Immediate Treatment for Scald Burns
Immediately cool the scald burn with clean running water for 20 minutes—this is the definitive first-line treatment that reduces burn depth, decreases the need for skin grafting, and minimizes pain. 1, 2
Initial Cooling Protocol
The cooling intervention must begin as soon as possible:
- Apply clean running water directly to the burn for a minimum of 20 minutes 1, 2, 3
- Cool running water is superior to wet towels or water spray for burn recovery 4
- Cooling can still be effective even if delayed up to 60 minutes post-injury, though immediate cooling is optimal 5
- Immediate cooling reduces the proportion of superficial burns that progress to deep burns requiring skin grafting by approximately 32% 6
Critical monitoring during cooling:
- Watch preadolescent children closely for hypothermia during active cooling 2
- Children under 4 years receiving whole-body cooling require monitoring for shivering and excessive body cooling 2
- Only cool burns in adults with <20% total body surface area (TBSA) and children with <10% TBSA in the absence of shock 2, 7
If clean running water is unavailable:
- Ice wrapped in cloth may be used for superficial burns 2, 8
- Never apply ice directly to the burn—this causes cold injury and extremity ischemia 9, 7
Immediate Actions During Cooling
Remove all jewelry and constrictive items from the affected area before swelling occurs to prevent vascular compromise and ischemia. 1, 2
Post-Cooling Management
After the 20-minute cooling period:
- Clean the wound with tap water, isotonic saline, or antiseptic solution 2, 7
- Apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1, 2
- Cover with a clean nonadherent dressing such as Xeroform, Mepitel, or Allevyn 2, 7
- For burns with intact skin or intact blisters, loosely cover with a clean cloth or nonadherent dry dressing while awaiting professional evaluation 1, 2
Pain Management
Administer over-the-counter analgesics:
- Acetaminophen or NSAIDs (such as ibuprofen 800 mg every 6 hours) are well-tolerated and effective for burn pain 1, 2
Critical Pitfalls to Avoid
These common mistakes worsen outcomes:
- Never apply butter, oil, or other home remedies—these trap heat and worsen injury 2, 7
- Never break blisters—this increases infection risk 2, 7
- Never use external cooling devices for prolonged periods—this increases hypothermia risk 2, 7
- Do not apply topical antibiotics as first-line treatment—reserve these only for infected wounds 2, 7
When to Activate Emergency Services Immediately
These burns require specialized burn center care: