5 Burns and Thermal Injuries

Burn causes and first-aid priorities

Burns can damage the skin and deeper tissues. Causes include heat, chemicals, electricity, and radiation. First aid focuses on stopping further injury, cooling the burn safely, and recognizing when urgent medical care is needed.

Recognizing burn depth and severity

Burns are described by how deeply they damage tissue. Superficial burns affect the outer skin and are often red, dry, and painful, without blisters. Partial-thickness burns affect deeper skin layers; they may be red or mottled, swollen, blistered, and very painful. Full-thickness burns destroy the full depth of the skin and may reach tissue beneath it. Skin may look white, brown, or charred, and the center may feel less painful because nerves are damaged.

Appearance alone cannot reliably show how serious a burn is. A burn that looks small may still be dangerous because of its location, cause, or associated injuries.

Stop the burning process safely

Before helping, check that the scene is safe. Do not enter a fire, touch a live electrical source, or contact an unknown chemical. Call emergency services if the scene is unsafe.

If it is safe, move the person away from the heat or source. For burning clothing, have the person stop, drop, and roll, or smother the flames with a blanket if available.

Remove hot or smoldering clothing and jewelry near the burn, but do not pull off anything stuck to the skin. Remove rings, watches, and other tight items before swelling develops.

For a dry chemical, brush away the powder before flushing. For a liquid chemical, use plenty of running water and avoid exposing yourself; follow emergency responders’ instructions. For electrical injuries, make sure the power is off before approaching. Electrical burns need medical evaluation even when the skin injury looks minor.

Cool and protect the burn

For a thermal burn, promptly cool the injured area with clean, cool running water. Aim for about 20 minutes when practical, but do not delay emergency care to complete cooling. Cool only the burned area and keep the person warm, especially when the burn is large or the person is a child, to reduce the risk of hypothermia. Do not use ice or freezing water because they can worsen tissue damage.

After cooling, loosely cover the burn with a clean, dry, non-adherent dressing or cloth. Do not break blisters or apply butter, oils, or creams as first aid. Continue monitoring the person’s breathing and responsiveness.

When to seek urgent medical care

Call 911 for difficulty breathing, suspected smoke inhalation, burns to the face or mouth with breathing concerns, a large or deep burn, signs of shock, or another serious injury. Signs of shock can include faintness, weakness, and pale or clammy skin. Smoke inhalation may be present after a fire in an enclosed space even if burns on the skin look limited.

Prompt medical evaluation is important for burns that:

• Are larger than the person’s palm or involve a substantial body area.

• Affect the face, hands, feet, genitals, or major joints.

• Circle around an arm, leg, chest, or neck.

• Look deep, blister extensively, or show white, brown, or charred skin.

• Were caused by electricity or chemicals.

• Occur in a young child, an older adult, or someone with significant health conditions.

When unsure about severity, seek medical advice. Burn-center referral criteria help clinicians decide on specialist care and are not a substitute for assessment.

Putting the response together

Make the scene safe, stop contact with the burn source, and remove nearby tight items without pulling away stuck material. Cool thermal burns with cool running water, keep the person from getting cold, and cover the injury loosely. Call 911 for breathing problems, shock, major burns, or other life-threatening injuries; seek prompt evaluation for deep, large, special-location, electrical, or chemical burns.