Germany, four months at the Army burn center in San Antonio, 18 months in VA polytrauma care in Tampa, and now physical therapy at his local VA in North Carolina—Jones is taking life one day at a time with his wife, Maria, and three-yearold daughter, Angel. He says he feels grateful for each milestone in his ongoing battle to regain function. "I can use PlayStation. I can go up stairs. I sing in the choir at church," says Jones, his speech still slow and slightly slurred. In addition to burns, he suffered a brain injury and damage to muscles and nerves throughout his body. He had strokes, seizures and a heart attack within two weeks of the blast. His left thumb was amputated. "My hands don't work. I can't feel my feet," says the 26-year-old veteran. He still uses a wheelchair, but increasingly he is able to walk.
Research collaboration between VA and DoD
A new study by researchers with VA and the Department of Defense is looking at long-term outcomes for people like Lee Jones—veterans of the wars in Iraq and Afghanistan who have suffered serious burn injuries. What are their health care and social-service needs months and years after their injuries? How well can they function?
There has been little research to date on the topic. "Until a decade or two ago, there was a much greater mortality rate for people with serious burns," says study co-leader Polly Hitchcock Noel, PhD, of the Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), based at the San Antonio VA. "With improvements in acute care, people are now surviving more severe burns. Now there is more of a population in which to study longer-term outcomes."
Lead investigator Valerie Ann Lawrence, MD, MSc, also of VERDICT, adds: "Along with rapid evacuation for military wounded, we are much better at acute resuscitation and innovations such as topical antimicrobials to prevent infection, and artificial skin options. Surgeons are more aggressive about removing tissue they feel won't survive and moving onto grafts earlier." She also cites the development of comprehensive, state-of-the-art burn centers such as that of the U.S. Army Institute of Surgical Research, located at Brooke Army Medical Center—where Jones received skin grafts and other treatments—as a key factor in the increased survival of burn patients.
Lawrence emphasizes that while the odds of surviving burn injuries are better than in the past, managing the burns is complex and may entail "extensive surgical, medical and psychological rehabilitation for years."
The location of combat-related burn injuries on the body is also likely to be different than in the past. Due to improved body armor, troops are more likely to suffer burns to their face, hands and feet, with fewer burns to the torso. "DoD and VA are particularly interested in learning more about the outcomes of relatively isolated hand injuries," notes Lawrence. Another twist of modern warfare: Burn injuries are also often accompanied by blast effects such as traumatic brain injury, which further complicates recovery.
Study to follow patients for four years
The VA and DoD researchers will assess patients at discharge from the hospital and then yearly for four years. They'll administer a wide array of questionnaires covering physical, psychological and social issues: How well are patients able to handle everyday activities ranging from bathing, eating and dressing to using the telephone, shopping for groceries and doing light housework? Are they struggling with depression or posttraumatic stress disorder? What coping strategies do they use? Do they have adequate social support? How much pain do they have, and how well can they sleep? Do they use alcohol? Are they able to return to work? How satisfied are they with the quality of their life?
Lawrence cites another long-term issue for burn patients that may figure in the study: "One thing we've found they struggle a lot with is scar tissue formation, which may cause deformities and contractures that limit range of motion and make patients feel physically unattractive. Even when scars are on parts of the body that are masked by clothing in public, it can involve intimacy problems in private."
The researchers say San Antonio is the ideal site for studying burn outcomes. The city is home to DoD's primary burn center and will soon host a new DoD polytrauma facility. Also, VA plans to build a fifth polytrauma regional center there. The agency currently has such centers in Tampa, Richmond, Minneapolis and Palo Alto.
"We'll be able to evaluate patients and their situations early on and then follow them as they transition to VA for longer-term care," says Lawrence.
The ultimate goal is to help people like Lee Jones. The Army veteran will likely continue improving in some areas, while other deficits caused by his injuries may be lifelong. For now, though, he's content to savor moments like those when he's holding his little girl—which he wasn't able to do until recently because of the burns on his hands and arms.
"I'm trying to be happy all the time," says Jones. "I'm glad I'm alive."