Burns and Scalds: First Aid and When to Get Help

A burn is damage to the skin, and sometimes deeper tissue, caused by dry heat, fire, electricity, chemicals, radiation (including sunlight) or friction. A scald is the same kind of injury caused by hot liquid or steam — for example a hot drink, a kettle, a bath or a pan.

First aid is the same for both: stop the burning, cool the area with running water for 20 minutes, keep the person warm, and cover the burn loosely afterwards.

• redness of the skin, which may be harder to see on brown or black skin
• peeling skin
• swelling
• pain and tenderness
• blisters
• white, waxy or charred skin in deeper burns

Importantly, the amount of pain does not always show how serious a burn is. Some deep burns hurt less because the nerves in the skin have been damaged. Judge by the size, depth and location of the injury — not by pain alone.

Go to A&E, or seek urgent medical assessment, for:

• burns larger than the injured person's hand
• deep burns of any size
• burns on the face, neck, hands, feet, genitals or a major joint
• circumferential burns — burns that go all the way around a limb, finger, toe or another body part
• all electrical and chemical burns

Also seek medical help promptly for burns affecting:

• babies and young children
• older or frail people
• people with diabetes, or heart, lung or liver conditions
• people with a weakened immune system
• anyone who is pregnant, if you are unsure what to do

Some small, superficial burns — for example a minor scald on the forearm that is smaller than the person's hand and has been cooled properly — can be looked after at home.

If there is any doubt about the size, depth or position of a burn, please contact NHS 111, a pharmacist, a GP practice, an urgent treatment centre or a minor injuries unit. It is always reasonable to ask.

Once the burn has been cooled for 20 minutes, cover it to keep it clean and reduce pain:

• Lay cling film loosely over the burn in layers. Do not wrap it tightly around a limb, because the area may swell.
• A clean plastic bag can be a good option for a burn on a hand or foot.
• Otherwise use a clean, dry, non-fluffy dressing.
• Do not use fluffy material such as cotton wool, sticky dressings placed directly on the burn, or tight bandages.

Blisters form a natural, sterile cover over damaged skin, so they help it heal. Do not deliberately burst a blister.

If a blister breaks on its own, keep the area clean and dry, avoid picking at loose skin, and ask a pharmacist, GP or nurse about a suitable dressing. Seek advice if the area becomes more painful, red or swollen.

An electrical injury can look small on the skin while causing more serious damage inside the body, including to the heart. Anyone who has had an electric shock should be medically assessed, even if they feel well.

• Do not touch the person while they are still in contact with the electricity supply.
• Switch off the supply at the mains or unplug the appliance if it is safe to do so, then call 999.
• Once it is safe, begin normal burn first aid and stay with the person.

High-voltage electricity — such as overhead power lines, railway lines or substations — can arc across a distance. Do not approach. Stay well back, keep others away and call 999 so the supply can be isolated by the network operator.

Lightning strikes also cause internal injury and heart rhythm problems. Call 999 and get the person assessed in hospital.

Breathing in smoke or fumes can injure the airway and lungs. Watch for:

• coughing, a sore throat or a hoarse voice
• difficulty breathing or wheezing
• burns to the face, soot around the mouth or nose, or singed nasal hair
• headache, dizziness, confusion or nausea

Some symptoms can be delayed by several hours, so anyone who has been in a smoke-filled space should be assessed even if they seem well at first. Call 999 for any breathing difficulty.

Burns to the face need urgent assessment, because swelling can develop quickly and may affect breathing, and because eye injuries can affect sight.

If a chemical enters an eye, call 999 immediately and follow the handler's instructions while rinsing the eye with clean water. Keep the eye open as far as is comfortable and let the water run away from the unaffected eye. Do not delay calling for emergency help in order to rinse first — do both if someone else can call.

Children have thinner, more delicate skin, so a burn can be deeper than it looks. They also lose heat quickly while a burn is being cooled.

• Cool the burn for 20 minutes, but keep the rest of the child warm.
• Remove nappies and nearby clothing before swelling starts, unless anything is stuck to the skin.
• Seek medical advice for any burn in a baby or young child, and call 999 for anything large, deep or affecting the face, hands, feet or genitals.

Everyday prevention that genuinely helps:

• Keep hot drinks out of reach and away from table edges — a hot drink can scald a child many minutes after it is made.
• Keep kettle and appliance cords short and pushed back.
• Turn pan handles inwards and use the back rings where possible.
• Run cold water into the bath first and test the temperature with your elbow.
• Store hair straighteners and irons out of reach while they cool — they stay hot for a long time.
• Use a fireguard for open fires and heaters.

