Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.
Estimate total body surface area (TBSA) burned to the nearest 10% using the Rule of Nines.
Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the HypothermiaPrevention Kit in order to both cover the burned areas and prevent hypothermia.
Fluid resuscitation (USAISR Rule of Ten)
If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.
Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40-80 kg.
For every 10 kg ABOVE 80 kg, increase initial rate by 100ml/hr.
If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over resuscitation for burn shock. Administer IV/IO fluids per the TCCC Guidelines in Section 5.
Analgesia in accordance with TCCC guidelines in Section 11 may be administered to treat burn pain.
Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per TCCC guidelines in Section 13 if  indicated to prevent infection in penetrating wounds.
All TCCC interventions can be performed on or through burned skin in a burn casualty.
Burn patients are particularly susceptible to hypothermia. Extra emphasis should be placed on barrier heat loss prevention methods and IV fluid warming in this phase.
If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000ml should be given, followed by Lactated Ringer’s or normal saline as needed.
Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40-80 kg.
For every 10 kg ABOVE 80 kg, increase initial rate by 100ml/hr.
If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over resuscitation for burn shock. Administer IV/IO fluids per the TCCC Guidelines in Section 5.
Tactical evacuation care
Emergency Medical Treatment and Active Labor Act
CT brain interpretation
Prehospital protocol pediatric airway management
Tactical field care
Ventriculoperitoneal shunt drainage
Neuro antibiotics
Newborn resuscitation