How to treat a burn

Key points about first aid for burns

  • Contact with any source of heat can cause a burn injury.
  • Act quickly when someone has been burned.
  • The key things to do are stop the burn, cool the burn and cover the burn.
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A thermal burn is a type of burn resulting from making contact with heated objects or liquid, such as boiling water, steam, hot cooking oil, fire and hot objects. When a burn is caused by contact with hot liquid, it is called a scald.

Hot water scalds are the most common type of thermal burn affecting children. In adults, thermal burns are most commonly caused by fire.

What are the signs someone has been burned?

Signs someone has been burned include the following, although they may not experience all of these:

  • severe pain – although a deeper burn may be less painful due to destruction of nerve endings
  • red, peeling or blistered skin (or blackened or waxy white) – exact appearance depends on both depth of burn, what caused it and time from initial injury
  • watery fluid weeping from the injured area
  • pale, cold and sweaty, feeling faint and dizzy, and complaining of nausea or vomiting, ie, signs of shock
  • swelling of the injured area may appear later.

What do I do if someone has a thermal burn?

There are 3 key steps to follow if someone has a burn injury:

  1. Stop the burn.
  2. Cool the burn.
  3. Cover the burn.
1. Stop the burn

Remove the heat source from the person or the person from the heat source, whichever is easiest and safest. If any clothing is wet with hot liquid or a chemical splash, remove it quickly and carefully as part of stopping the burn. Don’t remove clothes that are stuck to the burn.

2. Cool the burn

Immediately cool the affected area for up to 20 minutes using cool running water from a tap or shower. If there is no water, use any cool clean fluid, such as beer or soft drink. The burned part can be put in a bowl or bucket of cold water if this is easier than pouring water over the burn. Remember to keep the person warm.

A first aid burn gel may be used if water is not available.

Remove any tight clothing, watches, rings or jewellery from the burned area, if possible, because of the risk of swelling and tightening.

If the person is feeling faint lie them down.

Call 111 for an ambulance if:  

  • the person is badly injured
  • the burn is causing significant pain
  • the burn involves their eyes
  • the burn is larger than half the person’s arm.

See a doctor if:

  • the burn is causing ongoing significant pain
  • involves the face, hands, joints or genitals.
3. Cover the burn

After cooling the injured area for up to 20 minutes, apply a sterile dressing. Use a dressing that doesn’t stick to the skin. Clean plastic kitchen wrap can be used as a temporary dressing. Cover the burn but don’t wrap the dressing around the area.

Video: New Zealand Red Cross - Burn dressing

(NZ Red Cross, NZ, 2020)

What should I not do when someone is burned? 

  • Don’t apply ice to the burn.
  • Don’t try to remove fabric that is stuck to a burn.
  • Don’t break blisters or remove peeled skin
  • Don’t apply creams, ointments, lotions, toothpaste or butter to a burn. This will have to be removed later and may cause an infection and delay healing.
  • Don’t put small children or babies in a cold bath or shower for a full 20 minutes. This can cause hypothermia.
  • Don’t use adhesive (sticky) tape on the skin around the burn because this may cause further tissue damage.

Clothing on fire

If someone's clothing is on fire:

  1. STOP, DROP and ROLL the person before checking for burns and cooling the injury.
  2. Stop the burn by smothering the flames with a coat or blanket and then get the person onto the ground and roll them to extinguish the flames.

Burns of the mouth or throat 

If someone has been accidentally exposed to fire or heated gases, their mouth and airway may be damaged. There may be signs of burning around their lips, nose, mouth, eyebrows or eyelashes. A dry cough or hoarse voice is an early sign of airway injury. 

  1. Move the person to a safe area if it is safe for you to do so – preferably into fresh air.
  2. Cool the skin injury. Pour running water over the burn for 20 minutes.
  3. If there is any breathing difficulty, help them find the best position for easy breathing, with their head and chest raised.
  4. Call 111 for an ambulance.

An electrical burn is the result of electricity passing through the body. It may be caused by a number of sources of electricity, such as household current, power lines and lightning. The type of burn or damage depends on the amount, type and strength of the electrical current. An electric burn may appear minor or not show on the skin at all but may have caused more extensive internal injury.

If someone has an electrical burn, call 111. 

  1. Look first. Don't touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.
  2. Turn off the source of electricity if possible. If not, move the source away from both you and the injured person using a non-conducting object made of cardboard, plastic or wood.
  3. Check for signs of circulation (breathing, coughing or movement). If they are not there, begin cardiopulmonary resuscitation (CPR) immediately. Keep doing CPR until the ambulance arrives. 
  4. If CPR not required, prevent shock by lying the person down with the head slightly lower than the trunk and the legs elevated.
  5. Cover any burned areas with sterile dressings or temporarily with clean plastic kitchen wrap. Don't use a blanket or towel. Loose fibres can stick to the burns.

A chemical burn is a burn to internal or external organs of the body caused by a corrosive or caustic chemical substance that is a strong acid or base (also known as alkali). Chemical burns are usually the result of an accident and can occur in the home, at school or, more commonly, at work, particularly in manufacturing plants that use large quantities of chemicals.

