The first step in caring for a burn victim is to stop the burning process. Before cooling the wound, applying any dressing, or assessing how bad the injury is, you need to remove the person from the heat source and make sure the burning has actually ended. This sounds obvious, but clothing can trap heat against the skin even after the flame or hot liquid is gone, and rescuers sometimes skip straight to treatment while the burn is still deepening.
Stop the Burning Process
What “stop the burning” looks like depends on the type of burn. For flames, douse them with water or smother them with a blanket. If the person’s clothing is on fire, have them stop, drop, and roll. For scalds from hot liquid, remove any soaked clothing immediately, since fabric holds heat and continues damaging the skin underneath.
Remove clothing and jewelry from the burned area as quickly as possible. Rings, bracelets, and watches can trap heat and also become dangerously tight if the area starts to swell. One important exception: if clothing has melted into the skin (nylon is common for this), leave it in place. Pulling adherent material off the wound will tear tissue and make the injury worse.
For electrical burns, your own safety comes first. Disconnect the person from the electrical source before you touch them. If you can’t turn off the power, use a dry, nonconducting object like a piece of wood, plastic, or cardboard to separate the person from the source. Stay at least 50 feet away from downed or sparking power lines.
For chemical burns, brush off any dry powder before adding water. Then flush the area with cool running water for at least 20 minutes, using a shower if one is available. Remove any contaminated clothing or jewelry during the rinse.
Cool the Burn With Running Water
Once the burning has stopped, the next priority is cooling. Hold the burned area under cool running water for a full 20 minutes. This recommendation was updated in 2019 from an earlier guideline of 10 minutes, based on evidence that longer cooling reduces tissue damage and improves healing. The ideal water temperature is around 12°C (about 54°F), which feels noticeably cool but not cold.
Do not use ice, ice water, or anything frozen. Ice restricts blood flow to the damaged tissue, can numb the area so you can’t tell when the skin is getting too cold, and risks causing frostnip on top of the burn. This combination can lead to permanent blood flow problems and increase infection risk. Even ice-cold water carries these dangers. Stick with cool tap water.
Butter, toothpaste, and other home remedies have no place on a fresh burn. They trap heat in the skin and introduce bacteria into the wound.
Cover the Burn
After cooling, loosely cover the burned area with a non-stick dressing or clean cloth. If you don’t have a proper burn dressing, plastic wrap works as a temporary barrier because it won’t stick to the wound. Regular dry gauze should not go directly on an open burn, since it will adhere to the raw surface and cause pain and further damage when removed. If you’re wrapping gauze over a non-stick layer, keep it loose enough that swelling won’t make it tight.
If blisters have formed, leave them intact. Blisters act as a natural sterile covering for the damaged skin underneath. Popping them exposes raw tissue to bacteria and significantly increases infection risk.
How to Tell if a Burn Needs Emergency Care
Not every burn requires a trip to the emergency room, but several situations call for immediate medical help. Call 911 if the burn looks charred, white, brown, or leathery. These are signs of a full-thickness (third-degree) burn that has destroyed all layers of skin and damaged the nerves beneath, which is why these burns are often painless despite being the most severe. Full-thickness burns always require surgical treatment and take more than eight weeks to heal.
Also seek emergency care if the burn is larger than about 3 inches across, covers the hands, feet, face, neck, groin, buttocks, or a major joint, or wraps all the way around an arm or leg. Burns in these locations carry higher risks of complications even when they appear relatively minor.
Recognizing Burn Depth
Superficial (first-degree) burns affect only the outermost layer of skin. They look pink or red, feel painful, and stay dry with no blisters. These heal on their own within 5 to 10 days without scarring. A typical sunburn is a superficial burn.
Partial-thickness (second-degree) burns go deeper and almost always produce blisters. A superficial partial-thickness burn has a pink or red wound bed underneath the blister and is quite painful. These generally heal within 2 to 3 weeks with minimal scarring. A deep partial-thickness burn looks mottled rather than uniformly pink, and pain is reduced because some nerve endings have been damaged. Scarring is unavoidable with these deeper burns, and healing takes considerably longer.
Full-thickness (third-degree) burns extend through the entire skin into the tissue below. The skin looks stiff, dry, and leathery. It won’t blanch (turn white and then return to color) when you press on it, because the blood supply is destroyed. The person typically feels no pain in the burned area itself because the nerves are gone, though surrounding areas with partial-thickness damage will still hurt. These burns cannot heal adequately on their own and require surgery.
Quick Summary of the Steps, in Order
- Ensure safety. Make sure you and the victim are away from the heat source, electrical current, or chemical.
- Stop the burning. Remove heat-retaining clothing and jewelry. Leave anything melted into the skin.
- Cool with running water. 20 minutes at cool (not cold) temperature. No ice, no butter.
- Cover the wound. Use a non-stick dressing or clean cloth, loosely applied. Don’t pop blisters.
- Call for help if needed. Any burn that is full-thickness, larger than 3 inches, or on the face, hands, feet, or genitals needs professional medical care.