First-aid priority: stop the burning process, cool the injury safely, protect the airway, prevent heat loss and arrange medical review. The size, depth, location, mechanism and age of the casualty determine urgency; a small burn to the face or airway may be more dangerous than a larger superficial burn on the limb.
Add labelled images of burn depth, cooling, heat illness and hypothermia management here.
Learning outcomes
- Classify burns by cause, depth and extent.
- Perform immediate first aid for thermal, scald, chemical, electrical and inhalation injury.
- Recognise heat cramps, heat exhaustion, heat stroke, hypothermia and frostbite.
- Cool or rewarm safely without causing shock, tissue damage or secondary hypothermia.
- Identify burn and temperature emergencies requiring urgent hospital care.
1. Burns and scalds
A burn is tissue damage from heat, flame, hot liquid or steam, chemicals, electricity, radiation or friction. A scald is a burn from hot liquid or steam. Circumferential burns can constrict circulation; facial burns may threaten the airway; electrical burns can hide deep muscle and cardiac injury; chemical burns continue damaging tissue until the chemical is removed.
| Depth | Typical appearance | Teaching point |
|---|---|---|
| Superficial | Red, painful, dry, no blisters | Usually limited to epidermis; still painful and vulnerable to worsening. |
| Partial-thickness | Red or mottled, blistered, moist and very painful | Depth varies; blisters should not be deliberately broken in first aid. |
| Full-thickness | White, brown, black, leathery or painless areas | Nerves may be destroyed; urgent specialist assessment is required. |
2. Immediate burn management
- Make the scene safe: stop, drop and roll for clothing fire; isolate electricity before touching the casualty; use gloves for chemicals.
- Remove the heat source: remove hot clothing, jewellery, watches, belts and nappies near the burn unless stuck to skin. Do not pull away adhered fabric.
- Cool: place the burn under cool running water for 20 minutes as soon as possible. Use clean cool water; avoid ice or icy water.
- Prevent hypothermia: cool the injured area while keeping the rest of the person warm, especially infants, older adults and people with large burns.
- Cover: after cooling, loosely cover with sterile non-fluffy dressing or clean plastic film laid lengthwise. Do not wrap circumferentially around a limb.
- Remove hazards: do not apply butter, oil, toothpaste, flour, herbs, powders, adhesive dressings or unprescribed ointments. Do not burst blisters.
- Refer: call emergency help for airway, face, hands, feet, genitalia, major joints, circumferential, electrical, chemical, deep, extensive or inhalation burns.
3. Estimating burn extent
- Patient’s palm method: the casualty’s palm including fingers approximates about 1% of body surface area. It is useful for scattered burns.
- Rule of nines in adults: head and neck 9%, each upper limb 9%, each lower limb 18%, front trunk 18%, back trunk 18%, and perineum 1%. It is an estimate, not a substitute for clinical assessment.
- In children, body proportions differ; use a paediatric chart when available. Any significant burn in a small child or frail adult deserves medical review.
4. Special burn mechanisms
| Mechanism | Immediate action | Danger signs |
|---|---|---|
| Chemical skin burn | Brush off dry powder, remove contaminated clothing and flush continuously with copious running water. Protect the rescuer. | Eye injury, breathing difficulty, extensive exposure or persistent pain. |
| Chemical eye exposure | Irrigate immediately with clean water or saline for at least 20 minutes, from the inner corner outward; remove contact lenses if easy. | Any visual change, severe pain or inability to open the eye—urgent referral. |
| Electrical burn | Switch off the source before contact. Assess airway, breathing and circulation; call emergency help even if the skin mark looks small. | Loss of consciousness, arrhythmia, entry/exit wounds or high-voltage exposure. |
| Inhalation injury | Move to fresh air if safe, call emergency help and monitor airway and breathing. | Facial burns, soot, hoarseness, cough, noisy breathing, singed nasal hair or confusion. |
| Tar/bitumen | Cool with water; do not forcibly remove adherent material. Cover and refer. | Large surface involvement or airway exposure. |
5. Hyperthermia and heat illness
Hyperthermia occurs when heat production or environmental heat overwhelms cooling. Risk rises with exertion, dehydration, high humidity, heavy clothing, fever, young or advanced age and some medicines.
| Condition | Features | First aid |
|---|---|---|
| Heat cramps | Painful muscle cramps after sweating and exertion | Stop activity, move to a cool place, gentle stretching and small sips of oral fluid if fully alert. |
| Heat exhaustion | Heavy sweating, weakness, headache, nausea, dizziness, cool clammy skin | Lay or sit in a cool place, loosen clothing, cool with wet cloths/fanning and give small sips if alert. Seek medical help if not improving quickly. |
| Heat stroke | Altered mental state, collapse, seizures or very high body temperature; sweating may be present or absent | Medical emergency: call immediately, remove excess clothing, cool rapidly with cold water/ice packs/fanning while monitoring airway and breathing. Do not give drinks to a confused or unconscious person. |
6. Hypothermia
Hypothermia is a dangerous fall in core temperature, commonly after cold water, rain, wind, inadequate clothing, prolonged immobility, shock, alcohol or illness. Mild hypothermia may present with shivering and confusion; severe hypothermia may cause drowsiness, slow breathing, a weak pulse and cardiac arrest.
- Move the person away from wind, rain and cold surfaces; handle gently.
- Remove wet clothing, dry the skin and replace with dry layers, blankets and a hat.
- Warm the trunk gradually with warm dry blankets or a wrapped warm pack; place insulation between heat source and skin.
- Give warm sweet drinks only if fully alert and able to swallow; never give alcohol.
- Call emergency services for confusion, drowsiness, severe shivering, loss of shivering, abnormal breathing or suspected severe exposure.
- Check breathing for up to 60 seconds because it may be very slow. If absent or abnormal, start CPR and use an AED as available.
Avoid: hot baths, vigorous rubbing, direct high heat, massage of cold limbs and rapid rewarming of a severely hypothermic person. These can cause burns, arrhythmias or sudden circulatory collapse.
7. Frostbite and cold injury
Frostbite causes freezing injury to skin and deeper tissue. Protect the area from further cold, remove wet or constricting items, avoid walking on a frozen foot unless essential for evacuation, and arrange medical care. Do not rub, puncture blisters or rewarm if refreezing is possible.
8. Scenario
Scenario: A child spills boiling porridge over the forearm and chest. Response: remove hot clothing not stuck to skin, cool the areas under clean running water for 20 minutes, keep the child’s remaining body warm, remove jewellery, cover loosely with a clean non-fluffy dressing and arrange urgent assessment because of the child’s age and trunk involvement. Do not apply oil or toothpaste.
Exam points and revision questions
- Describe the first five actions for a thermal burn.
- Differentiate heat exhaustion from heat stroke.
- Explain why ice, butter and adhesive dressings are unsafe first aid for burns.
- List four indications for urgent referral after a burn.
- Describe safe first aid for hypothermia and state three actions to avoid.