Burns and scalds

Twenty minutes of cool running water, up to three hours after the burn. It is the single most effective first aid there is, and it is rarely done for long enough.

What it is

Injury to the skin from heat, chemicals, electricity, friction or radiation. Scalds, from hot liquids and steam, are the commonest burns in young children.

**The first aid is the treatment, and it is time-critical and almost always done inadequately.** Cool running water over the burn for **20 minutes**, starting as soon as possible and still worthwhile up to three hours afterwards, reduces the depth of the burn, the need for surgery and the scarring. Most people run it under the tap for a minute or two, which is not enough.

**Cool the burn and warm the patient.** Prolonged cooling causes hypothermia, particularly in babies and older people, so cover the rest of the body while cooling the burn.

Never use ice, iced water, butter, toothpaste, creams or ointments. Cling film applied loosely lengthwise, not wrapped tightly around a limb, is the ideal covering.

Chemical burns need irrigation for far longer, at least 20 minutes and often more, removing contaminated clothing.

Burns to the face, hands, feet, genitals, over joints, or circling a limb, and all electrical and chemical burns, need hospital assessment, as do any burn larger than the person's palm, any full-thickness burn, and any burn in a child under five or an older person.

Burns are also a safeguarding surface: injuries that do not fit the account, glove-and-stocking scalds, and delayed presentation all require a safeguarding thought.

Signs you might notice

Superficial: red, painful, no blisters. Heals in around a week.

Superficial partial thickness: blisters, wet, very painful, blanches when pressed.

Deep: patchy red and white, less painful, does not blanch.

Full thickness: white, brown or charred, leathery, painless because the nerves are destroyed.

**999** for: burns to the airway, suggested by soot around the mouth or nose, hoarseness, singed nasal hair, or breathing difficulty; large burns; electrical burns; chemical burns; burns with other injuries; and any burn in someone who is unwell.

Hospital assessment for: burns to face, hands, feet, genitals or over joints; circumferential burns; any burn bigger than the person's palm; deep or full-thickness burns; chemical or electrical burns; and burns in children and older people.

Safeguarding concern: an injury that does not fit the explanation, symmetrical scalds, or delayed presentation.

How it can affect day-to-day life

The 20-minute rule is the thing worth knowing, and it is not widely known. Setting a timer prevents the natural tendency to stop after two minutes.

Cling film is the best available dressing and most homes have it; loosely laid on, never wrapped tight.

Blisters should generally be left intact; deroofing is a clinical decision.

Pain is often under-treated, particularly during dressing changes, which are the worst part of burn care for most people.

Sun protection for a healing burn is essential for at least a year; new scar tissue burns and pigments easily.

Itching during healing is intense and under-treated; emollients and antihistamines help.

Scar management with silicone and massage, starting once healed, improves outcomes, and pressure garments are used for larger burns. See keloid scars.

Prevention in the home is specific: hot drinks out of reach, kettle flexes short and coiled, bath cold water first and temperature tested, thermostatic valves, and cooker guards.

Electrical burns can cause deep damage with minimal surface signs, and always need assessment.

Supporting someone well

Cool the burn under running water for **20 minutes**. Set a timer. It works up to three hours afterwards.

Remove clothing and jewellery from the area, unless stuck to the skin.

Cool the burn and keep the rest of the person warm; hypothermia is a real risk in children.

Never use ice, butter, toothpaste or creams.

Cover with cling film laid on loosely, or a clean non-fluffy cloth.

Irrigate chemical burns for much longer, and remove contaminated clothing.

Give pain relief early and generously.

Get the burns above assessed at hospital; call 999 for airway involvement.

Protect healing skin from the sun for at least a year, and use silicone for scars.

Raise safeguarding concerns where the injury does not fit the account.

Where to get help

999 for airway burns, large burns, electrical or chemical burns, or anyone unwell.

A and E or a minor injuries unit for burns needing assessment.

A specialist burns service for significant burns; referral criteria are clear and local units refer on.

Changing Faces support people with visible differences after burns.