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] :
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Partial thickness burns greater than 10% TBSA
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Third-degree burns
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Burns involving critical areas (eg, face, hands, feet, genitals)
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Circumferential burns of the thorax or extremities
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Inhalational injuries
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Significant chemical injuries, electrical burns, or trauma
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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:
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Burn team, for the evaluation and management of burns
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Trauma team, for the evaluation and management of traumatic injuries from explosions associated with napalm disbursement
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Pulmonary/critical care medicine, for monitoring of respiratory status and evidence of pulmonary injury
