Cool running water for twenty minutes does more for a burn than anything you could put on it.
ACT
- Remove the cause. Get away from the source, and put out flames by laying the person down and smothering the fire. Someone who runs feeds their own flames.
- Cool with lukewarm water, between fifteen and twenty-five degrees (59 to 77 °F), for twenty minutes. No ice, no ice-cold water: extreme cold worsens the injury and drops the body's temperature. Twenty minutes is a duration, not an estimate — count it.
- Take off rings, watches, bracelets and belts before the swelling traps them. It's urgent, and it's always forgotten.
- Don't pull off clothing stuck to the skin. Cut around it.
- Cover loosely with a clean, lint-free cloth. Cling film laid flat, not wrapped around, protects well and doesn't stick.
- Keep the rest of the body warm while you cool the burned area. A large burn cooled on an undressed person outdoors leads to Hypothermia within half an hour.
Apply nothing else. No butter, no oil, no toothpaste, no honey, no plants. Anything greasy traps heat in the tissue and turns a surface burn into a deep one.
Never pop a blister. It's a sterile, natural dressing. Once open, it becomes a way in for infection.
ADAPT
You don't have twenty minutes of water. Cool what you can, as early as you can. The benefit is greatest in the first three minutes and remains real for up to three hours afterwards. A wet cloth changed constantly beats a wet cloth left in place, which warms up and stops cooling anything.
It's a drowning. See Drowning: the resuscitation sequence is different there.
The product was swallowed or inhaled. See Poisoning: don't induce vomiting.
It's a chemical burn. Rinse generously and for a long time, much longer than for a heat burn. Remove soaked clothing without pulling it over the head. Don't try to neutralise an acid with a base or the other way round: the reaction produces heat and makes everything worse.
It's an electrical burn. Cut the power before touching the person. What you see on the skin says nothing about the real extent: the current burned along its whole path inside the body. A small entry and exit wound can hide major damage. See Electrical energy in everyday objects for how to cut the power safely.
The burn is large, deep, or on the face, hands, joints or genitals. These are the cases where getting the person out comes before everything else. Cool, cover, and call for help: see Signaling and getting found.
You're far from everything. What you can do comes down to three things: keep the wound covered and clean, give small, regular sips to drink if the person is conscious — safe water only, see Making water safe to drink — and watch for signs of infection over the following days, meaning smell, heat, swelling and fever.
UNDERSTAND
A burn doesn't stop when the source is gone. The stored heat keeps destroying tissue deeper down for several minutes: this is called burn progression. Cooling isn't about easing the pain, it's about stopping the burn that's still going on. That's why duration matters more than how cold the water is.
Severity is judged on two things, and the second matters most.
Depth. A painful redness that turns white when pressed is superficial and heals on its own. A blister with sharp pain reaches the dermis. Skin that is white, brown or leathery, and above all painless, is a deep burn: the nerve endings have been destroyed. No pain is a sign of severity, never good news.
Size. This is what kills, not depth. Skin holds in the body's water; destroyed over a large area, it lets a huge volume of fluid escape, and the person dies of dehydration and shock long before dying of the wound. For a quick estimate, the victim's palm, fingers included, is about one percent of their body surface.
That's also why a burn on a child is more serious than the same burn on an adult: for the same area, the share of the body affected is far greater.
One last point, often fatal and invisible. Someone burned in an enclosed space may have burned their airways. Soot around the nostrils, a hoarse voice, coughing, singed nose hair: these are signs of internal damage that will swell over the following hours. There's nothing to do about it in the field, but you need to know it so a clean-looking skin doesn't reassure you.