Cool with Running Water
Cooling the burn wound is a very effective way of decreasing pain, and can minimize the extent of damage (depth of burn) caused by the injury.
Evidence regarding the necessary duration of cooling is unclear (2). Consensus recommendations are:
Cool the burn with clean running water for up to 20 minutes
Prolonged cooling of large burn injuries can cause hypothermia
Duration of cooling should be considered in:
- Large burn injuries (> 10%TBSA burns)
- Burns in children or the elderly
Prolonged cooling of deep burns is unlikely to be helpful
20 minutes of cool running water is most beneficial for minor partial thickness burns where the risk of hypothermia is minimal.
Cooling the burn surface may be useful for up to 3 hours post injury (22).
During and after burn wound cooling the patient must be kept warm.
There is a greater risk of hypothermia with increasing % TBSA burn and in the extremes of age
Considerations
Immerse in water or use wet towels if there is no access to running water.
Do not use ice or iced water on burns. The extreme cold causes constriction of the blood vessels and can worsen injury by reducing blood supply (22).
Do not use butter, ointments, oil, salves or creams acutely as they may retain heat and worsen injury (2).
Hydrogel products should be considered for first aid when there is no access to clean water.
They are cooling and often analgesic
There are several hydrogel products on the first aid market. Some hydrogel products contain 90% water and melaleuca oil in a proprietary gel. It is postulated that tea tree oil has useful antibacterial, antifungal and anti-inflammatory properties, and this product is included in some formulations.
To date, there is limited evidence that these products are beneficial (2).
Hydrogel products can be used in adults with minor burns as a temporary dressing for up to 24 hours.
Do not use hydrogel products in children. In adults with extensive burns, do not leave hydrogel products on for longer than 20 minutes due to their increased risk of hypothermia