Ann. Medit. Burns Club - voL VII - n. I - March 1994

CIVILIAN AND MILITARY BURN INJURIES: A COMPARATIVE STUDY

Reda Mabrouk AM.

SUMMARY. A comparative study is made of burns sustained in civilian life and those sustained under war conditions. The different causes of the two types of bum are reviewed, and the ways in which individuals are affected. The management of civilian and military bums is also considered. In the case of civilian burns continued care frequently depends on the financial resources available to the burn victim, whereas military bum victims are not affected by economic considerations. The importance of research work and training is emphasized. It is concluded that although civilian and military bums may present different problems in management the ultimate aim in both cases in the same - the well-being of the patient. This study is the result of personal experience in dealing with civilian and military burn injuries. "Military burn injuries" means injuries sustained during war.

Aim

The aim of this study is to exchange knowledge and experience gained from each of the two systems of management.

The causes of civilian burn injuries are well known and may be discussed under three main headings: domestic, industrial and traffic. The causative agents may be hot liquids, fire, the results of use of petrol, gas or other burning agents, abuse of chemicals, and electricity.The causative agents of military burn injuries are vast: flame-throwers, burning shells, napalm, petrol, and chemical agents including phosphorus and nuclear weapons. Civilian injuries usually affect individuals, sometimes a family, but are rarely in mass. The extent and depth differ according to the causative agent and to the observation of prevention rules. Combined injuries are rare in civilian practice. War injuries are usually extensive and deep and they affect many individuals in mass, with frequent combined injuries. The only preventive factor is the capacity of the armed forces to prevent the enemy from using burning weapons.

The management of civilian burn injuries varies according to the available personnel involved in burn therapy and to the facilities and equipment supplied to them. The construction of burn units and centres is an important landmark in the development of burn management. That is why success in management differs from one area and from one country to another. Burn treatment being very expensive, finance is a vital factor in its success. The worst situation is that in which management depends on personal or family financial resources, while ideally responsibility is taken by an able government or by medical insurance organizations. For this reason we are forced in many cases to be satisfied with success achieved in one of the three stages of management - acute stage, rehabilitation stage and reconstruction stage -postponing the management of the other stages until economic and social conditions allow. Prevention of burn injuries in civilian practice entails propagation of knowledge and safety measures taken by governments in the form of protective rules and laws and in the form of propaganda delivered to the population by different information channels.
The management of war burn injuries is considered a national responsibility to be fulfilled by the armed forces. The plan of management is widely discussed as a part of war strategy and tactics. The different stages in management, once agreed upon, are issued as standing orders to be dogmatically executed, starting with first-aid management, sorting, evacuation and treatment at different levels of care until the victim reaches base hospitals and specialized centres. The aim of management is to save as many lives as possible and to reserve enough places for further expected casualties. Expense is never considered a crucial problem in treatment, this depending on the nation's ability to proceed with the fighting. The armed forces' responsibility for treatment is considered a life-term responsibility, the injuried being treated in military and veterans' hospitals, if necessary permanently.

Research work differs according to needs and circumstances. As regards civilian conditions, economy is a vital goal, and research should therefore aim at improving the management of the acute stage, i.Q. the treatment of shock, the correction of metabolic disturbances, and wound care. This type of research convinced us of the vital importance of the construction of burn units and centres with highly sophisticated ICU facilities and other equipment. Much research work also remains to be done to improve management during the stages of rehabilitation and reconstruction.
When on the other hand we consider war injuries, research work has to be directed towards the improvement of the standard of care at the different levels of evacuation, starting from the military unit medical officer, the field hospitals and the base hospitals. All these levels are affected by battle conditions and by whether the battle is defensive or offensive.

In conclusion, we may say that although there may be slight differences between the management of civilian burns and that of military burns the exchange of experience and the improvement that can be derived from research work are common to both, and they may be considered to be two dependent systems that aim at the proper care and preservation of man's well-being.

RESUME. L'auteur, dans une étude comparative des brûlures subies dans la vie civile et dans la guerre, considère les causes différentes des deux types de brûlure et les manières dont les individus sont atteints. Il considère aussi la gestion des brûlures civiles et militaires. Dans le cas des brûlures civiles la continuation des soins dépend fréquemment des ressources financières personelles de la victime, tandis que les victimes des brûlures militaires ne sont pas troublées par les problèmes économiques. L'importance de la recherche scientifique et de la formation professionnelle est soulignée. L'auteur conclue avec la considération que même si les brûlures civiles et militaires présentent des problèmes de gestion différents le but final est égal dans tous les deux cas: le bien-être physique du patient.

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