1. Stop the burning process. Use Airway and C-Spine precautions. Treat according to CPR protocol.
  2. Administer high flow 100% oxygen per mask. Intubate, if inhalation injury presents or is suspected. Be prepared to suction airway and support ventilation.
  3. Place two large bore IV’s in a nonburned extremity if possible. Use femoral approach if central line place is only alternative. Calculate fluid rate using the Parkland Formula. Titrate Ringers Lactate based on urine output. 4cc x kg body weight x % TSBA. Give ½ of calculated volume in first 8 hours post-injury.
  4. Place foley, discard urine in bladder.
  5. Give all pain meds IV route. Use cool water on wounds; NO ICE. Provide tetanus toxiod IM if indicated.
  6. NG tube if nausea/emesis, if burn wounds are greater than 20% TBSA, or if patient is to be transported by air. Keep patient NPO.
  7. Seek guidance of Burn Center surgeon for circumferential burns of chest or extremity.
  8. Obtain patient history: how victim was burned, concomitant injuries, allergies, medical history, current meds, last meal, drug and/or alcohol history.
  9. Wrap patient in a clean sheet. Place blanket over patient to prevent hypothermia-especially in infants and the elderly.
  10. Elevate head and upper extremities as soon as practical (NOTE—C-Spine should be cleared).

Excerpted from Guidelines for the Operations of Burn Units (pp. 55-62), Resources for Optimal Care of the Injured Patient: 1999, Committee on Trauma, American College of Surgeons.