Burns & Scalds
Twenty minutes of cool running water is the single most effective burn treatment there is, and it still helps up to three hours after the injury.
When to call an ambulance immediately
- Burns to the face, neck, hands, feet, genitals, or across a joint
- A burn larger than the patient's own palm
- A burn that looks white, leathery, charred, or is painless, because deep burns destroy the nerves
- Hoarse voice, singed nasal hair, soot around the mouth, or black sputum, which suggests an airway burn and is immediately life-threatening
- Electrical burns and chemical burns, however small they look
- Any significant burn in an infant, an older adult, or a person with diabetes
What to do
Work through these in order. If you are alone, put your phone on speaker so the 108 call handler can guide you while your hands stay free.
- 1
Stop the burning process
Move away from the heat source. Smother flames with a blanket and roll the person on the ground. For a chemical burn, brush off dry powder first, then irrigate continuously with running water for at least twenty minutes.
- 2
Cool with running water for 20 minutes
Cool, not ice-cold, running tap water over the burn for a full twenty minutes. This is the step people cut short, and it is the one that limits how deep the burn ultimately becomes. It remains worthwhile even up to three hours after the injury.
- 3
Remove jewellery and tight clothing early
Rings, bangles, watches and belts must come off before swelling sets in. Do not peel away clothing that is stuck to the burn. Cut around it instead.
- 4
Keep the rest of the person warm
Cooling a large burn can drop the body temperature dangerously, especially in children. Cool the burn, but cover the patient.
- 5
Cover the burn loosely
Lay cling film in sheets over the burn, rather than wrapping it around a limb, or use a clean non-fluffy cloth. This reduces pain and infection risk and still lets the hospital assess the wound.
- 6
Give simple pain relief and get help
Paracetamol or ibuprofen as per the label. Call 108 for anything on the red-flag list, and go to hospital for anything you are unsure about.
Never do these
Most of these are well-intentioned and widely believed. All of them make the situation worse.
- Never apply ice or iced water. It deepens the burn by shutting down blood supply to injured skin.
- Never apply toothpaste, butter, ghee, oil, haldi, ink, egg white, potato peel, mud or ash. These trap heat, introduce infection, and have to be painfully scrubbed off before the burn can even be assessed.
- Never burst blisters. An intact blister is a sterile biological dressing.
- Never use cotton wool or any fluffy dressing, because the fibres embed in the wound.
- Never wrap cling film tightly around a limb, because swelling will turn it into a tourniquet.
Once the immediate danger has passed
- Watch for infection over the following days: spreading redness, increasing pain, pus, fever, or a foul smell.
- Check tetanus immunisation status for any burn that breaks the skin.
- Deep or large burns need specialist burns care. Scarring and contractures are far easier to prevent than to correct.
Frequently asked
Why is toothpaste on burns such a persistent myth?
It feels momentarily cooling because of the menthol, which convinces people it is working. In reality it traps heat against the skin, introduces bacteria, and obscures the wound so its depth cannot be judged. Emergency departments spend real time scrubbing it off injured skin.
How much is larger than the palm?
The patient's own palm including the fingers is roughly one percent of their body surface area. It is a quick and reasonably reliable way to judge whether a burn needs hospital assessment.
Reviewed and written by
Dr. Poonam Sekhon Chahal, MBBS, MEM
Senior Emergency Physician, Manipal Hospital, Patiala · Certified in ACLS, ATLS, PALS and PoCUS