Reduction and mitigation of thermal injuries: what can be done?

Soon after the introduction of the crashworthy fuel system and Nomex flight apparel, morbidity and mortality rates from thermal injuries in aviation were reduced to zero. Although the incidence of aircraft mishaps involving postcrash fires have remained the same, there has been a recent increase in thermal injury morbidity. These case reports describe three different aircraft accidents in which fire was caused by factors other than the crashworthy fuel system. They also describe sustained thermal injuries and compare them to personal protection equipment. We found that the condition of the personal protective equipment and unauthorized use of unapproved apparel were responsible for the sustained injuries. We maintain that personal protection equipment is effective if worn in the manner for which it was designed. We believe that the lessons learned apply to all military operations where the risk of fire is high, not solely aviation. A proactive program focused on education would reduce the thermal injury morbidity.