Military Medical Ethics – Scenario Database

Infected burn-wounds in local children – can you treat them?

ID/Number: 97
Last updated: 03 Dec, 2019
Revision: 4
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During an international crisis management mission, you are the commander of the medical mission and thus responsible for the medical care of the allied soldiers. You do not have an explicit humanitarian mission.

In the middle of the night you are called to the emergency room of the camp. There's a local man sitting in front of the ER.
The ER is crowded and everybody is in a heated discussion. Two small bodies lie in the shock containers. The characteristic stench of Pseudomonas Aeruginosa hangs in the air.

According to the report of the local man, three days earlier, a gas stove had exploded in a village hundreds of kilometers away and burned his two boys massively. The local hospital had given them a basic treatment, but then refused any further treatment as hopeless and futile. In desperation, the father put his two whimpering sons in a taxi and drove them to your hospital. The journey took them three days and three nights.

In the emergency room, the completely glued bandages were loosened; this was only possible under general anesthesia. Under the bandages, third degree burns are visible all over the bodies of the children: in the elder almost 80% of the body surface, in the younger about 50%.
Both burns are superinfected with Pseudomonas Aeruginosa, a highly resistant hospital germ.

Questions for the discussion of this scenario

What can you do?
Should you accept the two children to your ICU, knowing that they will need a lot of resources and given their infection also pose a risk to personnel and other patients?
What other options do you have? Are they ethically acceptable?

Source: Adapted from Diller, HP, and Wolfgang Locher. 2014. Die Entscheidung. Eine Erfahrung als Kommandeur Sanitätseinsatzverband in Kabul. Wehrmedizin und Wehrpharmazie (1):55-57.

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This scenario is also listed in the following categories
folder Military Medical Ethics Scenarios -> Limited/ scarce resources environment -> Level of care under limited resources