AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Background

Napalm, invented by Fieser in 1942, is an incendiary substance made by the simple procedure of adding a "gelling" powder, composed of naphthalene and palmitate (hence "napalm"), to gasoline in varying concentrations to form a sticky, combustible substance.

This white, cloudy, jellylike substance has unique properties that render it an effective incendiary agent. Napalm is extremely stable, tolerating temperatures well above 150°F (effective in the tropics) and as low as -40°F (bomb shelters, cold weather environments). It is not shattered easily by explosives and can be stored for long periods without significant breakdown. Gelation of this substance occurs in 3-20 minutes. Gel formation enhances its effectiveness by allowing for a controlled, contained, and prolonged burn. Gelation also enhances its stability, with napalm requiring much higher temperatures to ignite than gasoline. There is no "off-sourcing" of hydrocarbon fumes associated with the nonignited compound. In fact, ignition requires the use of trinitrotoluene (TNT) to explode and ignite white phosphorus, the ignited temperature of which is high enough to result in the combustion of napalm.

Napalm has been used primarily in the form of incendiary bombs, firebombs, land mines, and flamethrowers. During World War II, firebombs, in the form of 165-gallon containers, were the primary method for the disbursement of napalm. One firebomb released from a low-flying airplane was capable of producing damage to a 2500-yd² area. During the Korean War, the United States dropped approximately 250,000 pounds of napalm per day. Napalm's increased viscosity resulted in the enhanced effectiveness of flamethrowers, which were frequently used in World War II. Because of gasoline's increased instability, volatility, and its rapid burning and self-consumption, its effectiveness was limited to within 30 yards. Napalm, through its unique properties, extended the effective range of flamethrowers to 150 yards.

After World War II, the United States conducted an intensive effort to enhance the properties and effectiveness of napalm as an incendiary agent. This effort resulted in the development of napalm B (super napalm, NP2), which substituted polystyrene and benzene for naphthalene and palmitate. The resulting substance continued to bear the name napalm, although it lacked the 2 components of its namesake. Conventional napalm burns for 15-30 seconds, whereas napalm B burns for up to 10 minutes. Napalm B provided the United States with an incendiary substance with enhanced stability and controllability and, as such, became the weapon of choice during the Vietnam War. Such enhanced stability required an igniting agent such as white phosphorus, which burns at a higher temperature of 4532°F. White phosphorus replaced thermite, the ignitor previously used for traditional napalm.

Frequency

United States

Napalm has been used by the United States as recent as the Persian Gulf War.

Mortality/Morbidity

Morbidity and mortality are related directly to the extent of injuries received from trauma and extensive burns from exposure. No cases have been reported of systemic poisoning of individuals in contact with nonignited napalm.

German post-war estimates reveal approximately 25,000 deaths and 30,000 wounded individuals during a 2-day attack on Dresden, Germany, with the use of 3.4 kilotons of incendiary, half of which was napalm. According to a memorandum released by the Ministry of Foreign Affairs of the People's Republic of Korea, after the Korean War more than 10,000 napalm bombs were released during a 20-day period killing 12,000 individuals and wounding 2,500 others.¹

CLINICAL

Section 3 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

History

• Exposure history usually is obvious, with the individual recounting the sounds of an explosion and the unbearable pain associated with the burns of exposure.
• Napalm produces carbon monoxide as a by-product of combustion. Thus, also evaluate individuals exposed to burning napalm for carbon monoxide exposure. In particular, consider individuals who are found with altered levels of consciousness near burning napalm to have been exposed to toxic levels of carbon monoxide until proven otherwise.

Physical

• Immolation, asphyxiation, and burns are the mechanisms by which incendiary weapons kill or wound.
• Immolation results in a rapid decrease in blood pressure leading to unconsciousness and death.
• Asphyxiation usually occurs as a result of napalm ignition, which results in a rapid deoxygenation of surrounding air. This rapid deoxygenation results in an atmosphere of approximately 20% carbon dioxide.
• Severe burns (second and/or third degree) are frequently found in areas exposed to burning napalm. Injuries related to the thermal elevation of the air temperature may result in respiratory embarrassment.
• Burning napalm raises the ambient environmental temperature and has been known to cause the deaths of individuals in raid shelters as a result of radiant heat and dehydration. This was a frequent cause of death in the bombing raids carried out over Hamburg, Germany, during World War II. The result of this phenomenon frequently was referred to as Bombenbrandschrumpfleichen (incendiary-bomb–shrunken bodies).

DIFFERENTIALS

Section 4 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Lab Studies

• Patients exposed to napalm represent individuals with severe burns; perform laboratory evaluation as for any burn patient.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

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.

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.

• 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.
• Perform full exposure and removal of the offending agent.
• Evaluate burns and calculate the exposed area. This can be done by 1 of 2 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.
• • Percentage of BSA involved assists in determining disposition and/or transfer of the patient to a regional burn center. The American Burn Association has developed criteria for burn-center admission that include 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; and significant chemical injuries, electrical burns, trauma, or 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.
• Take care to evaluate patients for carbon monoxide exposure.

Consultations

• Consult the burn team for the evaluation and management of burns.
• Consult the trauma team for the evaluation and management of traumatic injuries received as a consequence of explosions associated with napalm disbursement.

MEDICATION

Section 7 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Implement medical therapy as indicated by the patient's medical condition. Remember to administer tetanus prophylaxis.

Drug Category: Toxoid

Toxoid is used for immunization; a booster injection in previously immunized individuals is recommended.

Drug Category: Analgesics

These agents ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained injuries.

Drug Category: Nonsteroidal anti-inflammatory agents (NSAIDs)

These agents have analgesic, antiinflammatory, and antipyretic activities. Mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions, may exist as well.

Drug Category: Topical antibiotics

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

FOLLOW-UP

Section 8 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

In/Out Patient Meds

• Administer medications as indicated by the patient's medical condition.

Transfer

• If indicated, transfer patients to a regional trauma and/or burn center.

Prognosis

• The prognosis is dictated by extent of physical injury, burns, and existing metabolic complications.

Patient Education

• For excellent patient education resources, visit eMedicine's Bioterrorism and Warfare Center. Also, see eMedicine's patient education article Personal Protective Equipment.

MISCELLANEOUS

Section 9 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical/Legal Pitfalls

• Legal issues are associated with inadvertent exposure to the ignited agent and to its inappropriate use (detonation) in situations other than wartime deployment.
• Military personnel should be cognizant of the medical issues associated with exposure to ignited napalm and maintain an appropriate safe distance from any military use.

REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

1. Napalm. Globalsecurity.org. Available at http://www.globalsecurity.org/military/systems/munitions/napalm.htm. Accessed July 3, 2007.
2. Bullens EF. Chemicals in combat. Armed Forces Chem J. 1952;5(4):4-7.
3. Fieser LF. Napalm. Indust and Engin Chem. 1946;38:768-773.
4. Harvey F. Air war in Vietnam. Flying. 1966;5:38-95.
5. Hollingsworth EW. Use of thickened gasoline in warfare. Armed Forces Chem J. 1951;4(6):26-32.
6. McLean AD. Burns and military clothing. J R Army Med Corps. Feb 2001;147(1):97-106. [Medline].
7. Napalm. Wikipedia. Available at http://en.wikipedia.org/wiki/Napalm. Accessed July 3, 2007.
8. Reich P, Sidel VW. Current concepts. Napalm. N Engl J Med. Jul 13 1967;277(2):86-8. [Medline].

Article Last Updated: Aug 22, 2007