Pain (How much pain you have is unrelated to the level of burn. The most serious burns can be painless.)
Shock (watch for pale and clammy skin, weakness, blue lips and fingernails, and a drop in alertness)
Red, white, or charred skin
If you have burned your airways, you may have:
Burns on the head, face, neck, eyebrows, or nose hairs
Burned lips and mouth
Dark, black-stained mucus
Before giving first aid, it is important to determine what type of burn the person has. If you aren't sure, treat it as a major burn. Serious burns need immediate medical care. Call your local emergency number or 911.
If the skin is unbroken:
Run cool water over the area of the burn or soak it in a cool water bath (not ice water). Keep the area under water for at least 5 minutes. A clean, cold, wet towel will help reduce pain.
Calm and reassure the person.
After flushing or soaking the burn, cover it with a dry, sterile bandage or clean dressing.
Protect the burn from pressure and friction.
Over-the-counter ibuprofen or acetaminophen can help relieve pain and swelling. Do NOT give aspirin to children under 12.
Once the skin has cooled, moisturizing lotion also can help.
Minor burns will usually heal without further treatment. Make sure the person is up to date on tetanus immunization.
If someone is on fire, tell the person to stop, drop, and roll. Then, follow these steps:
Wrap the person in thick material; such as a wool or cotton coat, rug, or blanket. This helps put out the flames.
Pour water on the person.
Call 911 or your local emergency number.
Make sure that the person is no longer touching any burning or smoking materials.
Do NOT remove burned clothing that is stuck to the skin.
Make sure the person is breathing. If necessary, begin rescue breathing and CPR.
Cover the burn area with a dry sterile bandage (if available) or clean cloth. A sheet will do if the burned area is large. Do NOT apply any ointments. Avoid breaking burn blisters.
If fingers or toes have been burned, separate them with dry, sterile, non-sticky bandage.
Raise the body part that is burned above the level of the heart.
Protect the burn area from pressure and friction.
If an electrical injury may have caused the burn, DO NOT touch the victim directly. Use a non-metallic object to move the person away from exposed wires before starting first aid.
You will also need to prevent shock. If the person does not have a head, neck, back, or leg injury, follow these steps:
Lay the person flat
Raise the feet about 12 inches
Cover the person with a coat or blanket
Continue to monitor the person's pulse, rate of breathing, and blood pressure until medical help arrives.
Do NOT apply ointment, butter, ice, medications, cream, oil spray, or any household remedy to a severe burn.
Do NOT breathe, blow, or cough on the burn.
Do NOT disturb blistered or dead skin.
Do NOT remove clothing that is stuck to the skin.
Do NOT give the person anything by mouth, if there is a severe burn.
Do NOT place a severe burn in cold water. This can cause shock.
Do NOT place a pillow under the person's head if there is an airways burn. This can close the airways.
When to Contact a Medical Professional
Call 911 or your local emergency number if:
The burn is very large - about the size of your palm or larger
Also call immediately if symptoms of dehydration occur with a burn:
Nausea (with or without vomiting)
Children, the elderly, and anyone with a weakened immune system (for example, from HIV) should be seen right away.
The health care provider will perform a history and physical examination. Tests and procedures will be done as needed.
These may include:
Airway and breathing support, including a face mask, tube through the mouth into the trachea, or breathing machine (ventilator) for serious burns or those involving the face or airway
Blood and urine tests if shock or other complications are present
Chest x-ray for face or airway burns
EKG (electrocardiogram, or heart tracing), if shock or other complications are present
Intravenous fluids (fluids through a vein), if shock or other complications are present
Medications for pain relief and to prevent infection
Ointments or creams applied to the burned areas
Tetanus immunization, if not up to date
The outcome will depend on the type (degree), extent, and location of the burn; whether internal organs have been affected, and if other trauma has occurred. Burns can leave permanent scars. They can also be more sensitive to temperature and light than normal skin. Sensitive areas, such as the eyes, nose, or ears, may be seriously injured and lose normal function.
With airway burns, the person may have less breathing capacity and permanent lung damage. Severe burns that affect the joints may result in contractures, where there is decreased movement and a reduction in function.
To help prevent burns:
Install smoke alarms in your home. Check and change batteries regularly.
Teach children about fire safety and the hazards of matches and fireworks.
Keep children from climbing on top of a stove or grabbing hot items like irons and oven doors.
Turn pot handles toward the back of the stove so that children cannot grab them and they cannot accidentally be knocked over.
Place fire extinguishers in key locations at home, work, and school.
Remove electrical cords from floors and keep them out of reach.
Know about and practice fire escape routes at home, work, and school.
Set the water heater temperature at 120 degrees or less.
Bethel CA, Mazzeo AS. Burn care procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 38.
Gallagher JJ, Wolf SE, Herndon DN. Burns. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 22.
Holmes JH, Heimbach DM. Burns. In: Brunicardi FC, Andersen DK, Billiar TR, et al, eds. Schwartz's Principles of Surgery. 9th ed. New York, NY: McGraw-Hill; 2010:chap 7.
Singer AJ, Taira BR, Lee CC. Thermal burns. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 63.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.