Burns: The First Twenty Minutes
The most effective burn treatment in your house is the kitchen tap, and almost nobody uses it for long enough.
Twenty minutes of cool running water. Not two minutes, not until it stops hurting, not a wet cloth. Twenty minutes, and it remains worth doing for up to about three hours after the injury — which matters, because people frequently arrive at that realisation late.
Everything people reach for instead — ice, butter, toothpaste, creams, flour — makes the outcome worse.
The 10-minute version
- Cool running water for 20 minutes, as soon as possible. Still beneficial up to three hours later.
- Never ice. It causes further tissue damage and constricts blood flow to an area that needs it.
- Cover with cling film or a non-stick dressing afterwards. Cling film does not adhere to the wound, is clean off the roll, and lets a doctor see the burn.
Do this, in order
- Stop the burning. Remove them from the heat. If clothing is alight, stop, drop, cover and roll. If it is a chemical burn, brush off dry powder first, then flush.
- Remove jewellery and anything constricting near the burn, before swelling starts. Rings especially.
- Cool with cool running water for 20 minutes. A tap, a shower, a hose. Cool, not iced.
- Remove wet or soaked clothing unless it is stuck to the burn — never peel adhered fabric off.
- Keep the rest of them warm. Twenty minutes of running water on a child cools the whole body, and hypothermia while treating a burn is a genuine risk. Blanket over everything not being cooled.
- Cover the burn with cling film laid on in strips (not wrapped tightly around a limb) or a non-stick dressing.
- Pain relief — paracetamol or ibuprofen at normal doses.
- Seek medical care if it meets any threshold below.
When it needs a doctor or an ambulance
Call 000 for:
- Burns to the airway — any burn from inhaled smoke or steam, soot around the mouth or nose, hoarseness, or breathing difficulty
- Burns with loss of consciousness
- Electrical burns
- Very large burns
- Circumferential burns — right around a limb, hand, foot or chest
Go to a doctor or emergency department for:
- Any burn on a child or an infant, other than a very small superficial one
- Burns to the face, hands, feet, genitals or over a joint
- Burns larger than about the size of the person’s palm — roughly 1% of body surface
- Deep burns — white, leathery, charred, or painless (nerve damage means no pain is a bad sign, not a good one)
- Chemical or electrical burns, always
- Any burn with blistering that is more than trivial
- Any burn showing signs of infection later — increasing pain, redness spreading, pus, fever
- Anyone whose tetanus vaccination is not current
What never to put on a burn
- Ice or iced water — causes further damage
- Butter, oil, margarine — traps heat
- Toothpaste — a stubbornly persistent myth
- Flour, sugar, egg white, honey as a home remedy
- Antiseptic creams or ointments on a fresh burn — they trap heat and obscure assessment
- Cotton wool or fluffy dressings — fibres stick to the wound
- Adhesive dressings directly on a burn
- Do not break blisters. They are a sterile dressing your body made
The child and scald problem
Scalds from hot liquids are the most common burn in young children, and the mechanism is almost always the same: a cup of tea or coffee within reach, or a kettle cord that can be pulled.
Prevention worth doing today:
- Hot drinks out of reach, and never carried while holding a child
- Kettle cords short and pushed back, appliances at the rear of the bench
- Bath water tested with your elbow, cold in first, hot off last
- Hot water system tempered — bathroom outlets in newer homes are limited to 50°C, and it is worth checking yours
- Oven and cooktop guards if you have a crawling child
- Fireplace and heater screens
A child’s skin is thinner, so the same water causes a deeper burn faster. Which is why the threshold for having a child’s burn looked at professionally is much lower than for an adult.
Thresholds
| Situation | The rule |
|---|---|
| Any burn | Cool running water, 20 minutes. Still useful up to 3 hours later |
| Ice | Never |
| Covering | Cling film in strips, or a non-stick dressing |
| Jewellery near a burn | Off immediately, before swelling |
| Larger than a palm | Medical assessment |
| Face, hands, feet, genitals, joints | Medical assessment |
| Any child’s burn beyond trivial | Medical assessment |
| White, leathery, charred or painless | Deep burn. Medical assessment |
| Airway involvement, electrical, circumferential, unconscious | 000 |
| Blisters | Leave intact |
| Long cooling of a child | Keep the rest of them warm |
What it costs
| Tier | Spend | What it buys |
|---|---|---|
| Free | $0 | Twenty minutes at the tap, cling film from the kitchen drawer, knowing the referral thresholds |
| Solid | ~$25–50 | Two hydrogel burn dressings, a roll of cling film kept with the first aid kit, non-stick pads |
| Prevention | ~$40–120 | Short kettle cord, appliance placement, a bath thermometer, cooktop guard |
| Worth doing | ~$150–250 | A first aid course. Burn management is one of the highest-yield parts of it |
The drill: two minutes now
- Put a roll of cling film with the first aid kit, not in the kitchen drawer where it competes with sandwiches.
- Time twenty minutes once, standing at the sink with your hand under the tap. It is much longer than it sounds, and knowing that is the point — this is the step people cut short.
- Check your hot water temperature at a bathroom tap. If it is scalding, ask a plumber about a tempering valve.
- Look at your kettle cord and where hot drinks get put down.
- Say the rule out loud to everyone in the house: twenty minutes of cool water, never ice, never butter.
Frequently asked questions
How long should you run cool water on a burn?
Twenty minutes, starting as soon as possible. It remains beneficial for up to about three hours after the injury, so start even if there has been a delay.
Should I put ice on a burn?
No. Ice causes further tissue damage and restricts blood flow to tissue that needs it. Use cool running water, not iced water.
What should I cover a burn with?
Cling film laid on in strips, or a non-stick dressing. Cling film does not stick to the wound, comes clean off the roll and lets a clinician see the burn. Avoid cotton wool and adhesive dressings.
When does a burn need medical attention?
If it is larger than the person’s palm, on the face, hands, feet, genitals or a joint, on a child, deep (white, leathery or painless), chemical or electrical, or showing infection. Call 000 for airway burns, electrical burns, unconsciousness or burns right around a limb or the chest.
Should I pop blisters?
No. An intact blister is a sterile covering. Leave it and have anything significant assessed.
Why does a painless burn matter?
Because it suggests nerve damage from a deep burn. Absence of pain is a warning sign rather than reassurance, and it needs medical assessment.