Napalm Exposure Treatment & Management

  • Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Apr 23, 2012
 

Prehospital Care

Give care to extinguishing flames and removing smoldering napalm from the skin. Remove contaminated clothing to prevent continued burning from hot napalm. If carbon monoxide exposure is a concern, provide 100% oxygen via a nonrebreather mask en route.

Also see CBRNE - Personal Protective Equipment and CBRNE - Chemical Decontamination.

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Emergency Department Care

Rapid intervention to stop cutaneous burning from napalm is of paramount importance. As with all burn patients, provide respiratory support and multiorgan evaluation.

  • Follow the standard ABC approach to resuscitation, paying special attention to respiratory evaluation, since patients may experience severe respiratory injury secondary to elevated ambient air temperature.
  • Perform full exposure and removal of the offending agent.
  • Evaluate burns and calculate the exposed area. This can be done by 1 of 2 common methods. The first involves using an affected individual's palmar surface, which roughly represents 1% body surface area (BSA) of that individual. The second uses the "rule of nines" method.
    • Percentage of BSA involved assists in determining disposition and/or transfer of the patient to a regional burn center. The American Burn Association has developed criteria for burn-center admission that include third-degree burns over 5% BSA; second-degree burns over 10% BSA; any second-degree and/or third-degree burns involving critical areas (eg, face, hands, feet, genitals); circumferential burns of the thorax or extremities; inhalational injuries; and significant chemical injuries, electrical burns, trauma, or significant preexisting medical conditions.
    • Base fluid resuscitation on the Parkland formula (2-4 mL/kg/h of intravenous crystalloid). Maintain urine output at 1-2 mL/kg/h.
  • Perform a full trauma evaluation because patients may sustain injury from percussion of blast or projectiles.
  • Take care to evaluate patients for carbon monoxide exposure.
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Consultations

  • Consult the burn team for the evaluation and management of burns.
  • Consult the trauma team for the evaluation and management of traumatic injuries received as a consequence of explosions associated with napalm disbursement.
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Contributor Information and Disclosures
Author

Lisandro Irizarry, MD, MPH, FAAEM  Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine

Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mollie V Williams, MD  Assistant Clinical Professor, Fellow in Disaster Preparedness, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn

Mollie V Williams, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

José Eric Díaz-Alcalá, MD, FAAEM,  Consulting Staff in Medicine Service, Division of Emergency Medicine/Medical Toxicology, Veterans Affairs Caribbean Healthcare System; Medical Director, Puerto Rico Poison Control Center, San Juan, Puerto Rico

José Eric Díaz-Alcalá, MD, FAAEM, is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Keim, MD  Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

  1. Napalm. Globalsecurity.org. Available at http://www.globalsecurity.org/military/systems/munitions/napalm.htm. Accessed July 3, 2007.

  2. Bullens EF. Chemicals in combat. Armed Forces Chem J. 1952;5(4):4-7.

  3. Fieser LF. Napalm. Indust and Engin Chem. 1946;38:768-773.

  4. Harvey F. Air war in Vietnam. Flying. 1966;5:38-95.

  5. Hollingsworth EW. Use of thickened gasoline in warfare. Armed Forces Chem J. 1951;4(6):26-32.

  6. McLean AD. Burns and military clothing. J R Army Med Corps. Feb 2001;147(1):97-106. [Medline].

  7. Napalm. Wikipedia. Available at http://en.wikipedia.org/wiki/Napalm. Accessed July 3, 2007.

  8. Reich P, Sidel VW. Current concepts. Napalm. N Engl J Med. Jul 13 1967;277(2):86-8. [Medline].

 
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