Burns and Scalds: First Aid and When to Seek Emergency Care

Why burns need quick decisions

Burns are one of the most common household injuries, yet many people are unsure of the correct first aid or when a burn needs professional medical attention. Getting both right matters — proper first aid in the first 20 minutes dramatically affects healing and scarring, and choosing the right level of care ensures you get treatment without an unnecessary wait.

This guide covers first aid for all types of burns, how to assess severity, and when to head for A&E versus managing at home or visiting a UTC.

Immediate first aid: the first 20 minutes

Regardless of the burn's cause or severity, the initial steps are the same:

1. Stop the burning process

• Flames — stop, drop and roll; smother with a blanket or coat; douse with water
• Scalds — remove the person from the source. Carefully remove wet clothing unless it is stuck to the skin.
• Chemical burns — remove contaminated clothing (wearing gloves if available) and irrigate with running water for at least 20 minutes. Do not attempt to neutralise the chemical.
• Electrical burns — ensure the electrical source is disconnected before touching the person. Call 999 — electrical burns often cause internal injuries not visible on the surface.

2. Cool the burn

Run cool (not cold) running water over the burn for at least 20 minutes. This is the single most effective first aid intervention. The water should be comfortable to the touch — roughly 15°C. Do not use ice, iced water, or frozen peas directly on the burn, as these can cause further tissue damage by cooling the skin too rapidly.

Twenty minutes is the minimum — longer is better, particularly for larger burns. Cooling can be effective up to three hours after the burn occurred, so it is never too late to start.

3. Remove jewellery and clothing

While cooling, gently remove rings, watches, bracelets and clothing from the burned area — swelling develops rapidly and can make removal impossible later. Do not remove anything that is stuck to the burn.

4. Cover the burn

After cooling, cover the burn with cling film (laid along the burn, not wrapped tightly around a limb) or a clean, non-fluffy material. Cling film is ideal because it is sterile from the roll, transparent (so clinicians can see the burn without removing the covering), and does not stick to the wound.

Do not apply:

• Butter, oil, toothpaste or any home remedy — these trap heat and introduce infection
• Adhesive dressings or plasters — they will stick to the wound
• Fluffy materials like cotton wool — fibres embed in the wound

5. Manage pain

Burns are extremely painful. Give age-appropriate paracetamol and ibuprofen. For children, use the correct dose for their weight and age. Our children's guide covers paediatric medication dosing.

Assessing burn severity

Burns are classified by depth and area:

Depth

Superficial (first-degree): Only the outer layer of skin (epidermis) is affected. The skin is red, painful and may swell slightly. Sunburn is a typical example. These burns heal within a week without scarring.

Partial-thickness (second-degree): The epidermis and part of the underlying dermis are damaged. The skin is red, blistered, very painful and weeping. These burns take 2–4 weeks to heal and may scar.

Full-thickness (third-degree): The entire thickness of the skin is destroyed. The burn may look white, brown, black or leathery. Paradoxically, full-thickness burns may be less painful than partial-thickness burns because the nerve endings have been destroyed. These burns always require specialist treatment and often need skin grafting.

Area

Burn area is estimated as a percentage of the body surface. A rough guide: the palm of the patient's hand (including fingers) represents approximately 1 per cent of their body surface area. Burns covering more than 1 per cent in a child or 3 per cent in an adult generally need hospital assessment.

When to call 999

Call 999 for:

• Burns affecting the airway — the person was in a fire or explosion, has singed nasal hair, a hoarse voice, facial burns, or difficulty breathing
• Electrical burns — even if the skin burn looks minor, internal injuries may be serious
• Chemical burns to the eyes
• Burns covering a large area (more than 5 per cent of body surface area, or any full-thickness burn)
• The person is in shock — pale, cold, sweaty, confused or drowsy
• Burns in combination with other injuries (explosion, fall, road traffic collision)

Our guide on when to call 999 covers emergency decision-making in general.

When to go to A&E

Go to A&E (but a 999 ambulance is not usually needed) for:

• Any burn to the face, hands, feet, genitals or major joints — these areas need specialist assessment because of the risk of functional impairment and scarring
• Full-thickness burns of any size
• Circumferential burns — burns that go all the way around a limb, finger or toe — these can restrict blood supply as swelling develops
• Burns in babies under 12 months regardless of size
• Partial-thickness burns larger than the patient's palm
• Chemical burns (after 20 minutes of irrigation)
• Any burn you are unsure about — it is better to have a burn assessed and be told it is minor than to undertreate one that turns out to be serious

Check live A&E wait times before travelling to choose the least busy department.

When a UTC or self-care is sufficient

A UTC or minor injuries unit can assess and dress:

• Small superficial burns not on the face, hands, feet or genitals
• Small partial-thickness burns (smaller than the patient's palm) in adults, not on sensitive areas
• Minor scalds from hot drinks or cooking

Self-care at home is appropriate for:

• Sunburn without blistering
• Very small superficial burns (smaller than a 10p coin) not on sensitive areas
• Burns that are healing well after initial treatment

Treatment at hospital

At A&E or a specialist burns unit, treatment may include:

• Cleaning the burn under anaesthesia or pain relief
• Debridement — removing dead tissue
• Specialist dressings — silver-containing dressings, hydrocolloid dressings, or biological dressings
• Blistering management — whether to leave blisters intact or drain them (clinical opinion varies)
• Tetanus booster — if your tetanus vaccination is not up to date
• Antibiotic prophylaxis — for burns at high risk of infection
• Referral to a specialist burns unit — for complex burns requiring ongoing specialist care
• Skin grafting — for deep burns that will not heal on their own

Burns in children

Children's skin is thinner than adults', which means the same heat source causes a deeper burn. Scalds from hot drinks are the most common burn in children under five — a mug of tea or coffee is hot enough to scald a child 15 minutes after it was poured.

Any burn in a child under 12 months should be assessed at A&E regardless of apparent severity. For older children, apply the same first aid and severity assessment as adults, but with a lower threshold for seeking professional help. When in doubt, call 111 for advice.

Our children's A&E guide covers paediatric emergency attendance in general.

Common mistakes

• Not cooling for long enough. Twenty minutes feels like a long time when someone is in pain, but cutting it short significantly worsens the injury. Set a timer.
• Using ice or frozen items. Ice causes vasoconstriction and can convert a superficial burn into a deeper one.
• Applying butter, oil or cream. These trap heat and increase infection risk.
• Popping blisters at home. Blisters are a natural protective barrier. Popping them at home introduces infection risk. Let a clinician decide whether drainage is appropriate.
• Removing stuck clothing. If clothing is stuck to the burn, leave it for clinicians to manage. Pulling it off tears the damaged skin.
• Underestimating scald injuries. Scalds look less dramatic than flame burns but can be just as deep. Hot cooking oil and steam cause particularly deep scalds.

After treatment

Follow-up care for burns includes:

• Regular dressing changes — you may be taught to do these at home or asked to attend a practice nurse or burns clinic
• Scar management — moisturising, sun protection, and sometimes pressure garments or silicone sheets
• Physiotherapy — for burns affecting joints, to maintain range of motion
• Psychological support — burns, especially visible ones, can cause significant emotional distress

Our after discharge guide covers general post-A&E recovery and follow-up.

Bottom line

Cool the burn with running water for 20 minutes — this is the most important thing you can do. Cover with cling film. Give pain relief. Then decide: small superficial burns can be managed at home or at a UTC; burns to the face, hands, feet, genitals or joints, all full-thickness burns, large partial-thickness burns, and all burns in babies need A&E. When in doubt, err on the side of caution and have it assessed.