Burns and Scalds First Aid: The 20-Minute Rule That Limits the Damage

Twenty minutes feels like a very long time when you are standing at a tap with a crying child. It is also the single most useful thing you will ever do for a burn, and the step people cut short. Most Australian burn injuries are treated at home, and how well they heal is largely decided in the first twenty minutes.

This guide follows Australian guidance from healthdirect and St John Ambulance Australia, for heat burns, scalds, chemical burns and electrical burns.

Burns and scalds first aid, step by step

1. Stop the burning. Move the person away from the heat source. If their clothing is on fire: stop them moving, drop them to the ground, cover them with a blanket if one is to hand, and roll them along the ground until the flames are out.
2. Check for danger and follow DRSABCD. For an electrical burn, do not touch the person until the power is switched off.
3. Cool the burn under cool running water for at least 20 minutes. A tap, a shower or a hose is fine. Start as soon as possible — but if time has already passed, cool it anyway, because it still helps for up to 3 hours.
4. Remove clothing and jewellery from the burnt area while you cool it — rings and watches especially, because the area will swell. Leave anything that is stuck to the burn exactly where it is.
5. Cover the burn with a light, loose, non-stick dressing — clean, dry, non-fluffy material. Plastic cling film is a good choice for a burn on a limb or the torso. Do not use cling film on the face.
6. Keep the rest of them warm and watch for shock. Cooling a large burn can chill the whole person, especially a child. Cool the burn, not the patient.
7. Get medical help if the burn meets any of the criteria below.

What not to do

• Do not apply ice, iced water, butter, fat, lotions, creams or ointments.
• Do not burst blisters. Intact skin over a blister is a sterile barrier; breaking it invites infection.
• Do not remove anything stuck to the burn — melted fabric, plastic, bitumen. Cool it in place and let a clinician deal with it.
• Do not touch the burnt area or poke at it to see how bad it is.
• Do not use fluffy dressings like cotton wool or a towel — fibres stick to the wound.
• Do not stop cooling early because the pain has eased. Twenty minutes is the minimum, not the point at which it starts working.

How deep is the burn?

Depth matters more than area for deciding what happens next. A useful and counter-intuitive point: the deepest burns often hurt the least, because the nerve endings in the skin have been destroyed. A painless burn is a reason to worry, not to relax.

When a burn needs a doctor

See a doctor if a partial thickness burn is larger than a 20-cent coin — roughly 3 cm across — or if it has blistered. That coin is the standard Australian yardstick, and it is smaller than most people assume.

Also get it looked at if the burn:

• Is on the face, hands, feet, genitals or buttocks
• Goes right around a limb, a finger or a toe
• Is over a joint
• Was caused by chemicals or electricity
• Is on a baby, a young child or an older person
• Shows signs of infection later — increasing pain, redness spreading, swelling, pus or fever

Call 000 straight away if

• The burn is deep, even if there is no pain
• The skin looks brown, black or white
• It involves the face, hands or genitals
• It was caused by chemicals or electricity
• The person has any difficulty breathing, or you suspect they have inhaled smoke or hot air — an airway burn can swell fast
• A full thickness burn covers more than 10% of an adult's body, or 5% of a child's

Chemical burns are different: wash for longer

This is the exception to the 20-minute rule, and getting it wrong matters. A chemical keeps damaging tissue for as long as it is in contact with skin, so it needs washing for up to 60 minutes.

1. Protect yourself first — wear gloves if you have them, and avoid touching the chemical.
2. If the chemical is a dry powder, brush it off first before adding water.
3. Remove contaminated clothing while you flush.
4. Wash the area with running water for up to 60 minutes.
5. Call 000, and have the product name or container ready if you can do so safely. The Poisons Information Centre is on 13 11 26.

Electrical burns

Turn off the power before you touch the person. Electrical injuries can be far deeper than the small mark on the skin suggests, and can affect the heart, so they always need medical assessment — call 000. If the person is unresponsive and not breathing normally, start CPR and use an AED if one is available.

Burns and scalds in children

Most childhood burns in Australia are scalds — hot drinks, hot tap water, soup, noodles, kettles. Small children have thinner skin than adults, so the same liquid at the same temperature causes a deeper burn.

• Have every child's burn checked, even one that looks minor.
• Keep hot drinks well back from bench and table edges, and away from tablecloths that can be pulled.
• Turn pot handles inwards and use the back hotplates.
• Never carry a hot drink and a child at the same time.
• Check bath water with your elbow before a child gets in, and run cold last.
• Watch for chilling. A child can lose body heat quickly while a large burn is being cooled — keep the rest of them covered and warm.

Related reading: what to say when you call an ambulance, choking first aid, and the full DRSABCD action plan. And if you have a condition or medication a burns team would need to know about, you can create your emergency profile now.

Burns first aid FAQs

Sources

• healthdirect — Burns and scalds — cooling time, the 3-hour window, burn depth classifications, the 20-cent coin threshold, and when to call an ambulance.
• St John Ambulance Australia — Burn or scald — step-by-step management, cling film as a dressing, and what not to apply.
• healthdirect — Chemical burns — washing for up to 60 minutes and removing contaminated clothing.
• Better Health Channel — Burns and scalds — prevention, and why children burn more deeply than adults.
• Poisons Information Centre, 13 11 26 — for chemical exposures.

Disclaimer: This article is general first aid information, not medical advice or a substitute for accredited first aid training. In an emergency, always call Triple Zero (000). For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland) or speak with your GP. MedibandPlus stores and provides access to a member’s own medical information; it does not assess, diagnose or treat any condition.

More first aid guides

• DRSABCD: the first aid action plan explained
• Choking first aid for adults, children and babies
• How to do CPR: a beginner’s guide
• The recovery position, step by step
• How to use a defibrillator (AED)
• Calling an ambulance in Australia