Burn Mapping For Wounded Warriors

Disfigured while defending their country, statistics show more than 2,500 U.S. troops have been burned while serving in Iraq and Afghanistan. Keeping track of those injuries and how they’re healing used to involve a very low-tech process, but a new high-tech system could help save lives.

 “I think I’ve had like 60 different surgeries,” Wounded Warrior Mario Lopez told Ivanhoe.

His vehicle hit an improvised explosive device in Afghanistan.

 “I got burned over 54% of my body,” Mario said.

Until recently, military medical professionals used paper and colored pencils to keep track of troops’ burns. Wound care Coordinator CD Peterson says it was the standard, but it does leave room for error. Now, WoundFlow is becoming the new standard.

“It gives us a more accurate calculation,” explains CD Peterson, LVM, from the U.S. Army Institute of Surgical Research Burn Center.

With a laptop or tablet, caregivers color in the degree of the burn and how much of the body is burned. The percentage is automatically calculated. All the information is updated as patients progress. WoundFlow has helped find a pattern that shows if a patient is not healing at a certain rate after 21 days

“Those patients will have an extremely high mortality rate,” says Jose Salinas, PhD, Research Task Area Manager at the U.S. Army Institute of Surgical Research.

Now, therapies can be adjusted if that pattern is spotted and hopefully, “we save more patients that way,” Peterson said.

Right now, WoundFlow is only being used at the San Antonio Military Medical Center, which is home to one of the best burn centers in the country. Developers say the program is constantly being tweaked to make it better. There are also plans to add gunshot and knife wound mapping capabilities to the program.


BACKGROUND:  With over 2,500 U.S. troops suffering from burn injuries while they were in Iraq and Afghanistan, the medical community is making needed advances in burn care.  Military members have who have combat burn injuries can suffer some of the most intense and prolonged types of pain imaginable.  They need daily care to clean the wound and daily physical therapy.  Maj. Peter DeSocio, an anesthesiologist with the burn center at Brooke Army Medical Center, says that despite the use of strong painkillers, most of the patients he sees report severe to excruciating pain during wound care.  (Source: www.army.mil/article/34030).


EASING PAIN:  One of the newer advances for burn victims is an interactive video game that can be used to ease the pain and stress during burn wound treatment.  A group of military patients took part in a study using “SnowWorld,” a three-dimensional video game that employs high-tech goggles and earphones, allowing patients to immerse themselves in the game experience.  The game draws them into the action as they glide through the icy world of frozen mountains and canyons.  The frosty experience allows the wounded warrior to focus on something other than the excruciating pain they are going through.  "Not having to see the burn wounds helps keep them from thinking about it so much, or thinking about where and when the injuries happened to them.  Used as a complementary treatment, the VR game helps them relieve the stress of knowing the treatment is coming and gets them through their treatment better. It makes it a more tolerable experience,” Maj. DeSocio was quoted as saying.  (Source: http://www.army.mil/article/34030)


NEW TECHNOLOGY:  Accurate mapping and tracking of burn injuries is critical for creating and executing an effective treatment plan for burn patients.  Most burn mapping procedures are paper-based.  It can lead to variable treatment across patients and providers.  Now a product developed at the U.S. Army Institute of Surgical Research at Fort Sam Houston, Texas, is helping replace the out dated process.  WoundFlow is an electronic mapping software program used at the Institute of Surgical Research Burn Center to determine the percentage of the total body surface area burns and sounds on patients and is also a tool used to determine burn care management.  “WoundFlow was developed because of a need.  It was designed to help to improve burn care by providing burn teams with a tool that lets them track patients’ progression in the burn intensive care unit (BICU) a lot more accurately.  It also lets you upload images,” Jose Salinas, PhD, Task Area Manager for Comprehensive Intensive Care Research U.S. Army Institute of Surgical Research, was quoted as saying. 


Before this technology, photos of the patient were taken and those photos would get archived and the clinician would never see them again.  WoundFlow replaced the pencil and paper mapping diagram.  Digital photos and bronchoscope images of the lungs and trachea can be uploaded during the mapping of the patients.  Also, clinicians can use different color to depict the degree of the burns and other wounds.  When the electronic diagram has been completed, WoundFlow does the math to determine the total body surface area.  As the burns heal, the clinicians can then update the diagram to track the heal rate. (Source: www.usaisr.amedd.army.mil/news/news_stories/NOV2012_Woundflow.html)  

Jose Salinas, PhD, Task Area Manager for Comprehensive Intensive Care Research (CICR) U.S. Army Institute of Surgical Research, talks about a new treatment option for burn victims.

So, how could this change treatment and care for burn patients?

Jose Salinas, PhD: Well, one of the advantages of bringing information technology to the bedside is that now we have the ability to do computer analytics, to be able to analyze, determine, and predict potential patient outcomes based on the data that the computer is recording constantly and as new interventions are performed on the patient. So, one example is an analysis that we did where we looked at the healing trajectories and healing rates of our burn patients and based on the data that our WoundFlow system has recorded, we were able to determine that if a patient is not on what we call a healing trajectory within 21 days after admission into the Burn Unit, those patients will have an extremely high mortality rate. The advantage of that particular analysis is that a clinician can then look at a healing trajectory of every patient and be able to determine if patients are not healing correctly some days before that. They can adjust therapies and potentially help improve the survivability of our burn patients.

So, you can switch the path they are on.  Is that correct?

Jose Salinas, PhD: Exactly. By being able to visualize and graph how the patient is healing throughout their hospitalization stay and based on the data analysis that we have done, a physician can determine whether a patient is in the correct healing trajectory. Based on that, they can adjust how the patient is being treated to potentially improve their chances of survival and of staying in the hospital fewer days.

Do you think this is saving more lives?

Jose Salinas, PhD: Well, we have not conclusively determined that. However, any time you can improve the situational awareness of the providers we feel that patients get treated better. They can get intervened earlier and potentially will help to improve their outcomes.

Has this been used for a relatively short amount of time?

Jose Salinas, PhD: It has been used in our Burn Center for approximately two years. It was instituted as a test system approximately six months before that. So, overall, it has been about 2-1/2 years since people have been using the system in our Burn Unit.

Would you like to add anything?

Jose Salinas, PhD: Just the point about our institute and that we are very unique within Department of Defense. The fact that we have a hospital, a research unit, and a Trauma Center all co-located, it lets us develop products from bench to bedside very quickly and effectively because everything is in the same area and we have the resources available to do that.




Steven Galvan

Public Affairs Officer

U.S. Army Institute of Surgical Research

(210) 539-5470



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