What is the proper first aid for burns?

First Aid for Burns

Immediately cool thermal burns with cool or cold running water for at least 10 minutes (ideally 5-20 minutes) as soon as possible after injury. 1, 2, 3

Immediate Cooling Protocol

The single most critical first aid intervention is water cooling, which should begin immediately:

• Apply cool or cold potable running water to the burn for at least 10 minutes, with optimal duration being 5-20 minutes 1, 2, 3
• Use tap water at approximately 15°C (cool tap water temperature), which provides optimal outcomes for wound healing 4
• Never apply ice directly to burns—this causes additional tissue damage and worse outcomes 1, 4
• If running water is unavailable, use a clean cool or cold (but not freezing) compress as a substitute 1
• Remove jewelry and constrictive items from the affected area before swelling occurs 2, 3

Critical caveat: Monitor for hypothermia when cooling large burns, especially in children (burns >10% body surface area in children or >20% in adults) 1, 3

After Cooling: Wound Coverage

Once adequate cooling is complete:

• Loosely cover the burn with a sterile, dry, non-adherent dressing 1, 2, 3
• For small superficial burns managed at home, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling 2, 3
• Avoid natural remedies like butter, oil, or potato peel dressings in typical settings 1, 3
• Do not break blisters, as this increases infection risk 2, 3

When to Seek Immediate Medical Attention

Activate emergency medical services or seek immediate evaluation for burns involving: 1, 2, 3, 5

• Face, neck, hands, feet, or genitals (these require specialized burn center care regardless of size)
• Blistering or broken skin
• Difficulty breathing or signs of inhalation injury (soot around nose/mouth, singed nasal hairs)
• Large surface area (>10% body surface area in adults, >5% in children)
• Full-thickness (third-degree) burns
• Any burn causing significant concern

Evidence Supporting Water Cooling

The recommendation for immediate water cooling is supported by strong evidence showing it prevents superficial burns from progressing to deep burns requiring skin grafting. Research demonstrates a 32% reduction in the need for skin grafting when immediate cooling is applied, which is statistically significant 6. While the optimal duration remains somewhat controversial 7, the guideline consensus of at least 10 minutes (up to 20 minutes) represents the best available evidence 1, 4.

Common Pitfalls to Avoid

• Do not delay cooling to search for "better" materials—immediate water application is what matters 6
• Do not use ice or very cold water (2°C), despite faster temperature reduction, as 15°C tap water provides better healing outcomes 4
• Do not apply home remedies like eggs, pap, butter, or oils—these increase complication rates 8
• Do not underestimate facial burns—even small partial-thickness facial burns require specialized care due to airway and cosmetic concerns 5