In the Field
Rule of Ten is what you use when you cannot do the full Parkland formula calculation under stress. For a 70 kg adult with 30 percent TBSA burn: 30 times 10 equals 300 mL per hour. Start there. Reassess at 30 minutes and adjust based on urine output and mental status. The Rule of Ten reaches roughly the same 24-hour volume as Parkland in the first hour while requiring zero math beyond multiplying two numbers. TCCC 2026 specifies Rule of Ten for burn casualties greater than 20 percent TBSA, using Lactated Ringer, normal saline, or Hextend as the resuscitation fluid.
Common Mistake
Continuing the Rule of Ten rate without reassessment. The formula is an initial estimate, not a sustained rate. Urine output (target 30 to 50 mL per hour adult), mental status, and hemodynamic response guide ongoing titration. The other mistake is using Rule of Ten in burns with concurrent hemorrhagic shock without prioritizing hemorrhage control. TCCC 2026 explicitly states that hemorrhagic shock resuscitation takes precedence over burn shock resuscitation when both are present.
Technical Detail
Rule of Ten formula: initial IV or IO rate (mL/hr) equals TBSA percent burn multiplied by 10, for adults 40 to 80 kg. Add 100 mL per hour for every 10 kg above 80 kg. Example: 100 kg adult with 40 percent burn equals 40 times 10 plus 200 (for the 20 kg above 80) equals 600 mL per hour initial rate. Developed by USAISR to replace the more complex Parkland formula (4 mL per kg per percent TBSA over 24 hours, half in first 8 hours) in field settings. Compared with Parkland, Rule of Ten produces similar 24-hour volumes for moderate burns and slightly less for very large burns. Fluid choice per TCCC 2026: Lactated Ringer preferred; normal saline acceptable; Hextend acceptable up to 1000 mL followed by LR or NS (though Hextend is largely obsolete in current doctrine). Oral fluids considered for burns up to 30 percent TBSA in conscious casualties.