Skin becomes thinner with age, so a burn can be deeper than expected. Reduced mobility may mean someone cannot move away from the heat quickly, and altered sensation — for example from diabetes or a nerve condition — can mean a burn is noticed late.

Diabetes and poor circulation also slow healing and increase the risk of infection, and older people can become cold quickly while a burn is being cooled — so keep the rest of the body warm.

Please have a lower threshold for seeking clinical advice in these situations. A burn that would be minor in a fit younger adult may need proper assessment.

Sunburn is a burn caused by ultraviolet light. If someone is sunburnt:

• get them out of the sun, ideally indoors or into full shade
• cool the skin with a cool shower, bath or a damp flannel
• drink plenty of fluids to avoid dehydration
• cover the skin with loose clothing and keep it out of the sun until it has healed
• ask a pharmacist about suitable after-sun or pain relief

Contact NHS 111 if the skin is severely blistered or swollen, if a large area is affected, or if there is dizziness, confusion, headache, a high temperature, vomiting or other signs of heat exhaustion or heatstroke. Call 999 if someone is very unwell, confused or unresponsive.

The recognised instruction is short and easy to remember:

• Stop — do not run, because running feeds the flames.
• Drop to the ground.
• Roll over repeatedly to smother the flames.
• Then call 999 and begin burn first aid once it is safe to do so.

Smothering the flames with a heavy fabric such as a fire blanket or coat can help. Never put yourself in danger, and never use anything that could make the fire worse.

Burns can be very painful. A pharmacist, GP or nurse can advise on pain relief that is suitable for the person's age, health conditions and other medicines.

Always read and follow the label and patient information leaflet. We do not give doses on this page. Aspirin should not be given to children unless a doctor has specifically prescribed it.

If pain is severe or not controlled, please contact NHS 111 or the treating service.

• Keep dressings clean and dry.
• Follow the dressing-change instructions given by the clinic or nurse — do not remove clinical dressings early without advice.
• Elevate a burnt hand, arm, foot or leg if you have been advised to, as this reduces swelling.
• Protect healing skin from sunlight for many months, using clothing and a high-factor sunscreen once the skin has healed — new skin burns very easily and can darken permanently.
• Moisturise healed skin regularly if advised, and avoid scratching.

Contact NHS 111, a GP or the service treating the burn if there is:

• increasing pain rather than gradually settling pain
• spreading redness, swelling or warmth around the burn
• pus or an unpleasant smell
• a high temperature, shivering, or feeling generally unwell
• fluid soaking through the dressing
• a burn that is not healing as expected

Call 999 if someone becomes confused, very drowsy, breathless or extremely unwell.

Healing skin often feels itchy, tight or unusually sensitive for some time, and deeper burns can leave scars or changes in skin colour. Regular moisturising, gentle massage once advised, and pressure garments or silicone products where recommended can all help.

A burn across a joint can cause stiffness. Physiotherapy and occupational therapy help restore movement and daily function, and can be arranged through the burns service or GP.

A serious burn can also affect confidence, sleep, mood and how someone feels about their appearance. That is a normal reaction, not a weakness. Please speak to the burns team, GP or a support organisation — help is available and it works.

• Fit smoke alarms and test them monthly; many fire and rescue services offer a free home safety visit.
• Place hot drinks well away from edges, laps and children.
• Keep kettle cords and pan handles out of reach.
• Run cold water first into a bath and always test it before anyone gets in.
• Let irons, straighteners and grills cool somewhere safe and out of reach.
• Use fireguards and radiator covers where children, older or unwell people are at risk.
• Store chemicals in their original containers, clearly labelled, locked away and never decanted into drinks bottles.
• Take care with hot water bottles, heat pads and microwaved wheat bags.

A short note makes the assessment quicker and safer:

• when and how the injury happened
• what caused the burn — heat, liquid, steam, chemical, electricity, friction or sunlight
• how long it was cooled under running water
• the body area affected
• the approximate size — for example compared with the injured person's hand
• any breathing problems or smoke exposure
• any chemical or electrical involvement, and the name of the chemical if known
• the person's age, health conditions and medicines, including allergies
• whether the injury may have been caused deliberately

Occasionally a burn happens because someone has been hurt on purpose, or is living in a situation that is not safe. If that is the case, you have not done anything wrong and help is available.

In an emergency, or if anyone is in immediate danger, call 999. If you cannot speak safely, call 999 and then press 55 from a mobile so the call can be handled silently.

Healthcare staff are used to these conversations and will treat the injury first. You can tell them as much or as little as you wish.