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 or endotracheal intubation with 100% fraction of inspired oxygen (FiO₂) and venitilatory suport as needed.

Also see Hazmat and CBRNE - Chemical Decontamination.

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. Perform full exposure and removal of the offending agent.

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. Take care to evaluate patients for carbon monoxide exposure.

Evaluate burns and calculate the exposed area. This can be done by either of two common methods. The first involves using an affected individual's palmar surface, which roughly represents 1% of total body surface area (TBSA) of that individual. The second uses the "rule of nines" method.

Calculation of the percentage of TBSA involved assists in determining disposition and/or transfer of the patient to a regional burn center. American Burn Association criteria for burn-center admission include the following^[2]:

Partial thickness burns greater than 10% TBSA
Third-degree burns
Burns involving critical areas (eg, face, hands, feet, genitals)
Circumferential burns of the thorax or extremities
Inhalational injuries
Significant chemical injuries, electrical burns, or trauma
Significant preexisting medical conditions

Base fluid resuscitation on the Parkland formula (4 mL × TBSA × body weight (kg) of isotonic crystalloid fluid, with the first 50% given in first eight hours and the second 50% given over the following 16 hours). 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. If indicated, transfer patients to a regional trauma and/or burn center.

Consultations

Consultations to consider include the following:

Burn team, for the evaluation and management of burns
Trauma team, for the evaluation and management of traumatic injuries from explosions associated with napalm disbursement
Pulmonary/critical care medicine, for monitoring of respiratory status and evidence of pulmonary injury

Medication

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Author

David Vearrier, MD, MPH Professor of Emergency Medicine, Department of Emergency Medicine, University of Mississippi Medical Center

David Vearrier, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MS, MPH, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences; Senior Research Scientist, Data Science IV, Battelle Memorial Institute, Battelle Connecticut Operations

Zygmunt F Dembek, PhD, MS, MPH, LHD is a member of the following medical societies: American Chemical Society, American Legion, American Public Health Association, Association of Military Surgeons of the US, Council of State and Territorial Epidemiologists, Delta Omega Public Health Honorary Society, New York Academy of Sciences, Polish Legion of American Veterans, Reserve Organization of America, Society of American Federal Medical Laboratory Scientists, Veterans of Foreign Wars

Disclosure: Nothing to disclose.

Additional Contributors

José Eric Díaz-Alcalá, MD, FAAEM, FACMT Medical and Executive Co-Director, Medical Toxicology Consultant, Administración de Servicios Médicos de Puerto Rico, ASEM Poison Control Center; Chief, Emergency Medicine Unit, Medical Toxicology Consultant, VA Caribbean Healthcare System

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

Disclosure: Nothing to disclose.

Lisandro Irizarry, MD, MBA, MPH, FACEP Chair, Department of Emergency Medicine, Wyckoff Heights Medical Center

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

Disclosure: Nothing to disclose.

Mark Keim, MD Founder, DisasterDoc, LLC; Adjunct Professor, Emory University Rollins School of Public Health; Adjunct Professor, Harvard Affiliated Disaster Medicine Fellowship

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

Disclosure: Nothing to disclose.

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Napalm Exposure Treatment & Management

Prehospital Care

Emergency Department Care

Consultations

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