Thousands of people could need burn care following a nuclear detonation (which produces intense heat resulting in severe burns) or in a massive explosion. In addition to those catastrophic threats, between 2010 and 2014, emergency departments treated approximately 486,000 people for non-fatal burn injuries and in 2014 alone, fires took the lives of 3,275 people. Specialized treatment resources are limited, with only 127 burn centers nationwide; a mass casualty incident easily could overwhelm the nation’s burn care infrastructure.
Within ASPR, the Biomedical Advanced Research and Development Authority (BARDA) makes available vaccines, treatments and diagnostics for naturally emerging and intentional health threats, including those that cause thermal burns. The novel products under development are being designed to find uses in routine clinical burn care and would also help in response to a mass casualty incident. We want to prevent the national burn care infrastructure from being overwhelmed and provide patients with better outcomes.
The treatments for severe burns can require complex procedures including surgical skin grafting that is resource-intensive and technically demanding. BARDA is supporting development of products specially designed to address various aspects through the continuum of care. When fully integrated, the new products and their enhancements in burn care have the potential to eliminate resource-intensive steps, shorten hospital stays, and improve patient outcomes; bringing value in day to day routine care as well as in a mass casualty event.
Already, BARDA has purchased Silverlon so it’s available through the Strategic National Stockpile. The product, which has been used extensively by the military in the battlefield, now can be used for civilians to improve care for burn patients before they reach the hospital and receive surgical treatment for their burn injuries. Silverlon is a long-acting silver-impregnated nylon bandage available commercially and used widely to cover acute wounds and first- and second-degree thermal burns. The silver helps control bacterial growth within the dressing.
BARDA is developing four other products to address challenges in burn care treatment, including a topical gel made of pineapple-based enzymes and designed to dissolve damaged or dead skin tissue to create a clean wound-bed for skin grafting. If successful the product, called NexoBrid, could eliminate or reduce the need to remove damaged or dead tissue surgically, a technically-demanding and time-intensive step in burn care, and may also speed recovery.
BARDA is supporting development of a novel, cell-based, full-thickness skin substitute called StrataGraft made from human cells. The product could eliminate or reduce the need for donor skin from other areas of the patient’s body or using animal or cadaver skin.
Another product is a device called ReCell, which produces a topical spray derived from a small sample of the patient’s own skin. This topical spray may enhance skin growth, allowing burn surgeons to use smaller skin donor grafts, and stretch grafts over a larger burn wound.
BARDA also is supporting advanced development of a temporary cover for burned skin called the Biodegradable Temporizing Matrix. If successful, the product could provide off-the-shelf temporary cover for burn wounds, even for patients who have lost large areas of skin. The product also may prevent wound contraction (wounded tissue tightens and becomes less flexible). Wound contraction often results in disfigurement, loss of function of that part of the body and in severe cosmetic problems for the patient.
BARDA is working with companies on other technologies which, when fully developed, can better visualize burns wounds to help doctors figure out whether the burns would heal on their own or if the patient would need surgery. In addition, BARDA is developing other products to help burn wounds heal faster.
BARDA works with industry partners on developing these products, and we’re also working with the American Burn Association on strategies to integrate new products into routine burn care. In addition to integrating innovative products into routine health care, having such products commercially available reduces stockpiling burden. Wide availability of these products also means more doctors and emergency responders would be familiar with the products and comfortable using them.
As the new products become available, scientists in BARDA are working closely with physicians, Emergency Medical Services organizations and other members of the burn care community on how and when to use the products. Information about the products’ use also may be woven into the burn sections of the Radiological Emergency Medical Management (REMM) and Chemical Emergency Medical Management (CHEMM) websites which are run jointly by ASPR and the National Library of Medicine.
To prepare the United States as best we can, across ASPR we continually look at mass casualties that occur in other countries and here at home to understand what worked in the public health and medical response and the challenges emergency responders, health care facilities, medical professionals, and patients faced. We constantly add to our burn collection of peer-reviewed literature, plans, and research in the ASPR Technical Resources Assistance Center and Information Exchange (TRACIE).
Has your community responded to a mass casualty involving burns? Share your experience through TRACIE or as a blog comment.
