Napalm Exposure Treatment & Management

Updated: Jan 14, 2016
  • Author: Lisandro Irizarry, MD, MPH, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Treatment

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 venitilatory suport as needed.

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. 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% body surface area (BSA) of that individual. The second uses the "rule of nines" method.

Calculation of the percentage of BSA 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:

  • 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
  • Significant chemical injuries, electrical burns, or trauma
  • 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.

 

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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

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