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Emergencies & first aid · Chapter 23 of 26

Burns and scalds

The first twenty minutes decide more about the outcome than anything done later in hospital.

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The first twenty minutes decide most of it

  1. Cool running water, twenty minutes

    Not five, not "until it feels better". Twenty minutes of cool — not ice-cold — running water, and it remains worth doing up to about three hours after the injury. This single step reduces depth, reduces the need for surgery and reduces scarring more than anything done later in hospital.

  2. Remove clothing and jewellery, unless it is stuck

    Swelling comes fast, and rings and watches become tourniquets. Anything stuck to the burn stays where it is.

  3. Cover with cling film, loosely

    Laid lengthways, not wrapped around a limb, so it cannot constrict as swelling develops. It is sterile inside the roll, it does not stick, and it lets the burn be seen without disturbing it. A clean plastic bag works for a hand or foot.

  4. Keep the rest of them warm

    Cooling a burn cools a person, and hypothermia is a real risk in a child or in a large burn. Cool the burn, warm the patient.

What not to put on it, and why the myths persist. No ice or iced water — it causes further injury by vasoconstriction and deepens the burn. No butter, oil, cream, toothpaste or flour: they hold heat in, introduce infection and have to be scrubbed off later, which is far worse than the burn. No burn gels or dressings instead of cooling — they are for afterwards, and a gel applied at two minutes usually means the twenty minutes of water never happened. And do not break blisters.

Which burns need medical assessment

  • Anything larger than the person's own palm, roughly.
  • Any burn to the face, hands, feet, genitals, or across a joint, regardless of size.
  • Any circumferential burn — right around a limb, finger or the chest.
  • All full-thickness burns — white, brown, leathery or charred, and often painless, because the nerve endings have gone. Painlessness is a bad sign, not a good one.
  • All chemical and electrical burns, and any burn with inhalation — soot around the nose or mouth, a hoarse voice, singed nasal hairs. Airway swelling after smoke inhalation can develop over hours and is a 999 call.
  • Any burn in a child, an older person, or anyone whose burn does not fit the story. Scalds in children are the commonest presentation of physical abuse, and a burn that does not match the account given is a safeguarding matter.