First Aid for Mild to Moderate Burns
Immediately cool the burn with clean running water for 5 to 20 minutes—this is the single most important first aid intervention to limit tissue damage and reduce pain. 1
Immediate Cooling Protocol
- Start cooling as soon as possible after the burn occurs, ideally within the first few minutes 1
- Use clean running water at room temperature—avoid ice water which can cause further tissue damage 1
- Continue cooling for 5 to 20 minutes to achieve optimal benefit 1, 2
- Remove all jewelry and tight clothing from the affected area before swelling begins, as this prevents vascular compromise 2, 3
- Monitor children closely for hypothermia during the cooling process, especially if the burn covers a larger area 1, 2
If Running Water Is Not Available:
- You may use ice wrapped in cloth for superficial burns with intact skin, but never apply ice directly to the burn 1, 2
After Cooling: Treatment Based on Burn Severity
For First-Degree (Superficial) Burns:
These burns only affect the outer skin layer, appear red without blisters, and heal without scarring 1
- Apply petrolatum, petrolatum-based antibiotic ointment (such as bacitracin), honey, or aloe vera to the cooled burn 1, 2, 4
- Cover with a clean, non-adherent dressing 2, 3
- Take over-the-counter pain medications (acetaminophen or NSAIDs) for pain control 1, 2
For Second-Degree (Partial-Thickness) Burns:
These burns involve deeper layers, typically form blisters, and may take up to three weeks to heal 1, 5
- After cooling, loosely cover with a clean cloth or non-adherent dry dressing while awaiting medical evaluation 1, 2
- For small second-degree burns being managed at home, apply petrolatum-based antibiotic ointment and a non-adherent dressing 2, 6
- Take over-the-counter pain medications for pain control 1, 2
Critical Pitfalls to Avoid
- Never apply ice directly to burns—this causes additional tissue damage 2, 3
- Never apply butter, oil, or other home remedies—these can trap heat and worsen the injury 2, 3
- Never break blisters—intact blisters provide a natural barrier against infection 2, 3
- Do not use prolonged cooling in young children without monitoring for hypothermia 1, 2
When to Seek Immediate Medical Care
You must seek professional medical attention if the burn involves:
- Face, hands, feet, or genitals—these areas require specialized care to prevent permanent disability 1, 2, 3
- More than 10% body surface area in adults (roughly the size of your palm equals 1% body surface area) 1, 2
- More than 5% body surface area in children 1, 2
- All third-degree (full-thickness) burns where the skin appears white, charred, or leathery 1, 2
- Signs of inhalation injury: soot around nose or mouth, difficulty breathing, singed nasal hairs 1, 2
- Circumferential burns (burns that wrap completely around an arm, leg, or torso) 3
Pain Management
- Over-the-counter NSAIDs or acetaminophen are reasonable first-line options for mild to moderate burn pain 1, 2
- Pain medications should be taken as directed on the package label 2
Special Considerations
- Do not use prophylactic antibiotics for outpatient burn management—antibiotics should only be used if signs of infection develop 6, 5
- Signs of infection include: increased pain, redness spreading beyond the burn, swelling, warmth, purulent discharge, or fever 6
- Patients with diabetes are at higher risk for complications and should have a lower threshold for seeking medical evaluation 5