A study revealed that the prehospital burn management in a combat zone resulted in the affected troops receiving higher levels of prehospital fluids or no fluids at all. Ehline Law and our burn injury attorneys have worked closely with veterans and those actively serving to understand their problems and fight for the compensation they deserve. Here, we will review the practical realities of fluid resuscitation and some solutions.
The Modified Brooke and Parkland Formula
To calculate the required fluid requirements for a burn victim, the medics may use the following two formulas:
- Modified Brooke formula: Under the modified Brooke formula, medics must multiply 2mls by the body surface areas burned (BSAB) and then multiply that by the victim’s weight.
- Parkland formula: Under the modified Brooke formula, medical professionals must multiply 4mls by the body surface areas burned (BSAB) and then multiply that by the victim’s weight.
Both formulas help the medical professional calculate the first 24-hour fluid requirement with half of the fluids administered during the first 8 hours. However, these formulas may be unrealistic before fluid resuscitation in a prehospital setting.
The USAISR Rule of 10
The USAISR (Department of Defense’s primary laboratory for developing solutions to trauma and critical care challenges) Rule of 10 formula provides a helpful framework for guiding the initial fluid resuscitation of burn victims to prevent shock and optimize outcomes in the early stages of the burn injury.
Under the Rule of 10, the medic rounds of the burn size to the nearest 10% total body surface area. For burn victims weighing between 40 and 80 kg, the medic multiplies the burn size by 10 to derive the initial fluid rate. For every 10 kilograms of weight above 80 kg, the medic must increase the rate of fluid by 100 ml/hour.
Let’s look at an example of a burn victim who weighs 90 kg and has burn injuries over 10% of their TBSA. The medic would administer 100 ml/hour (10 multiplied by 10) of fluids plus another 100 ml/hour since the victim is 90 kgs.
In most cases, the USAISR Rule of 10 estimates falls between the estimates derived using the modified Brooke and Parkland formula.
Prehospital Fluid Resuscitation Study Identifies the Need for Educating Prehospital Personnel
A study examined the US burn casualties arriving at the Ibn Sina Combat Support Hospital (CSH) between 2006 and 2009. During the study period, the hospital received 255 burn casualties, with only 48 of them meeting the inclusion criteria (mean injury severity score of 37.1). Around 50% of the 48 received prehospital vascular access, while 20 received prehospital fluid resuscitation.
According to the study’s findings, 28 of the burn casualties did not receive prehospital fluid resuscitation. In contrast, those that received fluid resuscitation received fluid volumes higher than the American Burn Association guidelines (ABA). Only 13 of the 48 burn casualties received pain medication.
Observations Support Improved Education
The study revealed that half did not receive any fluid resuscitation in a prehospital setting. On the other hand, the other burn casualties received fluid resuscitation over ABA and Committee for Tactical Combat Casualty Care guidelines on fluid volumes. The medics also did not provide pain management uniformly to major burn casualties and vascular access.
The findings suggest the need for better education of the prehospital personnel serving in a combat zone for prehospital fluid resuscitation of primary thermal injury.
Schedule a Free Consultation with Ehline Law Burn Injury Lawyers for Tactical Combat Casualty Care
If you’ve suffered burn injuries due to another’s negligence or recklessness, contact us at (833) LETS-SUE for a free consultation with our burn injury attorneys, as you may be able to seek compensation. We will do the surgical research and grab this bull by the horns to discuss specific prehospital lifesaving interventions and more.