A burn injury is damage to the skin and underlying tissue. The immediate first aid response is to cool the affected area to halt the destructive process and limit tissue damage. While the impulse may be to apply the coldest substance available, such as ice or ice water, this common practice can actually worsen the injury rather than help it. Understanding why extreme cold is detrimental is crucial for effective burn treatment.
Understanding the Dangers of Extreme Cold
Applying extremely cold water or ice directly to a burn can cause further injury because of a biological process called vasoconstriction. When tissue is exposed to near-freezing temperatures, the local blood vessels narrow significantly to conserve core body heat. This constriction reduces the necessary blood flow to the burned area, which starves the damaged cells of oxygen and nutrients required for repair.
Cooling with ice water, typically 1–8°C, can lead to more tissue death (necrosis) than if the wound had not been cooled at all. The reduced blood flow prevents the intended cooling and traps heat deeper within the tissue layers. Furthermore, the already compromised skin is highly susceptible to a secondary injury known as an ice burn or frostbite, adding cold-induced damage to the initial thermal trauma.
Excessive or prolonged cold application, especially over a large area, introduces the risk of systemic hypothermia. This dangerous drop in the body’s core temperature poses a threat to vulnerable individuals like infants and the elderly. Since the body’s ability to regulate temperature is impaired when skin is damaged, a sudden drop in core temperature is a serious complication. The goal of burn first aid is moderate, sustained cooling, not rapid freezing.
The Proper Way to Cool a Burn Injury
Immediately cool the burn with clean, running water that is cool, but not icy cold. The ideal temperature range for this cooling process is generally between 12°C and 18°C, which is often the temperature of standard tap water. This moderate temperature is sufficient to draw heat out of the burned tissue without triggering adverse vasoconstriction.
The water should flow continuously over the injury to maintain a consistent temperature and prevent the water from heating up. This continuous flow helps to reduce pain, decrease swelling, and minimize the depth of the burn injury. The cooling process should be sustained for a minimum of 10 minutes, with 20 minutes being the duration recommended by medical guidelines for optimal effect.
It is important to remove any clothing or jewelry near the burn, unless it is stuck to the skin, before beginning the cooling process. After the burn has been thoroughly cooled, it should be covered loosely with a clean, non-stick material to protect it from infection and reduce pain by keeping air away from the nerve endings. A common household item like plastic wrap (cling film) works well for this purpose, but it should be laid over the burn, not wrapped tightly around a limb.
Traditional household remedies must be avoided because they are ineffective or detrimental to healing. Substances like butter, oils, toothpaste, or creams should never be applied, as these fatty or thick substances can trap heat and increase the risk of infection. Pain relievers like ibuprofen or acetaminophen can be taken to manage discomfort after the cooling is complete.
Assessing Burn Severity and Seeking Professional Care
Understanding the level of tissue damage helps determine whether a burn requires professional medical care. Burns are commonly categorized by depth: first-degree burns affect only the outer skin layer, causing redness and pain without blistering. Second-degree burns extend to the layer beneath, resulting in intense redness, swelling, and the formation of fluid-filled blisters.
Third-degree burns are the most severe, destroying all layers of the skin, and they may appear white, leathery, or charred. These deep burns often cause little to no pain because the nerve endings have been destroyed. Any third-degree burn, regardless of its size, requires immediate emergency medical attention.
Medical help should be sought immediately for any burn that covers a large area, such as one bigger than the palm of the injured person’s hand. Professional evaluation is also necessary for burns located on sensitive or complex areas. Furthermore, all chemical or electrical burns must be assessed by a healthcare provider due to the potential for deep tissue damage.
Criteria for Professional Care
- Any third-degree burn, regardless of size.
- Burns covering an area larger than the injured person’s palm.
- Burns located on the face, hands, feet, major joints, or genitals.
- All chemical or electrical burns, due to the potential for deep tissue damage.
Even for minor burns initially treated at home, ongoing monitoring is necessary for a few days following the injury. Signs of infection, such as increasing pain, spreading redness outside the burn area, excessive swelling, or a foul-smelling discharge, indicate the need for a follow-up medical consultation.