Objective:
The Tri-service General Hospital Burns Protocol was implemented in 2015 to standardize treatment for all major burn patients, incorporate goal-directed fluid resuscitation, silver dressing and early renal replacement therapy (RRT) and streamline the processes and workflow of major burn care. This study aims to analyze the effects of the Burns Protocol 10 years before and after Formosa fun coast water park explosion in Taiwan.

Materials and Methods:
Using the electronic medical records database, all major burns patients admitted from 2003 to 2022 were included in the study. The historical preimplementation control group composed of patients admitted from 2003 to 2015 (n = 114). The postimplementation cohort consisted of patients admitted from 2015 to 2022 (n = 89). Details of the patients collected included age, sex, mechanism, total body surface area (TBSA) burns, 28-day mortality and all cause mortality. Fluid resuscitation details within the 48 hours postburn from 2015 to 2022 were collected and compared with the period of Formosa fun coast water park explosion.

Results:
There was no statistically significant difference in the age, mean TBSA and Baux score of
both groups. The postimplementation group had a statistically significant lower 28-day mortality with the preimplementation group (2.3% vs 19.3%), lower all-cause mortality (7.9% vs 34.2%). Among patients with renal replacement therapy, the postimplementation group had lower 28-day mortality. Under guidance of goal-directed fluid resuscitation, the mean fluid infused in the first 48 hours is lower than Parkland formula prediction without oliguria. Major burns with RRT in the postimplementation group had better mortality than the preimplementation group (40.0%% vs 85.2%).

Conclusion:
The new Tri-service General Hospital Burns Protocol had revolutionized major burn care by introducing a streamlined, multidisciplinary burns management, resulting in improved patient outcomes.