Most people instinctively reach for ice when they suffer a burn, believing the fastest way to stop the pain is to apply the coldest possible temperature. This common reaction is counterproductive and potentially harmful. The correct first-aid response focuses on gentle, sustained cooling to halt the burning process without causing secondary tissue damage. Understanding the nature of a thermal injury is the first step toward proper care.
Understanding Thermal Injury
A burn is an injury caused by the transfer of energy from a heat source to the skin and underlying tissues, resulting in cellular destruction. When skin cells are exposed to temperatures exceeding about 45 degrees Celsius, their proteins denature, leading to cell death. The skin and tissue retain heat even after contact with the heat source ends.
This retained thermal energy continues to conduct into deeper layers, meaning the injury can progress in depth after the initial accident. Immediate and proper cooling is necessary to create a “heat sink” that rapidly extracts this residual heat. Failure to cool quickly allows the damage to expand, potentially transforming a superficial injury into a deeper one.
The Dangers of Using Ice or Excessive Cold
Applying ice or ice water to a burn is strongly discouraged because the extreme cold actively worsens tissue damage. Severe cold causes rapid vasoconstriction, which is the narrowing of small blood vessels near the skin’s surface. Constricted vessels significantly reduce blood flow to the injured site, slowing the delivery of oxygen and healing factors necessary for recovery. This lack of blood flow can cause the burn to deepen, as the compromised tissue is deprived of necessary resources.
Secondary Injuries
Direct application of ice can lead to a secondary injury known as a cold burn or frostnip, adding frostbite-like damage to the already compromised skin. Damaged nerves in a burn may prevent the person from feeling the extreme cold, making it easy to leave the ice on too long and inadvertently cause this additional damage.
Systemic Risks
In cases of large burns, especially in children or older adults, applying extreme cold over a significant body area risks systemic hypothermia. Hypothermia occurs when the body’s core temperature drops below 35 degrees Celsius and can lead to serious complications or shock. Extreme cold can also mask the true depth and severity of the burn injury, potentially delaying necessary medical treatment.
Immediate and Safe Cooling Methods
The standard for immediate burn first aid is the application of cool, running water, which should be done as quickly as possible. Running water is effective because it constantly replaces the warmed water at the skin interface, accelerating the transfer of heat away from the injury. The water should be cool or lukewarm, not freezing cold, to stop the burning process without triggering vasoconstriction.
The burn should be held under the running water for a minimum of 10 to 20 minutes to ensure all residual heat has been removed. Before or during cooling, gently remove any clothing or jewelry near the burn site, unless it is stuck to the skin. Removing these items is important because they can retain heat or become restrictive as the tissue begins to swell.
Recognizing When a Burn Requires Medical Attention
After initial cooling, assess the injury to determine if professional medical attention is needed. A burn requires a visit to the emergency department if it is larger than the size of the injured person’s palm.
When to Seek Professional Care
Medical evaluation is required for burns located on the face, neck, hands, feet, genitals, or over a major joint, regardless of size. Signs of a deeper injury, such as skin that appears charred, dry, white, or leathery, indicate a serious burn needing immediate assessment. Any burn caused by an electrical current or a chemical substance should also be treated by a professional. If there is any doubt about the severity, or if the injured person is a child or an older adult, seeking medical advice is the safest course of action.