01 — Burn severity
What the skin tells you: reading burn depth to triage correctly
Burn depth determines whether a burn can be managed at home or requires emergency care. The Red Cross 2024 guidelines classify burns by how far into skin tissue the injury reaches.
| Depth | Appearance | Blisters | Pain level | Action |
|---|---|---|---|---|
| Superficial (1st degree) | Red, slightly swollen | None | Painful | Home care: cool water, cover loosely |
| Partial-thickness (2nd degree) | Red or mottled, weeping, swollen | Present | Severely painful | Medical evaluation; home care only if small and not on face, hands, feet, joints, or genitals |
| Full-thickness (3rd degree) | White, charred, or leathery; brown or black patches | None (tissue destroyed) | May feel less pain — nerve endings destroyed | Emergency care always required; call 911 |
A burn that feels less painful than expected is not a good sign. Full-thickness burns destroy the nerve endings that detect pain. Reduced or absent sensation at the burn site, combined with white, charred, or leathery-looking skin, is a signal that the burn is severe and requires emergency care.
The Red Cross specifies that any burn larger than the person's palm, or any burn involving the face, hands, feet, genitals, joints, or airway, requires medical evaluation regardless of depth. When in doubt, seek care.
02 — Thermal burns
Cool running water is the treatment. Do not add anything else to the burn.
Harmful myth
Apply butter, oil, toothpaste, or ice to a burn to reduce pain and cool the tissue.
What the Red Cross and Mayo Clinic say
Never apply butter, oil, ointments, or ice to a burn. These trap heat in the tissue, worsen the injury, increase infection risk, and complicate emergency care. Cool running water is the only correct cooling method.
The Red Cross burn first aid procedure is to place the burned area under clean, cool running water for 5 to 20 minutes as soon as possible. Cooling within the first 20 minutes significantly reduces burn depth. The water should be cool but not ice-cold; ice and very cold water cause additional tissue damage by reducing circulation to the already-injured area.
- Move the person away from the heat source.
- Remove clothing and jewelry from the burn site, unless any item is stuck to the burned skin. Do not peel off stuck material.
- Cool the burn under clean, cool running water for 5 to 20 minutes. Lukewarm water is acceptable if cool water is not available.
- Do not apply butter, oil, ointments, ice, or any home remedy.
- Do not pop blisters. Intact blisters protect against infection. If a blister breaks on its own, clean the area gently and cover with a clean, non-adhesive dressing.
- Loosely cover the burn with a clean, non-stick dressing or clean cloth. Do not use adhesive bandages that will stick to the wound.
- Seek medical care for any burn larger than the person's palm, or burns on the face, hands, feet, joints, or genitals.
03 — Chemical burns
Flush for at least 20 minutes. Protect yourself from the chemical before touching the person.
Chemical burns continue to damage tissue as long as the chemical remains in contact with skin. The immediate goal is decontamination, not wound care. The Red Cross specifies wearing personal protective equipment before touching someone with a chemical burn, because the chemical on their skin or clothing can cause a secondary burn on the rescuer's hands.
- Put on gloves or use a barrier before touching the person or their contaminated clothing.
- If the chemical is a dry powder, brush it off the skin before adding water. Adding water to dry reactive chemicals can accelerate the burn reaction.
- Help the person remove contaminated clothing, unless it is stuck to the burn.
- Flush the burn area with cool running water for at least 20 minutes. Do not use a high-pressure stream directly on the burn.
- If the chemical has entered the eye, flush continuously with water until emergency services arrive.
- Call 911 for any significant chemical burn. Remove the chemical container or identify the chemical so emergency responders know what they are treating.
The 20-minute flush duration is a minimum, not a target to stop at. Some chemical burns benefit from longer flushing. The person should continue flushing while waiting for emergency services unless they become unstable.
04 — Electrical burns
Electrical burns are always more serious than they look. Do not touch the person if they are still in contact with the current.
Do not touch first
Never touch a person who is still in contact with an active electrical source. You will become part of the circuit. Ensure the power source is confirmed off before approaching. Call 911 before touching the person.
The Red Cross states that even a small electrical burn can mean significant internal injuries. Electrical current travels through the body along the path of least resistance, which is typically through blood vessels, nerves, and muscles. The entry wound on the skin may look small, but the current can cause severe damage to internal organs, disrupt heart rhythm, and cause cardiac arrest along the way.
Any person who has had contact with electrical current should be evaluated by emergency medical personnel, regardless of how minor the visible burn appears. The AHA 2024 First Aid Guidelines note that cardiac arrhythmia can occur minutes after exposure, even after the person appears stable. Call 911 for all electrical burns.
After confirming the power is off, the first aid steps are the same as for thermal burns: cool with running water, cover loosely, keep the person still, and wait for emergency services. Do not attempt to transport an electrical burn patient in a private vehicle if emergency services are available.
Quick reference
- All burns: cool with running water immediately; never apply butter, oil, ice, or any home remedy
- Full-thickness burns may feel less painful — nerve endings are destroyed; this is a sign of severity, not improvement
- Seek care for: full-thickness burns, burns larger than the palm, face/hands/feet/joints/genitals, chemical burns, electrical burns
- Do not pop blisters; they protect against infection
- Chemical burns: brush off dry powder first, then flush with cool water for at least 20 minutes; protect yourself before touching the person
- Electrical burns: never touch a person still in contact with current; call 911 always; even a small entry wound can mean severe internal damage
- Sunburn requiring medical attention: blistering, covering a large area, accompanied by fever, severe pain, or dehydration
Primary sources
- Red Cross — Burns: Types, Symptoms, and How To Help: Cool with running water for 5–20 minutes; do not apply butter or oil; chemical burns require PPE and 20-minute flush; electrical burns: confirm power off before touching, call 911 always; partial-thickness burns with intact blisters covered loosely.
- Red Cross — 2024 First Aid Guidelines Summary: Full-thickness burns, partial-thickness larger than palm, and burns on face/hands/feet/genitals require medical evaluation; loosely cover with clean, non-adherent dressing; petroleum jelly or antibiotic ointment for small partial-thickness burns managed at home after cooling.
- Mayo Clinic — Burns: First Aid: Do not pop blisters; do not apply butter, ointment, or ice; call 911 for burns through all skin layers, burns larger than 3 inches, charred or leathery skin, or burns on sensitive areas.