INTRODUCTION: Resuscitation for major burn is challenging globally, from low- and middle-income countries (LMICs) to military and mass casualty settings. Enterally based resuscitation (ER) may have operational advantages in austere settings. However, there are no data to inform ER implementation in real-world scenarios. We describe the early implementation of an ER bundle in an austere environment. METHODS: This single-center pilot effectiveness-implementation randomized trial in Nepal aims to enroll 30 adult patients with 20% to 40% total body surface area (TBSA) burns. Intervention arm receives goal-directed ER with oral rehydration solution administered orally or via nasogastric lavage. Standard of care arm is goal-directed IV resuscitation. Both arms received education, supplies, flowsheets, and communication tool. Resuscitation endpoints, symptoms, biomarkers, and clinical outcomes are measured. The Consolidated Framework for Implementation Research is being used to identify challenges and facilitators of ER implementation via provider focus group discussions (FGD), patient in-depth interviews, and quantitative measures of protocol fidelity. The first 12 patients are presented. RESULTS: Pre-enrollment FGD informed development of context-appropriate ER and IV protocols and implementation strategies. The first 12 patients were allocated equally across arms. One patient crossed over from ER owing to gastrointestinal (GI) intolerance, although GI symptoms were similar in both groups (4 IV vs 3 ER). Twenty-four-hour resuscitation volumes, urine, output and serum creatinine are similar across both groups (Table). Table. - Patient Demographics and IV and Enterally Based Measures Demographic IV resuscitation (n=6) Enterally based resuscitation (n=6) Patient age, median 45.5 years (IQR 27.5-53.8) 30.5 years (IQR 23.8-51.5) Burn size, median (% TBSA) 32% (IQR 30-39) 24% (IQR 22-29) Time to presentation, median 13.75 hours (IQR 13.0-15.6) 6.25 hours (IQR 2.9-11.1) 24-hour urine output, median 1.06 mL/kg/hr (IQR 0.75-1.10) 0.88 mL/kg/hr (IQR 0.85-0.88) 24-hour resuscitation volume, median 3.85 mL/kg/%TBSA (IQR 3.53-4.67) 5.81 mL/kg/%TBSA (IQR 4.45-8.42) Arterial lactate at 24 hours, median 1.10 mmol/L (IQR 1.00-1.28) 2.05 mmol/L (IQR 1.85-2.40) Serum creatinine at 72 hours, median 0.69 mg/dL (IQR 0.62-0.72) 0.61 mg/dL (IQR 0.55-0.7) GI symptoms* during resuscitation 4 3 *GI symptoms are considered any of the following: nausea, bloating, distension, diarrhea, vomiting. CONCLUSION: An ER protocol was successfully implemented in an austere environment. Resuscitation endpoints are currently similar between both arms, indicating that ER is likely effective in austere environments.