When a person suffers a burn, the immediate, instinctive reaction is often to grab the closest source of intense cold, usually a handful of ice. This action is driven by the understandable desire to stop the heat and relieve the sharp pain. However, applying ice directly to a burn is a harmful misconception that can worsen the injury. The extreme temperature difference creates a secondary form of damage in the already compromised tissue. Understanding the specific physiological reasons for this counterintuitive harm is crucial for proper first aid, which involves a method of cooling that is both effective and safe.
The Physiological Danger of Extreme Cold
Applying ice or ice water to burned skin causes rapid and severe narrowing of the blood vessels, a reflex known as vasoconstriction. This is the body’s natural response to protect itself from extreme cold, but in the context of a burn, it creates a new problem. The goal of immediate burn care is to remove retained heat from the tissue, but not at the expense of circulation.
When blood flow is dramatically restricted by the intense cold, the burned cells are immediately deprived of oxygen and essential nutrients. This lack of adequate circulation leads to a condition called ischemia, which means the tissue is starving on a cellular level. The result is a secondary injury layered on top of the initial burn damage.
The aggressive cooling from ice can cause the tissue to freeze, leading to frostnip or a form of cold-induced injury, similar to frostbite. Since the initial burn has already numbed the area, the person may not feel the ice causing this additional damage. This combined trauma significantly increases the overall depth and severity of the wound.
The Approved First Aid Response
Instead of using ice, the approved first aid response focuses on continuous, gentle cooling with running water. The correct procedure is to immediately place the burned area under cool, but not freezing, running tap water. This method provides the necessary heat dissipation without triggering the harmful vasoconstriction reflex.
Running water is superior because it constantly removes the heat that has sunk into the deeper layers of the skin, a process that continues even after the heat source is gone. The recommended water temperature is comfortably cool, typically falling between 15°C and 25°C. This temperature range is cold enough to draw heat away effectively but mild enough to maintain healthy blood flow.
The cooling process should be maintained for a period of 10 to 20 minutes to ensure the heat is fully removed from the deep tissue. Once the continuous cooling is complete, the burn should be covered loosely with a clean dressing or plastic film. Applying a cool compress or standing water is less effective than running water, as the water temperature quickly rises and ceases to provide continuous heat transfer away from the wound.
Determining Burn Severity and Next Steps
Once the initial cooling period is complete, the next step is to assess the burn’s severity to determine if medical attention is needed. Burns are classified by depth. First-degree burns affect only the outer layer of skin, causing redness and pain. Second-degree burns penetrate deeper, resulting in blisters, significant pain, and swelling.
Third-degree burns are the most severe, destroying all layers of skin and sometimes reaching underlying tissue. They often appear charred, white, or dry and may cause little pain because nerve endings are destroyed. Any burn that appears deep, is larger than the palm of the hand, or is located on the face, hands, feet, genitals, or major joints requires immediate medical attention.
Even for apparently minor burns, a person should seek professional care if signs of infection develop, such as increased redness extending beyond the wound, a foul odor, or persistent fever. If a third-degree burn is suspected, the person must go to an emergency room immediately after the cooling process, regardless of the burn’s size. Prompt assessment helps ensure proper wound care, pain management, and prevention of long-term complications.