If someone has a chemical burn:

  1. Quickly remove any contaminated clothing. Avoid touching yourself or the person with the chemical as you do that. If the chemical is a powder brush it off without touching it yourself and before flushing the burned area with water.
  2. Cool the injury. Flood the burned area with lots of water and continue for at least 20 minutes. First aid for alkali burns can take up to an hour to return skin pH to normal.
  3. If a chemical solution has splashed into their eyes, hold the eyelids open so that water washes thoroughly under the lids to remove any trapped chemical.
  4. Call 111 for an ambulance urgently.

Video: How do you treat a chemical burn?

This video may take a few moments to load.

(NHS, UK, 2017)

Sunburn is a burn to the skin caused by excess exposure to ultraviolet (UV) radiation in the sun. It can also be caused by other sources of UV, such as sun beds. 

If someone has severe sunburn:

  • Run a cool shower or cool running water over the burn area for 20 minutes.
  • Don’t burst large blisters.
  • Use sunburn ointment for minor burns that are not severely blistered and have no broken skin.
  • Drink plenty of fluid (non-alcoholic).

See a healthcare provider:

  • for sunburns over a large area as these will be very painful
  • if the person is feeling unwell
  • if there are large blisters in the sunburn.

Read more about sunburn.

Video: Maia: Burns Survivor's Story

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(Inspire NZ, 2016)

Video: Burns Survivor: Dukie's Story

This video may take a few moments to load.

(Inspire NZ, 2016)

Video: Burns victim making a positive change for others (Being Me: Joshua)

This video may take a few moments to load.

(Inspire NZ, 2019)

Video: Burns Psychology - Patient Stories - Becky

This video may take a few moments to load.

(Pinderfields Hospital Regional Burns Centre, UK, 2021)

The following links provide further information about first aid for burns. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Burns and scalds(external link)(external link) Starship, NZ
Burns – key facts(external link)(external link) KidsHealth, NZ
First aid handbook(external link)(external link) St John, NZ
Burns and scalds(external link)(external link) NHS Choices, UK, 2015
Burns and scalds(external link)(external link) Patient Info, UK, 2018
National Burn Service(external link)(external link) NZ
Good food for wound healing(external link)(external link) 3D HealthPathways, NZ

Resources

Burn first aid factsheet(external link)(external link) ANZBA English(external link)(external link), Arabic(external link)(external link), Chinese(external link)(external link), Greek(external link)(external link), Italian(external link)(external link), Sudanese Arabic(external link)(external link), Vietnamese(external link)(external link)
Stop burns around the house(external link) Safekids Aotearoa
Initial management of small burns(external link)(external link) ANZBA, Australia
Initial management of severe burns(external link)(external link) ANZBA, Australia
Guide for trauma patients and whanau brochure(external link)(external link) Guide for trauma patients and whānau brochure, National Trauma Network, NZ, 2020 English(external link)(external link), te reo Māori(external link)(external link)
ANZBA fact sheets(external link)(external link) - Cement burns(external link)(external link), Car radiator burns(external link)(external link), Campfire burns(external link)(external link), Burns in elderly(external link)(external link), Gas BBQ burns(external link)(external link), Burns first aid(external link)(external link), Hot noodle burns(external link)(external link), Hot oil burns(external link)(external link), Hot water bottle burns(external link)(external link), Heat pack burns(external link)(external link), Hot ash burns(external link)(external link), Childhood bathroom scalds(external link)(external link), Treadmill burns(external link)(external link), Wood heater burns(external link)(external link), Motor vehicle exhaust burns(external link)(external link), LPG burns(external link)(external link), Childhood bathroom scalds(external link)(external link)
Initial management of small burns(external link)(external link) ANZBA
Initial management of severe burns(external link)(external link) ANZBA
Burn action plan(external link) Burn Support Group Charitable Trust, NZ

References

  1. First aid(external link)(external link) Australia and NZ Burn Association
  2. Burns(external link)(external link) St John, NZ
  3. Chemical burn(external link)(external link) Dermnet, NZ, 2007

Clinical resources

Initial assessment and management of burn injuries – guideline(external link) National Burn Service, NZ, 2017
Initial management of small burns(external link) Australian and NZ Burn Association
Paediatric burns(external link) Starship Clinical Guidelines, 2016
Burns guideline(external link) NZ Resuscitation Council, 2016
Lund and Browder Chart(external link) National Burns Service, NZ

Continuing professional development

Podcast

Burns – Jonathan Heather(external link)(external link) Goodfellow Podcast, NZ, 2018

Jonathan Heather is a New Zealand-trained plastic surgeon working at Counties Manukau Plastics Unit, the National Burns Centre and privately at the North Shore Plastic and Cosmetic Surgery Clinic. Jonathan talks about burns in primary care.

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Richard Wong She, Clinical Leader for Burns, National Burn Centre, Middlemore Hospital

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