Purpose: The lethal triad of trauma (acidemia, coagulopathy and hypothermia) is associated with substantial morbidity and mortality. Patients with severe burn injuries are one group of patients at risk of developing this triad. The aim of this study was to evaluate the prevalence of the lethal triad and factors associated with the lethal triad in severe burn patients on arrival to an adult tertiary burns service hospital. Methodology: A 5-year retrospective cohort study was conducted of adult patients (>18 years of age) with severe burns (>20% total body surface area, TBSA) admitted to a burns service hospital. The Burns Registry of Australia and New Zealand (BRANZ) was used in combination with electronic medical records to extract relevant data. Hypothermia was defined as a body temperature ≤35.5°C, coagulopathy was defined as an international normalised ratio (INR)>1.2 and acidemia was defined as pH≤7.25. Results: From 158 patients identified, 142 patients met inclusion criteria. Among 106 patients with available data, the lethal triad was present on arrival to hospital in 6 patients (5.7%; 95%CI: 2.1-11.9%). Acidemia was present in 58 of 116 (50.0%; 95%CI: 40.6-59.4), coagulopathy in 18 of 125 (14.4%; 95%CI: 8.8-21.8) and hypothermia in 53 of 140 (37.9%; 95%CI: 29.8-46.4). Among patients with the lethal triad, all 6 patients (100%) died, compared to 27 patients (27.0%) without the lethal triad (odds ratio 21.0; 95%CI: 2.91->99.9). Individuals presenting with the lethal triad were more likely to have a larger %TBSA (p < 0.001) and presence of inhalation injury (p < 0.001). Conclusion: A small proportion of patients with severe burns presented to hospital with all three components of the lethal triad of trauma. Acidemia and hypothermia were more commonly observed when compared to coagulopathy. Recognition, prevention and early management may result in improved outcomes.